Medical Billing & MU Updates in February Getting Paid Newsletter

Lea Chatham February 10th, 2016

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The February Kareo Getting Paid Newsletter provides some updates on medical billing and Meaningful Use for 2016. Get advice on managing fee schedules, applying for a MU hardship exemption, the latest survey on patient use of online physician reviews, and more. The newsletter also offers a chance to discover upcoming events, news, and resources from Kareo. Plus, learn about how to register for upcoming webinarsRead all this and more now! Tweet this Kareo story


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The Medicare Fee Schedule and Your Specialty: What’s the Scoop?

Lea Chatham February 8th, 2016

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Have you taken the time to review and update your fee schedules? It’s an important part of starting the year off right. Your practice management system should update the Medicare Physician Fee Schedule (MPFS) for you, but you still need to make adjustments to your practice fee schedule and ensure you make any other needed updates for commercial payers. Often staff are so busy closing out the old year and getting ready for the new one that things like this get overlooked. You may not even know how the changes to the MPFS are impacting your bottom line.

On Thursday, February 11, you’ll have a chance to get a great overview from expert Elizabeth Woodcock on what changes occurred on January 1 and how your Medicare reimbursement has changed based on your specialtyTweet this Kareo story

Here are a few highlights from her presentation:


To attend this free webinar, register now.

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Meaningful Use Hardship Exception Extended, But Not by Much

Lea Chatham February 8th, 2016

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Barbara Drury, BA, FHIMSS

If you won’t be able to successfully attest for Meaningful Use (MU) under the Medicare or Medicaid program for 2015, you may be looking at a payment adjustment in 2017. The only way to potentially avoid the MU penalty is by filing for a hardship exception. Tweet this Kareo story


The hardship exception process can be used if you tried to demonstrate meaningful use but had difficulties due to external circumstances. Essentially, you tell the Centers for Medicare and Medicaid (CMS) about the circumstances through an application form called the “2017 Payment Adjustment Hardship Exception Application,” which can be found on the CMS website. The deadline to submit the application was extended in recently legislation from February 29 to March 15, 2016.

Some of the external circumstances are self-explanatory (i.e., insufficient Internet, natural disaster, practice closure, bankruptcy, and complete lack of face-to-face interaction). One, not multiples of these may be selected as the primary reason that prevented you from demonstrating meaningful use. Two other hardships are also allowed:

  1. Lack of Control over EHR Availability: Typically this would apply to an EP who is an employee or contractor and provides 50% or more of his/her encounters in a practice where the EP has no control over the presence or use of a certified EHR.
  2. EHR Certification/Vendor Issues: Circumstances that may fall into this category include:
    1. Delays experienced by the vendor trying to get certified to the 2014 Edition
    2. Delays in vendor’s availability of installation and training resources due to a backlog of customers
    3. Decertification of the currently installed EHR
    4. Vendor decision to no longer pursue certification.

More than one eligible professional (EP) may be included on the application as long as the same hardship applies to all EPs listed. This application can be submitted electronically or by fax to a third party contractor on CMS’s behalf.

In addition to submitting the application to CMS, you must keep all records that would support the specific hardship being claimed: emails regarding sales, training, installation, available dates, sales invoices, training invoices, press releases regarding availability of EHR, certification, meeting minutes, etc. For 2017, these documents are not required to be submitted with the application but you must make them available upon request.

For more details on the application process or to start your application, visit the CMS website or the CMS Frequently Asked Questions.

If you are looking for help with Meaningful Use, check out the Kareo Meaningful Use Resource Center.

About the Author

Join Barbara Drury to find out what you need to know about meaningful use nowBarbara Drury, BA, FHIMSS, is President of Pricare Inc., an independent health information technology consulting firm founded in 1982. She frequently lectures and writes about the impact of office-based computer systems and electronic medical record systems for entities such as medical societies, healthcare organizations, and others. Ms. Drury served as an appointee to the ONC’s Technical Expert Panel on Unintended Consequences of HIT Adoption. She has achieved Fellow Status with the Healthcare Information and Management Systems Society (HIMSS) and has served on the HIMSS Public Policy Committee and the Davies Ambulatory Award Committee. Ms. Drury is also a frequent speaker at the HIMSS Annual Conference and is the recipient of the December 2004 and the April 2009 Spirit of HIMSS award.

