How would you handle clinic notes coming up missing after you've delivered them to the facility?
Posted By: MissouriMT on 2008-02-13
In Reply to:
I type the clinic notes at home, print them, verify the all notes printed, place them in a manila envelope clearly marked with the clinic name and dictator doctor's name and date of clinic. I then deliver the notes to the lead Transcriptionist at the hospital which manages the clinics. She in turn distributes them to the clinics.
The last two weeks, I have gotten several calls from the lead MT that I give the work too that clinics are calling saying they are missing certain notes from certain days which is impossible because I type all notes for a specific day in one large document and print them out together. There is no way that some are printing and some are not. Plus I ALWAYS verify that each note printed. Today, she called and said there were missing notes from two different days.
Then there is the issue of my work being typed by someone in the hospital. When I deliver work I get a print out of what's on the system as far as clinic notes. It is a worktype specific list that only I am supposed type. There are a couple of doctors who dictate all their notes in one looooong job. There were two very long jobs on my list, but were never pooled to me. When I enter the specific job number, it says they have been transcribed. In one instance, the dictator dictated half on one job and half on another. I typed one job and the other just magically got transcribed. When I've called to ask who's typing these reports, no one seems to know.
These ladies in this particular transcription department are not a friendly bunch. I have felt that they sort of resent the fact that I am doing work from home while they have to come in and type. I think they are wondering why they aren't allowed to work from home. The work I do is very easy clinic work and would be pretty easy lines for one of them to do just to pad their line counts.
I have a meeting tomorrow with the HIM director who contracted with me about TAT and I know they want a shorter TAT than the agreed upon 24 to 48 hours and I know she is going to want me to make more deliveries than the three I do a week now. I have asked that they set up a remote printer for me so I can print from home that way delivery isn't an issue anymore, but they act like this can't be done which I know it can be done.
I'm about to cut this account loose, but it's such easy work. It's just that I'm running into brick walls at this place.
Thanks for listening to me whine! 
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clinic is not walk-in or ER notes; it is clinic
could be a small clinic with just famiy practice, internal medicine, maybe physical therapy, or it could be like mine, large, every speciality, cardio, nephro, neuro, ortho, endo, surgery, ENT, podiatry, ophtho, derm...
So do you have the missing notes??
If you have the missing notes then someone is misplacing them and you simply charge them a re-printing fee. Are you doing digital and delivering back or do you pick up tapes? If they want more delivery back, charge a delivery fee. You can make it work if you want to but they will have to pay for the time you are putting into the work. If you feel someone at the clinic is doing your work, explain that also. Good luck.
Missing Notes
I have that problem once in a while and my doc and I got into an argument about it once. I knew he didn't dictate the notes, but he kept telling me he puts a check mark on the notes he does dictate.
I've been with this doc since 1995 and I have a phone in system, so if he dictates them, they're transcribed. If he doesn't dictate them, then he didn't do them.
Well, for how busy he is, if he put the check mark on the note PRIOR to dictating, then gets called away for a patient or starts to fall asleep while dictating (which he has done already), it could very easily be overlooked. What aggravates me is that he makes me type Re-dictation on any notes he says he did before but didn't.
Also, I have found that since the last secretary left, there aren't as many "missing notes" as before. Hm-m-m-m. That tells me something. I can understand if I put a blank for the patient name (no list to follow and if it's a new patient or can't understand Speedy Gonzalez, then those notes could very well be thrown away if they can't verify the patient.
I don't print the notes or hand deliver them anymore. We use PCAnywhere, and the notes are in one file with the dates of the notes dictated, which I transfer directly to his computer, so they print them out on their end. I have the notes and so do they, so if they are missing a note, all they have to do is check their files to see if that note is there. If not, then he didn't do it. End of argument.
This has worked out great for me, but for you, well, I'd think twice about keeping a job with that much aggravation. Find another account.
