Which one of the following statements are true:
If you guessed ‘C’, then You’re Wrong! Just like me! That’s right. Thanks to several of you who correctly pointed out that there are several states that do allow Physician Assistants to bill incident to in the same way as nurse practitioners.
Evidently, the articles I had used for my references were not quite totally true. Remember this valuable lesson: I don’t view myself as an expert. Neither should you. I view myself as ‘experienced’ and ‘wanting to improve.’ If we stick together to keep on learning and correcting ourselves, then hopefully others (i.e., government auditors) won’t have to. So to clarify: Several states allow PAs to bill incident to in the same manner that NPs do. For more information check out www.aapa.org
Thanks everybody for your comments and corrections!
As many of you know, I am in the process of building a new clinic. As we’ve grown over the last few years, we now have 3 providers seeing patients and we’ve outgrown our current space that has 5 exam rooms. It takes quite a bit longer to create and construct a building, but we’ve finally finished the plans, purchased the land, and are getting on with it.
But what until then? How can we handle our busy winter season this year seeing more patients when we were already “full” last year? And now we have a 3rd provider where last year we just had two!
Here are a couple things we are doing: Basically, any two of the providers can run a “full clinic” with 5 rooms. When all 3 of us are seeing patients, we typically spend more time standing around and are less effective because there are just not enough rooms.
First solution is days off. One of our providers is on hourly wages and wants to work 5 days per week. But 2 of us want a day off. So on Tuesdays and Thursdays there are only 2 providers working. No problems then.
What we’ve done for Mondays, Wednesdays, and Fridays is a little different. Normally, we start seeing patients at 9:00 and have 1-1/2 to 2 hours for lunch, depending on how busy we are. I’m now arriving at 8:00 and seeing lots of patients until about 9:20. The other two still work regular hours. I then go make rounds and come back and work from 11:00-1:00 while they’re eating lunch.
This simple fix has allowed us to see many more patients in the same space and time. As we get busier this winter, the next step is we will alternate ourselves working later until 6:00 and will also start staggering lunches so that there are 2 of us seeing patients almost the entire workday on those 3 busy days. I’ll let you all know how it works and if we have other ideas in the next few months.
Over the next few weeks I would like to share in-depth some of the changes we’ve made to our Coding Growth Strategies presentation. We have expanded our examples section and now have an all-new documentation section. Many of you have said how helpful the addition of the video examples has been. And we’ve added more than 50 new examples. Our main focus now is walking through these example patients and exploring the many types of office visits and coding challenges they present. This exercise offers wonderful “hands-on” training and greatly improves the retention of material.
We now cover 7 patients in-depth. Two are pediatric and five are adults. However, they present common problems and issues to all practices. We now teach how to quickly assess patients to determine their level of risk and subsequently know what level of service they are. Is it a 99203? A 99215? Something else? How do we know?
I really feel we’ve brought our teaching full-circle. With documentation examples and worksheets, we show how to not only recognize the level of service but quickly analyze and write notes appropriately.
For example, the first patient we discuss is Katie. Through the process of several types of office visits, we “audit” several notes. We determine first what is her “Nature of the Presenting Problem.” Once that is done, we then quickly decide what the office visit level should be. Once that is done, we analyze the notes and find out if the note is acceptable.
Some of the notes we will learn are “too much.” I like to call these “Papa Bear notes.” While you won’t be penalized for writing a note that is more than you need, you will learn how to write an appropriate length note. No, the government won’t audit you and say “well you wrote too much for a 99213.” That’s true. But if you have 25 to 45 notes to write per day, let’s learn how to write them as quickly as possible so you can go home!
“Mama Bear notes” will be too soft. Some of the notes will have missing items. Quickly identify these common problems so that you don’t fall victim to the trap of having “almost enough” documentation. Especially for higher levels of service.
And yes, some of the notes will be “juuuuuusssst right.” What surprises most of our attendees is how these “Baby Bear notes” are so much smaller and simpler than people ever imagined! A great note does not have to be a big note. But it has to have all the correct components for that level of service. By the end of the program, we’ll make sure your documentation is “just right.”
Next week I will be restarting our Tiffany newsletters. Over the next several weeks I will give you more information about the new system. It will officially be called Tiffany Medical Records and has been running in my office for 3 months. All of our marketing efforts to this point have been local and we will be installing in 10 more offices later this month. The upcoming newsletters will focus on Tiffany’s features, pricing and availability and we should soon have some demos available. Hope to hear from you all!