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Survey Shows Patient Use of Online Physician Reviews Growing

Lea Chatham February 8th, 2016

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A new study from Software Advice shows that reviews of physicians are having a greater impact on patient decision making. It turns out that the majority of patients are using online physician reviews in some way. Tweet this Kareo story

Nearly 85% of patients surveyed said they consult a reviews website to view or post comments and ratings of healthcare staff. And when using review sites, 77% of patients said they use them prior to choosing a physician, making it a crucial first step in selecting a new doctor.

“Our data shows online reviews are a very significant part of the selection process when it comes to healthcare providers,” says Market Researcher Gaby Loria. “Reviews-based rankings are often the first impression people get of a practice and can make or break a doctor’s online reputation. Seeing as more than three-quarters of patients surveyed use online reviews as their first step in finding a new doctor, individual physicians and large practitioner groups alike can’t afford to ignore the influence of these sites. ”

The impact of positive reviews is so strong that many patients would consider going out of network if the physician’s ratings were better than those of an in-network provider. “Good reviews have the power to loosen purse strings, as 47% of people in our survey say they wouldn’t mind going out-of-network to be treated by a well-reviewed health care provider,” says Loria. “It pays for practices to keep their web presence front of mind.”

Reviews are also playing a role in patient retention and satisfaction. According to the survey, 23% of the respondents said they use reviews primarily after selecting a provider or to evaluate a current provider. Half of of patients said they leave very positive or somewhat positive feedback while only 6% said they leave somewhat negative or very negative reviews.

The low number of negative reviews should be encouraging news for physicians, many of whom are hesitant to ask patients to leave reviews for fear of a bad one. Even more encouraging is that patients also said they would be likely to disregard a review that seemed exaggerated or where the author’s expectations seemed unreasonable.

The survey really indicates that there is definitely benefit in asking patients for feedback after a visit. Doing this is more likely to generate positive reviews than negative ones, and potential patients will probably view negative reviews with a critical eye.

The survey also asked patients what information is most important to them in a review. Quality of care was at the top of the list followed by physician ratings and patient experience. Within the category of quality of care, accurate diagnosis was the top concern. For the practice at large, staff friendliness topped the list.

This survey strongly points to physician reviews and ratings playing an increasing role in recruiting and retaining patients. With today’s affordable practice marketing automation solutions practices can’t afford not to focus on increasing patient reviews and improving their online reputation.

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Believe or Not: Patient Portals Can Improve Efficiency

Lea Chatham February 4th, 2016

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Patient portals really can save time for patients, providers, and practice staff. Discover how in this short video from Dr. Molly Maloof. Tweet this Kareo story

Are you interested in learning more about the benefits of engaging patients in your practice? Download 10 Ways to Engage Patients now.

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Find Out What You Need to Know about Getting Paid in 2016 in Free Webinar

Lea Chatham February 3rd, 2016

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Getting Paid in 2016: What You Need to Know
Thursday, February 11
10:00 AM PT, 1:00 PM ET

Learn about key changes in medical billing coming for practices in 2016 in this free webinar Tweet this Kareo story


Are you wondering how the implementation of ICD-10, dramatic changes to meaningful use and the government’s newest incentive program will affect your practice in 2016? This is no time to go into retreat mode. In this high-energy educational webinar, national speaker and author Elizabeth Woodcock highlights the key changes in payments for practices in 2016.

Take this webinar’s tactics back to your practice to improve your bottom line in 2016. You’ll come away from this event:

  • With an overview the new CPT codes that will go into effect in 2016, as well as the fall-out from the October 2015 implementation of ICD-10
  • Aware of the reimbursement changes to the 2016 Medicare Physician Fee Schedule, including the Advanced Care Planning codes
  • Having the ground rules for participating in the government’s incentive programs for 2016 to gain incentives—and avoid penalties
  • Understanding the new government incentive program—the Merit-based Incentive Payment System—and how to prepare

Register now to to join Elizabeth. We’re sure you’ll be enlightened!