P.S. - and also, I have had missing notes too
dictation system by the doctor when they dictate. So instead of coming to your pool, it ends up somewhere else. And someone in the hospital ends up getting it and, not being sure what it is (or maybe knowing but welcoming the easy work), they transcribe it.
As far as them telling you notes are missing...sm
you can always cut and paste names into a log. That way, they can't claim to be missing certain notes.
I think clinic/ ER notes sm
would be a good place to start, either working as an IC/employee for a national or getting your own accounts.
Good luck!
Do you get more LPH with clinic notes or Ops? nm
x
only clinic notes can have
an actual name in a report. hospital reports should never have an actual name but instead just have * the patient *. hipaa rules.
Yes, it is clinic notes...sm
I also have an extensive list of Expanders that I wouldn't doubt was well over 20,000. I've been building it for the last 11 years working at home. I don't even type out the word with (wi).
I appreciate your response and the boost.
Clinic notes
Mostly clinic notes from my experience:
S - subjective
O - objective
A - assessment
P - plan
Clinic notes
I have always done acute care. If you get a good line rate, could you make good money doing cardiology clinic notes. I was not sure since you have letters too.
I do clinic notes...sm
Clinic notes are a lot easier to do. The letters are very easy. If you have good rate of pay then you should make as much money. I do general surgery clinic notes and letters. The only problem I have with clinic notes is you will run out of work. It is according to if it just that one clinic or not you work on. But they can only see so many patients in a day. And if they do surgeries to then they aren't always in the office to see patients all day. So I don't always have enough work. But to remedy that I have another job too. So if I run out on one I work on the other. But if you have plenty of work there is no reason to me you couldn't make good money. My problem is just having enough work.
I do clinic notes also
I love them. They are very easy and I have a lot of normals that I use. I don't have any problems keeping busy with work. The doctor's I work for sometimes see 50 patients a day total. And I don't worry about having no work because I'm an employee and if there's no work I still get paid.
I think clinic notes are boring, you have the same
number of doctors usually and for the most part there isn't a lot of medical terminology and they have lots of normals, which is good because they you can have lots of macros/expanders to help, but I like learning from my dictation. With clinic notes I did know when viruses/illnesses were going around and what the standard treatment was, so I could try some of the same treatments if we got sick without a doctor visit, just after a while they were just boring. I much prefer acute care. I have lots of dictators so I don't get sick of hearing one doctor all day, although occasionally I do get a slew of the same dictator, the terminology is constantly changing, new drugs, new equipment, new procedures, etc.
Some have said clinic, some op notes, some ER, depends on what you
s
Clinic notes questions
I see lots of jobs looking for clinic notes. I have only done acute care. What exactly are clinic notes? Are they office visits by specialty? Also is the pay for clinics typically higher, lower, the same for acute care?
Thanks.
Depends on clinic notes, sm
I really think it depends on the type of clinic notes you transribed. I went from transcribing very detailed and lengthy multispecialtiy outpatient clinic notes for a major teaching hospital to transcribing acute care, mainly op notes, for another hospital, and it seemed to make the transition, although I felt very confident after about 3 months. But if you were transcribing clinic notes for just a regular outpatient clinic or clinics (well child checkups, lots of cold and flu, etc) you may have a longer transition period. It really just depends on whether it's a teaching hospital, the number of dictators, etc? You CAN do it though--it is all a matter of mindset. If it IS a teaching hospital or they have an ophthalmology department, I would definitely recommend getting the Stedman's Ophthalmology book. That made my transition SO much easier, that book, and the Stedman's Equipment Words. Good luck. Just give yourself 3-6 months to get acclimated to the op notes, number of doctors/residents, etc., don't pressure yourself to get it right away, and make copies of each report for every dictator--it will save you in the long run because they usually say the same things. Good Luck!!
I do much better $ wise with clinic notes
I have local office accounts and also work part-time for a national. The repetitive nature of doing the same dictator day in and day out increases my production at least 30-50%; more expanders, more normals, familiar terminology, etc.
