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  • nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    My employer has done a great job with MAWV visits. We treat them as the annual physical and split bill 95%+ by addressing their concerns and doing comprehensive exam all within a single note template and solid order set. MAs do all the screening questionnaires and we just do a “physical” and get the extra 1.5 RVUs.

    Our pts are now accustomed to it and if they complain we simply state we can split it up into two visits in the future if you’d like. They seem to like the convenience and value of the combined visit.

    It was even sweeter earlier this year when many Medicare Advantage plans allowed triple billing: AWV, preventative, and E3/4 for other concerns. That was admittedly challenging to get enough components to satisfy all three but was doable. Those plans realized they were paying more for the same services so stopped after a few months.

    in reply to: RNs performing Medicare wellness exams #237460 Reply
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    Got my spot! Sadly cannot make preconference shenanigans but excited to see familiar faces and meet new ones!

    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    This sounds like a non compete clause in sheep’s clothing

    Click to expand…

    Bingo. I’ve most commonly seen 3 months’ notice and occasionally 6 months’ notice but anything more is over the top. How about you work in that if you leave for cause then they have to pay you $60k?

    in reply to: contract termination agreement #228255 Reply
    Liked by hatton1, SLC OB
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    Our family is planning on it. I’m ready to purchase at 6 pm Central time on Monday. We have little kids and like an adventure. Beforehand, we are thinking Death Valley instead of Zions. Better choice for March. I prefer 80s/50s to 50s/30s. It also seems about equidistant.

    Regardless, looks like plenty of Teslas on Turo in Vegas. We have paid off toyotas. and I figure this conference is our chance to drive my dream car.

    Click to expand…

    FYI: 7pm MST is 8pm CST

    If I can secure a spot I’m there—had too much fun at WCICON 2018 not to go again! @vagabondmd devastated to hear you’re not going 🙁

    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    My employer recently instituted a nurse triage line. It has decreased the calls we get. My clinic’s group is similar size with similar call schedule to OP’s but part of a much larger organization. I can say it’s nice but at the same time we’ve lost RN support in the clinic. I’d much rather have an RN every day at work which helps get me home faster daily than cutting the number of calls down a little for my home call.

    I believe my employer billed it as a provider satisfier as well as patient satisfier as a wider pool of RNs get back to pages or answer a phone faster than we can. Really, I think we were the only large organization without such coverage so we were playing catch-up. I’d take the angle of helping docs, helping pts with less wait time, etc etc.

    in reply to: Overnight phone call #227362 Reply
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    The staffing shortage is independent of the CDS administrative task, which will fall upon the radiologist to complete. At some point, I expect that it will be automated, but I do not see that happening out of the gate.

    Good questions!

    Click to expand…

    From your link:

    • “No rendering provider can receive Medicare payment for an ADIS if the referring provider does not attach a HCPCS/G-codes and modifiers to the referral
    • All radiology providers may refuse Medicare referrals without this documentation, with few exceptions as outlined above
    • Imaging providers cannot perform AUC administrative duties for referrers (as with prior authorization)
    • Ordering providers cannot shift the AUC requirement to radiologists”

    Looks like their intent is that this responsibility falls on those ordering the tests and not the radiologists. Who knows after the dust settles and there will be lots of unsettled dust. I guess radiology staff can refuse to schedule an imaging test until they have the necessary CDS documentation? This just sounds awful. You can see how someone thought that this idea could help save costs. Unfortunately, as someone above mentioned, this would prompt me as a PCP to refer to a specialist to determine necessity and appropriateness of advanced imaging that falls under this purview. That will only add another layer of costs AND make doctors more miserable. Lose-Lose. Sigh.

    in reply to: Another reason to RE if you're in rads #207675 Reply
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    35/38 as well. Annuity questions be damned.

    in reply to: Financial Literacy quiz #203391 Reply
    Liked by Hank
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    The fact that you day that means your not ready…..
    – Arrested Development quip

    Click to expand…

    ”I have poppop in the attic.“

    Love that show.

    in reply to: TD Ameritrade commission fee can be negotiated #200873 Reply
    Liked by Hank, Peds
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    I agree with Stag and saildawg that they are using one excuse to rip you off in 2-3 ways instead of just excluding that one thing OR charging higher overall and covering it.