Register Now

About the Speaker

Elizabeth Woodcock, MBA, FACMPE, CPC is a professional speaker, trainer and author specializing in medical practice management. She has focused on medical practice operations and revenue cycle management for more than 20 years.

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Are Your Practice’s Insurance Claims “Squeaky Clean?”

Lea Chatham February 2nd, 2016

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By Lisa A. Eramo

Every practice strives for clean insurance claims. In other words, physicians want to ensure that the claims they generate are:

  • Accurate
  • Complete
  • Compliant

Doing so minimizes the potential for payment delays and denials. The goal is to get paid the first time around to reduce costly expenses related to appeals and resubmissions.

Claims scrubbing—the pre-submission process during which claims are reviewed for key components—has become particularly relevant now that the industry has transitioned to ICD-10. Tweet this Kareo story

Many diagnosis codes are not only expanded in terms of the number of options, but they’re also more specific—requiring a level of detail that wasn’t present in ICD-9. The process of reviewing each claim prior to submission is a critical aspect of coding and billing compliance. Practices can’t afford to spend valuable time and resources chasing payments on the back end. The good news is that a robust claims scrubber can essentially ensure smooth sailing for 100% of your claims.

Make the 100% clean claim metric a reality
Unfortunately, not all claims scrubbers are created equally. Although most practice management systems include some type of claims scrubbing functionality, you need to question the validity of the scrubbing process and just how much your claims are “put through the ringer” before you send them off for payer approval.

What exactly does a robust claims scrubber include? A robust claims scrubber runs your practice’s claims against the following sources:

  • National Coverage Determinations (NCD)
  • Local Coverage Determinations (NCD)
  • Correct Coding Initiative edits
  • CPT-4/HCPCS edits
  • ICD-10-CM edits
  • Payer-specific requirements
  • State Medicaid edits

Cleaning your procedure codes
Your claims scrubber should automatically be able to identify the following procedure code-related red flags:

  • Invalid or expired for the date of service
  • Incompatible with the patient’s age
  • Not appropriate with the patient’s gender
  • Defined as an add-on code (that requires submission of a primary procedure code as well)
  • Cannot be billed using a modifier
  • Modifier is not valid or active
  • Modifier is not valid when submitted with this procedure code
  • Is a component of another code (and requires a modifier)
  • Is mutually exclusive to another code (and cannot be billed using a modifier)
  • Is mutually exclusive to another code (but may be billed using a modifier)
  • Duplicate code for the same date of service

Cleaning your diagnosis codes
The scrubber should also be able to identify the following diagnosis code-related red flags:

  • Does not meet medical necessity for the procedure performed/coded
  • Requires an additional character(s)
  • Cannot be reported as a principal diagnosis because it’s a manifestation code
  • Requires additional information for adjudication because it’s a trauma code
  • Incompatible with the patient’s age
  • Not appropriate with the patient’s gender

Scrub-a-dub-dub for demographics
In addition, the scrubber should be able to verify demographic information—for example, to ensure that a name, valid date of birth, valid SSN, and valid insurance ID number are all present on the claim. Typos can easily cause errors that are completely avoidable when scrubbing demographic information prior to submission.

Three tips to consider
Finally, enhance your claims scrubbing process with these three tips:

  1. Hire a certified coder. A certified medical coder can provide insight what edits are triggered and why.
  2. Incorporate data mining. Some claims scrubbers continually re-evaluate the adjudication rules of different payers, thereby constantly improving the quality of the scrubbing process. This is particularly helpful in ICD-10 as payers continue to update LCD policies and capitalize on the greater specificity inherent in the new code set. When reviewing various products, ask potential vendors whether they have the capability to update processes in real time to keep up with changes in payer guidelines.
  3. Monitor your processes. Are errors resolved in a timely manner? Monitor repetitive errors, and follow up with staff members directly.

A 100% clean claim rate may seem far-fetched, but with the right claims scrubber—and a process for ongoing monitoring—you can achieve this goal, or get close to it, and then reap the rewards of an improved cash flow.

If you are looking for ways to improve you medical billing, use this Billing Best Practice Checklist to establish goals for best practices.

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What the Heck is Going On with MU?

