Any ballin’ FM attendings?

[cabinbuilder]

Jesus. That started out at half my starting salary. My mortgage plus my kid's private school is decently below that.

Yah. The first 2 years were very hard. Down to $200 at the end of the month. I'm 4 yrs in. halfway done.

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Members don't see this ad.

 

[Splenda88]

Or ex-husbands. My ex was awarded 8 years of alimony: 5k/month for 3 yrs, 3.5K/month for 3 yrs, 2.5K/month for 2 yrs. Got 2 vehicles paid for. It was cheaper paying for my son's college.

Yikes...

Is your spouse paying for your son's college? Marriage can be costly.

 

[deleted87716]

Marriage can be costly.

No, divorce can be costly.

Marriage actually saves you money.

10 Ways Getting Married Saves You Money

Getting married can benefit couples financially in many ways, from college tuition to insurance to Social Security.

blog.cheapism.com

Why Marriage Makes Financial Sense

Getting married has many financial positives (and a few negatives) but recent changes in the federal tax code have removed much of the downside.

www.investopedia.com

7 financial benefits of marriage (and 4 possible drawbacks) | Money Under 30

Married couples enjoy more Social Security benefits, tax breaks, retirement options, estate planning perks, and cheaper insurance (health and auto).

www.moneyunder30.com

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www.key.com

 

[cabinbuilder]

Yikes...

Is your spouse paying for your son's college? Marriage can be costly.

No, I paid for my son's college - cash.

 

[cabinbuilder]

No, divorce can be costly.

Marriage actually saves you money.

10 Ways Getting Married Saves You Money

Getting married can benefit couples financially in many ways, from college tuition to insurance to Social Security.

blog.cheapism.com

Why Marriage Makes Financial Sense

Getting married has many financial positives (and a few negatives) but recent changes in the federal tax code have removed much of the downside.

www.investopedia.com

7 financial benefits of marriage (and 4 possible drawbacks) | Money Under 30

Married couples enjoy more Social Security benefits, tax breaks, retirement options, estate planning perks, and cheaper insurance (health and auto).

www.moneyunder30.com

Error 467

Page Not Found

www.key.com

Yah, I told my current husband that I will never get divorced again. If he feels he needs to go, he can go live on a different property. Haha. he's got it pretty good.

 

[cabinbuilder]

To give some of us hopes/ ideas or to gloat anonymously online, any attendings making $500k+ gross? If so, how and advice to get started would be appreciated.

Yes, I work urgent care and pull a ton of extra shifts at the end of the year. Will be very close to that #. Was 465K last years.

 

[Sardonix]

Random segue, but I'm seeing a lot of chatter over on r/medicine about healthcare organizations seeing the CMS changes in RVU compensation and basically refusing to provide PCPs the additional cash. Word on the street is it's being used to supplement proceduralist pay (or of course admin pay because why not?)

 

[VA Hopeful Dr]

Random segue, but I'm seeing a lot of chatter over on r/medicine about healthcare organizations seeing the CMS changes in RVU compensation and basically refusing to provide PCPs the additional cash. Word on the street is it's being used to supplement proceduralist pay (or of course admin pay because why not?)

I'm hospital employed and I don't expect to see much change for exactly that reason. We'll all get paid the same $/wrvu that is in our contracts and admin will shuffle the money around to make sure it works out.

 

[deleted87716]

Random segue, but I'm seeing a lot of chatter over on r/medicine about healthcare organizations seeing the CMS changes in RVU compensation and basically refusing to provide PCPs the additional cash. Word on the street is it's being used to supplement proceduralist pay (or of course admin pay because why not?)

In our revenue-based model, I'll receive any increase (or decrease). I'm anticipating things being pretty much the same, however. Chronic undercoders are likely to benefit more than me.

 

[Bacchus]

In our revenue-based model, I'll receive any increase (or decrease). I'm anticipating things being pretty much the same, however. Chronic undercoders are likely to benefit more than me.

Am I an undercover now bc I don’t do 4s and longer for sinusitis, UTI etc? Stop scaring me .

 

[deleted87716]

Am I an undercover now bc I don’t do 4s and longer for sinusitis, UTI etc? Stop scaring me .

Dunno, but I don't code many 99213s. And, when I do, they're probably undercoded.

 

[Sardonix]

Dunno, but I don't code many 99213s. And, when I do, they're probably undercoded.

They're... the most appropriately coding physician in the world US.

"Stay compliant, my friends."

 

[deleted87716]

They're... the most appropriately coding physician in the world US.

"Stay compliant, my friends."

The only time I've ever "failed" an internal coding audit was for...undercoding.

 

[VA Hopeful Dr]

Dunno, but I don't code many 99213s. And, when I do, they're probably undercoded.

Same. I'm at just under 80% 99214s.

 

[bronx43]

Random segue, but I'm seeing a lot of chatter over on r/medicine about healthcare organizations seeing the CMS changes in RVU compensation and basically refusing to provide PCPs the additional cash. Word on the street is it's being used to supplement proceduralist pay (or of course admin pay because why not?)