Right now I am averaging $25.00+ an hour on my local notes, and less than $12.00 with my national acute care. I do have more taxes and such with my locals as it is 1099 income but I still come out much better on clinic notes.
good luck!
LOVE clinic notes
I do clinic work and I LOVE it. I transcribe for 3 docs. There are 4 girls on the acct. And we ALWAYS have work. When I am bored on Saturdays or Sundays, I sit down and type for a few hours. Rarely is the server empty by Monday morning. I have never been at a loss for work. It is so repetitive and easy. Each doctor has his own way of talking and I have tons of shortcuts for each doc in my autocorrect in Word. So easy, so fast, so fun!
Clinic notes are less detailed normally
than acute care/hospital reports. They are limited to that 1 speciality with only sparse mentioned normally of other medical conditions not pertaining to the clinic visit. However, in acute care, you have to be aware of drugs, generic versus brand, correct dosages, all types of medical conditions, problems, side effects, lab values (a working knowledge of correct and invalid values dictated in case the doctor is in error), and "all" specialities. That is just a few of the things required for acute care transcription.
Many MTSOs looking for acute care MTs will not consider someone who has only been in a "clinic" per se because the MT has only been possibly working in 1 speciality. You need a broad overall knowledge to work in acute care as you never know from 1 report to the other what is going to be thrown at you. In the clinic setting, the MT can be isolated from anything new that has cropped up, especially if in a clinic for a number of years.
clinic notes to acute care
Has anyone gone from doing clinic notes for different specialities to acute care in a hospital? I have been a Transcriptionist for four years and lost most of my work to India. I went back to medical billing for about 5 months and have been offered a position to work at home for a hospital. I never did hospital work. This will exclude lab and X-ray reports. I am a little scared. Any good sites to brush up on for documents or any words of wisdom?
Thanks!!
I was getting $3 a page 12 years ago. But $2 might not be bad for VERY short clinic notes.
Whew! I just left clinic notes after 4 years..sm.
and got back into acute care. My momentum is back and I feel like I'm part of the medical process again. I guess I just like acute care better. I can never go back to clinic notes. I can't deal with those 20-second charts. Took me longer to get in the chart than to type it. The company I WAS with had such a screwed up demo screen if you made 1 mistake you got put on probation. Just toooooo much for me.
IMO, that is.
Wow, 600 lines from 30 minutes of clinic/chart notes - sm
The most I would squeeze out of that would be 350 probably. You must have one fast talking doctor. You are also very fast if you can do 600 lines in one hour, or else you have it macroed/expanded to death and there is very little actual typing so that is why you can do so much in such a small amount of time.
I am working today but i don't get extra pay. just behind on clinic notes and trying to catch up
between cooking.
It is clinic ortho notes , same doctor, very easy dictator
I am supposed to be p/t and he dictates between 30-50 min a day, many times 50-70 min even. It takes me many hours since I am a newbie. The paychecks just don't seem worth it for the amount of time that I am putting in.
I get close to 9 cpl as an IC doing clinic notes. No chance of raise unless I find my own accounts
x
My mistake, I am not thinking tonight, I actually make 11.5 cpl, clinic notes. I earn my money thou
nm
I've had to buy a few keyboards because of missing keys
The main reason I do that is because other people in my family use my computer. It's not just used for my MT work.
So if you've never done OP notes,
do they figure 3 out of 4 ain't bad????? 
I've been off after 3 notes.
Better yet, I've also gone straight to client upload with no QA.
I've been doing lots of dental notes. Not boring at all
when you think about the ease and money you can make cuz they always say the same things. I'd take it.
Only 7 or 8 cpl for clinic and acute unless they've changed recently. nm
s
I've never seen mixed acute care & clinic at the same time. That's a production killer for sur
s
And you'll almost never get just Op notes. Probably get mixed acute care - op notes, discharge su
s
We got pizza delivered.
Church group tonight.