    Saw a pt of mine recently who’s a group life insurance actuary and I lamented that his company probably has better health data than the medical system and how I’d love to use that data for patients on an individual and population level. He shrugged and agreed that their data is better and that we’d (medical system) would never see it since they’ve personally invested so much in developing their database. He didn’t have much of a reply when I said sure but your doctors having that data could help you and everyone in your company too.

    in reply to: Mental Nervous exclusion #200559 Reply
    Liked by ENT Doc
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016
    Earnest refinancing bonus

    I kept a spreadsheet to spot check every once in a while but then we rolled out a dashboard in Epic where you can see your # visits, RVUs, and other similar data on an ongoing basis. It’s been accurate albeit delayed 1-2 days but that’s not surprising. I find it very helpful.

    in reply to: Keeping track of wRVUs #200488 Reply
    Liked by Zaphod
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    That is the danger of timing any kind of activity near the cutoff (including submitting paperwork to set up a solo-k). However, given that Fido states the contribution was received before the eoy, I would at least attempt to take your issue up the chain of command to see if you can persuade someone there who would be willing to change the date on the confirmation letter. It is a minor journal entry on their end and I am guessing they are far from closing out the books for 2018.

    If you cannot get satisfaction then, yes, you’ll need to amend your 2018 income tax return and hope you’re in an even higher tax bracket in 2019.

    Click to expand…

    Talked with Fidelity. They said the date that matters it the date “received” and as long as that occurred in 2018 then it counts as a charitable contribution for IRS purposes. Their settlement date is simply processing the contribution and investing it per my allocation. Their confirmation letter does state both dates, so that is reassuring. Glad I don’t have to deal with an amended return and sending the IRS a check.

    in reply to: DAF contribution timing woes #197879 Reply
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    As others have pointed out, either you have access to a 457f plan or you do not and contributions are by employer only. Both my wife and I have these plan as part of the HCE benefit package. Our employers contribute a set percentage of our income annually. Minimum vesting period is 2 years but we can defer that date to anytime in the future.

    That last statement was true up until the end of last year when my employer changed everything about it and caused quite an uproar. Many docs had been deferring for years into the future for when they were in their 60s and had quite a sum saved up and my company decided to do away with that and disburse it all in 2020. This was one of several changes they made, all unfavorable to us.

    I was part of a mini-rebellion that countered the administration’s changes but we only got ground on allowing those forced distributions over 3 years instead of 1 year–didn’t effect me (since I get that money disbursed as soon as I can to limit the golden-handcuff-ness) but worth fighting for it for my colleagues.

    in reply to: another 457f question #195425 Reply
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016
    Splash Refinancing Bonus

    Switched from ATT to Cricket this past summer. Bill went down from $110 to $30/month. My ATT bill included a 25% med school discount and had a grandfathered in unlimited data plan. However, ATT kept increasing the unlimited data plan cost by $5 every few years and more recently did what seemed like a total of $15 over 3 months.

    Be careful when looking at the MVNOs because they’ll tell you your phone will work on their service but sometimes that’s only for 3G and not their 4G or LTE. Since I had an ATT phone, I went with an ATT MVNO. Something to keep in mind.

    in reply to: Cell Phone Service #195424 Reply
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    My residency did not give us a match either. Our resident council petitioned hard for this on behalf of all residents since our tenure is 3-7 years based on specialty but they said we were temporary workers. They ignored the fact that the average nurse tenure was 2.7 years or something similar (this average included those nurses who had been there for decades). Nursing unions are very aggressive about benefits.

    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 426
    Joined: 01/12/2016

    Did you contribute to both 2017 and 2018 IRAs during 2018? That is one way the software will do that.

    Click to expand…

    You are probably filling it out in such a way that it is believing that this is what you did, which is what you may have done… Perhaps delete out that section and start it over to see if you arrive at the same outcome.

    in reply to: HR Block software Backdoor Roth issue #188411 Reply
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