That's because RVUs are total BS. It has zero meaning, since the compensation per RVU is the other factor in the equation that determines your compensation. RVU went up? Just adjust down the comp/RVU, and voila! No raise for you.

Proceduralists bring something that outpatient docs don't do, which has nothing to do with RVUs... and that's facility fees.

 

[VA Hopeful Dr]

That's because RVUs are total BS. It has zero meaning, since the compensation per RVU is the other factor in the equation that determines your compensation. RVU went up? Just adjust down the comp/RVU, and voila! No raise for you.

Proceduralists bring something that outpatient docs don't do, which has nothing to do with RVUs... and that's facility fees.

True, but we bring in referrals to those proceduralists. There's a reason why the systems that do well invest heavily in primary care.

 

[bronx43]

True, but we bring in referrals to those proceduralists. There's a reason why the systems that do well invest heavily in primary care.

For sure, though a lot of bean counters don’t seem to make that logical deduction.

 

[door_to_balloon_knot]

. RVU went up? Just adjust down the comp/RVU, and voila! No raise for you.
.

Would definitely need a contract attorney at that point

 

[cabinbuilder]

That's because RVUs are total BS. It has zero meaning, since the compensation per RVU is the other factor in the equation that determines your compensation. RVU went up? Just adjust down the comp/RVU, and voila! No raise for you.

Proceduralists bring something that outpatient docs don't do, which has nothing to do with RVUs... and that's facility fees.

If your RVU compensation value keeps getting changed, I agree that you would need a contract lawyer. Mine has never changed in 5 years.

 

[bronx43]

If your RVU compensation value keeps getting changed, I agree that you would need a contract lawyer. Mine has never changed in 5 years.

Medicare also hasn’t revalued E&M coding In the last 5 years. I’m just using an example of opaque math that I suspect bean counters will use to screw outpatient docs out of money.

 

[cabinbuilder]

Medicare also hasn’t revalued E&M coding In the last 5 years. I’m just using an example of opaque math that I suspect bean counters will use to screw outpatient docs out of money.

I am far from feeling screwed in my job. Raking in the RVU's

 

[bronx43]

I am far from feeling screwed in my job. Raking in the RVU's

That wasn't my point, but ok... good job, i guess.

 

[cabinbuilder]

That wasn't my point, but ok... good job, i guess.

Not really sure what your point is then??

 

[SLC]

Antibiotics, lab review and X-ray review on a sinus infection still isn’t a 99214 I thought? Antibiotics or prescription medications is a 99213 at the least, but complexity matters. If I have a stable hypertensive and refill his meds and tell him return in 3-6 months, that’s not high complexity (it’s low). It’s a chronic condition, but stable and took 2 minutes. A sinus infection being prescribed antibiotics is not high complexity - this is def low complexity, but because of the antibiotics it’s gonna be a 99213. Complexity is king with coding (I thought atleast ... what I was taught in residency in 2014)

if you get an X-ray, the key (in my opinion) is that you must independently review it, and document the result in the standard way. Then work the result into your MDM.

you don’t get enough credit for just ordering a chest X-ray.

 

[door_to_balloon_knot]

if you get an X-ray, the key (in my opinion) is that you must independently review it, and document the result in the standard way. Then work the result into your MDM.

you don’t get enough credit for just ordering a chest X-ray.

With respect, y’all are confused (and incorrect) as it seem like you don’t understand how the points are gathered to equal a moderate level of medical decision making. For example in the quote above, you don’t need any imaging to qualify for 99214. Hell, it could be newly diagnosed HTN and a simple rx for lisinopril and that would qualify for 99214.

Confused/ don’t believe me? Please see here:

New office patients (99201-99205) - E/M Coding Education, EM evaluation and management coding, e&m documentation, 99214, 99213

emuniversity.com

 

[SLC]

With respect, y’all are confused (and incorrect) as it seem like you don’t understand how the points are gathered to equal a moderate level of medical decision making. For example in the quote above, you don’t need any imaging to qualify for 99214. Hell, it could be newly diagnosed HTN and a simple rx for lisinopril and that would qualify for 99214.

Confused/ don’t believe me? Please see here:

New office patients (99201-99205) - E/M Coding Education, EM evaluation and management coding, e&m documentation, 99214, 99213

emuniversity.com

I hear you. But I was always taught to lean on risk and data as the prime drivers of my billing and coding.

and of course, you don’t need imaging for sinusitis. But if you get it because you’re entertaining PNA in your differential, look at the image in real time and document your findings independently. You get 1 (out of 3) point for ordering. And 2 for interpreting.

then if you prescribe, it’s a rock solid 99214.

and I disagree with that article. That visit is a 4, obviously, but that doc assessed 3 established and stable problems, not 3 minor/self limited ones as the article implies.

he also did medication management, in addition to managing 2 or more stable chronic illnesses, which the article doesn’t seem to point out, so the risk category is met in multiple ways.
Continuing prescription meds unchanged is still medication management. Literally all that needs to be documented for each problem is “chronic, well controlled, check monitoring labs and continue medication(s) at current dose” and you’ve met moderate criteria for the risk category.