Month 5
Random thoughts stray at times, was this the right time to do this? Perhaps grinding away at a local ‘big box’ entity is wiser. Maybe I should just anchor in 1-2 side gigs and make that be the practice? And many more of these ‘what if thoughts’… are actually occurring so much less. This practice is settling into my reality and a pinch of identity. More now when I have these thoughts, I pair it with feeling of “I can’t go back… never again” to traditional employment. I am living the dream and the sensation of freedom and independence is liberating. I enjoy seeing small things and thinking maybe I should do that? Or add this? Or buy this?’ and smiling knowing that it could happen and I CAN make it happen. It won’t get lost in a sea of bureaucracy or take 10 months for a work order just to be added to the list of work orders to be completed in 6 months. My building has heat that works (a previous job didn’t…). My building has AC that works (a previous job didn’t…). The office has a professional ambience (a previous job didn’t). I can buy a printer/scanner with snap of my finger (and not listen to a CEO tell me how I should feel privileged and excited as a kid at Christmas that I dared to request an additional tool to make me more efficient). The belief that I can do this job for the next 30 years is starting to return.
Positively the receptionist I reached out to is interested, and with past working history we have been quite open of pros/cons for each. Made an offer for 20hrs/week, she’ll be getting a pay raise from previous job and is on upper end of clerical work pay. However, she is a proven individual and knowing that is worth the cost. The last thing I need is poor performance or work place drama in a set up this small, or even staff turnover. Reached out to state LAI to get the check list of what I need to do for hiring. Reaching out to lawyer to field questions with them about how I do the official offer letter. Clerical work is consuming me and detracting from patient volume – I need this position filled last month! Signed the letter with plans to start July 1. (MISTAKE: Should have hired clerical staff much, much sooner. I suggest those reading this to do things yourself for first 3 months, but already have ball in motion to have some one start by month 3-4 at the very latest)
Have 1 insurance denial from medicare advantage and 1 from a lower payor – both are ridiculous and infuriating. I want to drop these insurance panels, but as long as the ECT dream lives I won’t. Privileges application goes to committee at end of Month 6 – we’ll see what happens. (Medicare advantage denial did eventually pay.) (After third phone call, finally discovered this is another Inpatient vs outpatient facility code error, so they are resubmitting it, so hopefully will get paid in coming weeks)
Definitely starting to see the rise in follow ups, like the tide at the ocean, you look away and then your feet are wet. Reassuring feeling to get the continuity and see results (or lack of) in treatment plans for patients. This is what outpatient is about! Have had a few patients end services for various reasons. Also, had my first no show for a follow up. Even had first angry “I won’t pay message” from patient feeling disappointed at end of consult I wouldn’t continue a certain controlled prescription. Picking up a few patients from local psychiatrists who have narrower insurance panels, so patients are excited to have an in-network doc.
Previous accountant dropped the ball on several things, and fees were in excess of what was originally discussed and other fees are more than double what competitors are charging. Positively have now reduced my long-term overhead by going with an experienced CPA who is transitioning from larger firm for solo operation. Continue to review my overhead and ways to reduce it. Connected to mobile check deposits now with bank, so that will hopefully save time on clerical errands. Eventually will circle back to handful of payors that are still sending paper EOB and checks, to see if possible, for EFT and electronic EOBs.
Discussed with medical liability insurance carrier with how they define part time. Positively, not by posted office hours, but by actual clinical work. So I have dropped down to part time, and reduced my liability insurance costs. (MISTAKE: for those reading this, I should have done this from the start, but didn’t down grade after I left the inpatient independent contractor gig. Overly optimistic in assuming things would be past 20hr part time mark by month 3-4).
Long story shortened a bit… my land lord didn’t pay attention to need of having office space certified with local government, as precondition to having the USPS give you keys for an actual mail box. I’ve been using a separate mailbox for some time. As such, Google won’t truly certify this address until I verify through their post card in the mail process, but oops, landlord is still jumpy through regs to get this place certified, and is paying all sorts of fees for their screw up. I had a simple Google Ad going, which anchored my web presence with all sorts of web search permutations. But when I stopped 2-3 weeks back my searchability also tanked. So I reinstated it, until this address fiasco is solved.
Clinical volume this final week tanked. Same time I extend offer to secretary. Uneasiness of knowing a week without hitting overhead bench mark has pulled down the enthusiasm of feeling like I truly hit the overhead bench mark. Billing resubmits seemed to have mostly worked their way thru with the repeat EOBs and a couple positive changes for both patient and myself, but good to know that headache is resolving. Medicare isn’t paying on my UDS claims. Confusing as can be when I have a certified CLIA lab certificate, and billing company hasn’t got me much of answer yet as to what the issue is. Might have to write off those few unpaid UDS bills from Medicare.
Luminello EMR had some updates at end of month I’ve been waiting for. So excited! Never felt this way about Epic updates in previous jobs, but the small, simple quaint feel of this EMR, I’m actually excited. One of which is new charts, however they are created, can now have a customized setting for access. In other words I can wait to send a message to patients that online scheduling is available to them once appropriate, and now I’m fully integrated with the online schedule feature.
I’ve done ketamine infusions during residency. Re-considering this service line. Liability insurance company will cover this additional service, too. Exploring discussions of a joint venture with an anesthesiologist next month, or may just go solo with this, or leave it for something to consider another day.
Year-to-date Business Income -7.9K, balance 4.5K
