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I had your exact situation. I'll try to explain. - Old Anon

Posted: Feb 19th, 2021 - 7:42 am In Reply to: IC need help restructuring pay scale - MTranscript

My client was a consulting cardiologist who visited the primary care's office.

One caveat is you cannot get a line count in most EMR platforms because of all the existing headings that cannot be excluded and other people (office staff--PAs, NPs, etc. entering things into the EMR.

At the start, I just typed his dictation into a Word document--reason for visit, the narrative of his exam, and his impression and plan. All these topics had a corresponding sections in the practice's EMR. I completed all the patient's for that day's visits in one Word document. I then entered each patient's dictation into their existing EMR file. I copied and pasted this dictation from the Word document into the practices EMR, patient by patient. I got my total line count for that day's dictation from the Word document and that's how I billed. It does take a bit longer to do the cut/paste thing, so you might want to consider increasing your line rate by one half to one cent and see if that flies.

After a time and several upgrades to their EMR platform, the cut and paste started to be problematic. It would put several words on a line then wrap to the next line. Even the EMR vendor could not figure out why it did that, and we could not remedy the situation. At that point, I had enough Word files to get an average lines per patient note figure by taking a month's worth of files from my Word documents and dividing by the number of patients seen. I told the practice that I would charge per patient visit rather than by line, and they were fine with it because they knew about the cut/paste problem. It ended up being $3.75 per patient (I had originally been charging 12 cpl on a 65 char. line). The notes were not very long at all because it was a consultation and not a complete H&P, meds, allergies and the like.

So, to sum it up, if you are doing the whole patient encounter, you might want to do a separate Word file and cut/paste for a week or two, then get yourself an average cost per patient from that data, and charge per patient. It would be so much easier in the long run. You can explain all that to the client, and if they are reasonable people they should understand. The EMR is a very different animal, one which is impossible to do line counts on and charging per patient makes more sense. You just need a little time to figure out what that charge should be.

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