Could you have lunch delivered for
the staff one day? I'm not suggesting anything too pricey, but something they all enjoy. A donation in their name to an animal rescue in your area might be appreciated as well. Congratulations on your puppies!
Gevalia - its the best and delivered to my door
monthly by the UPS guy! Amaretto is the best and regular is #2. Great coffee and prices are better than buying premium in the supermarket. Keeps me going...
If MT has checked off list of reports delivered,
x
Glad somebody got us going in the right direction! Signed and delivered! Thanks!...nm
x
I had a family doctor who was a D.O. - delivered my boys 38+ years ago
Need to prepare -- Anyone out working at home delivered by C-section? I know they say 6 weeks to
recover and get back into an 8-hour day job routine, but did anyone come back sooner because they worked at home and were able to rest more and space out your work time?
You could have a bigger gift delivered to their home, too, and just put a note in the card. How
s
Chicken dinner delivered from local restaurant and $10 gift card for a turkey.
a
I am an MT at the facility where the
report came in. This dictator is not our best, but he's not our worst, either. I also transcribe his dictation. MQ does our overflow and has for YEARS! This is not an ESL dictator, and this physician has been at our hospital for years. I know nobody is perfect. All I'm saying is, I would never send a report through with that many blanks without someone checking first. I also know that yesterday one came through from MQ with more than 14 blanks, and it was from one of our easiest dictators! It doesn't matter whether you are management or an MT in the trenches (as am I). You should take pride in your work and care what the finished product looks like. If you have done your absolute best, then okay. If not, then there's a problem. With multiple reports coming through like this every day, it makes us wonder if all whoever types these cares about is getting the lines and doesn't care about the work they do.
Maybe work like this is why things aren't going so well at MQ, at least according to what I read on these boards. And for the record, I worked for MQ for a short period of time as an IC about 6 years ago but chose to go to work in-house for this facility for benefits.
I have been transcribing for 19 years, and I have had my share of difficult dictators, ESL, bathroom talkers, dictating in cars, airplanes, screaming children, fighting spouses, gum chewing, burping, and hearing other bodily functions, along with transcribing while parties, code blues, superbowl games, etc. are going on in the background. I know about crappy dictation and good dictation. I struggle through the bad and rejoice in the good.
The patients deserve the best. Our best! Yes, the ultimate responsibility should be the physicians, but isn't it our job to create the best possible report with what we have to work with? Medical Transcription is not a perfect world. There are no perfect dictators, but I do know a couple that come awfully close! In a perfect world there would be no sickness and we wouldn't be needed!
It's time for us to quit complaining about the dictation and do our absolute best with what we have. We owe the patient that much.
It is up to the facility not the MT (eom)
m
Whatever the facility wants is what you should do.
x
No facility should be given permission (sm)
for any kind of physical discipline. Its not a spare the rod spoil the child issue. When having to discipline someone elses child, the results could be far less or far more than what the parents would have inflicted. The result in some cases, especially in Texas, is the accidental deaths of children. I spank my children, on the behind but as a LAST result. THerefore, I would not allow my children to go to a school or facility, camp, counseling, etc, that would attempt to discipline my child physically. Call me and I will come and take care of it, but don't put yourself in the parents position.
incompetent facility
Your story sounds like something from a small town (or small office). That many radiology reports withheld from being distributed, you know some of them had remarkable findings such as a chest x-ray that needed a follow-up MRI, CT scan, etc. I hope this girl gets terminated soon enough and out of there. Otherwise, the radiologists themselves will be paying the price and hence it would be followed through to the administrative office/CEO office of the medical center/hospital.
This is how we let facility know they need to check
sef
No, I know not every facility/provider is
compliant, but two wrongs don't make a right. I want to keep my nose clean if the facility/provider is ever charged and investigated for a HIPAA violation - if the gov't has done so thus far. You think the gov't will buy 'oh, I was non-compliant because my client signed my checks'?...nope!
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