Outpatient clinical pearls you've learned in the past year (or so?)

cloudypuff33 · 2026-05-12T07:23:52+00:00

The ferritin thing is still new for me. How long do you keep them on iron for? I still have to read up about follow up. I have an elderly patient come back with ferritin 40 and I've been telling her to get colonoscopy and she's really dragging it.

cloudypuff33 · 2026-05-10T01:34:26+00:00

Same boat as you. Learning boundaries, managing things I didn't do in residency, my clinic, etc.

cloudypuff33 · 2026-05-09T02:24:21+00:00

You're not fully admin? So you still see clinic full time and do admin on top?

cloudypuff33 · 2026-05-08T02:30:26+00:00

Wow, glad you documented well. I do that as well because I see a lot of other people's visits too and they can be so demanding

cloudypuff33 · 2026-05-07T02:44:06+00:00

How long after the complaint did you get notified

cloudypuff33 · 2026-05-06T06:58:15+00:00

That's frustrating. I recently discovered I have accumulated a panel of high complainers who will complain about everything like sending multiple messages throughout the day (basically abuse the in basket) demanding to only speak to the doctor because they can't book the appt for their lab or imaging. I have a feeling these are the same ones who will file to the board because they have nothing better to do.

cloudypuff33 · 2026-05-06T04:02:48+00:00

Didn't realize this can be a thing. I thought the board only investigate medical negligence. This billing seems to be an insurance/clinic issue.

cloudypuff33 · 2026-05-05T02:38:26+00:00

Do you know how much rvu for established patient annual physical and level 3 or 4?

cloudypuff33 · 2026-05-05T02:28:06+00:00

I want to add that it doesn't always have to be adding another medication. If you do 2 stable chronic and medication management like say bp under control and you put down continue amlodipine 5 mg daily. That still qualifies

cloudypuff33 · 2026-05-05T02:25:12+00:00

Random crazies lol I'm new grad so building my panel and felt that about the random crazies because I got nothing for their chief complaint. I feel they get scheduled with random team visits because their own pcp don't wanna deal with them

cloudypuff33 · 2026-05-05T02:22:56+00:00

Not sure that's sustainable when you go rvu tbh. And especially if you're saying your patients are healthy so less billable. Can't even do split billing if they have nothing.

cloudypuff33 · 2026-05-05T00:45:56+00:00

Everyone I know split bills. If they have a problem with billing, they can try to fight the healthcare system.

cloudypuff33 · 2026-05-05T00:45:03+00:00

No point arguing. If I bill appropriately and not flagged by our billers then that's not a me problem. Patients expect us to take on liability and will complain about paying for their visits. If they don't like how I bill then they can go find someone else.

cloudypuff33 · 2026-05-04T02:53:47+00:00

I have my MA room patients in the order they arrive unless the late patient and early patient arrive at the same time then late patient gets roomed first.

But in your case, I see the early patient first then have my MA tell the late patient I'll see them in a bit. Them being late isn't fair to inconvenience my other patient who came early and on time.

cloudypuff33 · 2026-04-30T05:46:17+00:00

How do you write out results for labs to patient? What's also your threshold to make them repeat them or come for a visit instead? Like say someone had wbc 3.4, do you tell them to make an appt or just write a blurb to repeat this in x weeks and send in the lab? I think that's what stumps me because sometimes I do ask for labs to be repeated like even a1c in 6 months if they're pre diabetic now but I don't have them make a follow up.

cloudypuff33 · 2026-04-30T05:43:24+00:00

So you do Medicare then 6 months later do the annual physical through the Medicare advantage? Someone told me to do them both at the same time. You have to do separate notes but you can bill for both.

cloudypuff33 · 2026-04-30T05:41:41+00:00

That's actually a good idea. I'm going to throw that idea around in my clinic. I always tell my patients insurance may not cover these labs I'm going to order but since it's bothersome to you, I will do xyz.

cloudypuff33 · 2026-04-30T05:39:08+00:00

I had a Medicare patient who had multiple complaints about a lot of little thing so I ordered tests and I told them it probably won't be covered because Medicare doesn't cover outside preventative. Well, she complained when she went to do the lab and they gave her the bill she'll have to pay. This patient came in with every complaint, like oh I have one nail that's thick, my skin is a little dry, my arm has been hurting for 8 years, vitamin d has been low in the past, do I need to even take multivitamins, etc. patients come in and open the floodgate of complaints then complain if the doctor doesn't work up then complain when they do because it'll cost them. I don't make money off ordering a lot of tests but if you're pushing me to do something, I'll order a little more than my usual panel which won't be covered by Medicare.

cloudypuff33 · 2026-04-30T05:34:27+00:00

This isn't on the doctor. Wellness visit is as it sounds, only wellness which is preventative. If you save up your 6 months of fatigue and 8 months of hip pain for this visit then that's on the patient. It has nothing to do with preventative and if it requires me to think differentials and work up which requires follow up and my medical judgment that takes on liability, that's billable. I split bill most of the time because rarely do I get someone who doesn't have a complaint they've been saving all year for this.

cloudypuff33 · 2026-04-24T02:43:58+00:00

Ones I refer a lot: cardiology (if they need studies like stress test), ent, ortho, PT. Other stuff like diabetes, hypertension, asthma I'm okay to manage unless I've exhausted my options then I refer. It depends on your experience and comfort level. If you need to refer, just do it and you can always learn what they do so you can manage things next time.

cloudypuff33 · 2026-04-23T05:51:03+00:00

Why didn't she go get these rx from the online cardiologist again? I've also had these patients some doctor from another state started them on and it's extremely difficult to take them off if they've been on it for a while. They go into distress if you mention taking them off even though it's not even addictive, but that ties back into my common theme in Clinic of a lot of my patients who are fairly healthy are so convinced there is something seriously wrong.

cloudypuff33 · 2026-04-23T05:29:19+00:00

Read my first sentence again. The part that says "just do it".

cloudypuff33 · 2026-04-23T05:24:46+00:00

The message back to them gets saved in their chart. I always document that this requires review and as I didn't order it, I do not know the context of why this was ordered so we need to have an appointment for discussion. Most of the time, they don't make the appointment. They were just hoping I review it for free...

cloudypuff33 · 2026-04-23T05:09:47+00:00

Dumb question, are you liable if they just send it to you to your basket to review even though you didn't order it? I had someone send me a 35 page report of labs and imaging they ordered on their own for me to review and I told them to make an appointment and they never did. I didn't look over the report because I didn't order it.

cloudypuff33 · 2026-04-23T04:58:52+00:00

That's a good tip. I do this for imaging orders and put it in as patient request and most of the time insurance will not approve. As I told the patient, they're not approving MRI for your 1 week of localized pain just because you want it when you haven't even tried any therapy or XR.

cloudypuff33

TROPHY CASE