Lea Chatham January 27th, 2016

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By Beth Onofri

“What the heck is going on with Meaningful Use,” is a phrase that is probably popping up for a lot of people right now thanks to the huge number of conflicting articles that are flooding our inboxes. Is Meaningful Use (MU) ending or not? Even Andy Slavitt, CMS Acting Administrator, tweeted “In 2016, MU as it has existed—with MACRA—will now be effectively over and replaced with something better.” A week later, an article was released to clarify his statements.

There is no doubt that changes are coming once again to the EHR Incentive Program. But it is not just changes to the MU program. Tweet this Kareo story 

There are a number of other programs that will see changes too—PQRS, Value-Based Modifiers, and clinical quality measures. The overall goal is to align all these programs, using the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as a foundation.

Less than a decade ago, the MU initiative began with the objective to bring technology into the healthcare system. Initiatives encouraged providers to collect data electronically. The phased approach allowed us to move into connecting with one another, sharing the information we collected, and beginning the process of outcome measurement.

MACRA focuses on quality, cost, and clinical practice improvement when calculating how Medicare physician payments are determined. In other words, a shift to focusing on patient care and reimbursement for the quality of that care. It is important to point out that this realignment is strictly for Medicare reimbursement and not for Medicaid. Medicaid physicians will continue to be reimbursed in line with the previously established program.

So, What the Heck Is Going on with MU?
Many of you are wondering what does this mean for me and what should I do now. The answer is: Continue with the MU program. If you have not begun Meaningful Use, begin in 2016. The MU program may be replaced at some point, but the concepts, in particular e-prescribing, interoperability, and clinical quality measures, will continue whatever the initiative may be called.

If you have successfully attested to Meaningful Use, continue collecting the necessary data. The October 6, 2015 CMS rule streamlined Stage 1 and Stage 2 into one stage, Modified Stage 2, with ten (10) objectives. All providers use one set of objectives, no differences for the number of years in the program. Additionally, these objectives will remain basically the same for the next two years, through the 2017 attestation year.

Both new and returning participants should take a closer look at the MU clinical quality measures (CQMs) and the Physician Quality Reporting System (PQRS) measures. Although there has been some attempt in the past to align these two programs, they have been relatively distinct. However, these programs will be aligned, and hopefully consolidated, with the coming changes. Providers should begin to look at the results as well, and not just the collection of information. Trending of outcomes is not far in the future.

Watch for more details and updates on MU coming soon.

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5 Tips to Respond to Negative Online Reviews

Lea Chatham January 26th, 2016

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By John Sung Kim

Bad online reviews can happen to any business at some point. So negative reviews are always a looming threat to the marketing and reputation of a medical organization. And while this can hang like a dark cloud over providers, it’s important to understand the best practices to respond when this type of consumer content comes across our profile pages.

The first step is to make a request to the website that the negative review be removed, but most first attempts that I’ve seen don’t succeed. That is why it is important to understand these five tips to handling negative reviews before requesting removal: Tweet this Kareo story

  1. You will, in all likelihood, only get one shot at requesting a review be removed, so it’s critical to have a strategy before contacting the review site.
  2. Reading the Terms of Service (TOS) from that review site will go a long way in helping to determine what that strategy should be. It’s common for these review sites to publish in bullet points what types of content they do not allow, for example mentioning a competing company, naming one of your employees specifically, using profanity, etc.
  3. Once it’s determined that a review could violate one or more of the terms, write that in the subject line of the email to the review site, “Violation of Your Terms of Service,” or “This Review Violates Your Terms of Service.” This will often bring your review removal request to the front of the queue.
  4. It’s also a best practice not to respond to the patient directly as this lowers your brand by having you “stoop to their level.”
  5. It is perfectly acceptable, however, to have your Office Manager respond to the review with a statement that, “This review has been flagged for violating the website’s terms of service and is awaiting moderation for removal.”

Using these strategies the next time you have a negative online review will significantly increase your chances of having it removed. However, if it isn’t removed keep in mind that the occasional negative review isn’t the end of the world, especially if you have a lot of positive reviews. They are only a problem if you don’t have many reviews.

Organically (meaning passively waiting for reviews to generate), the average medical practice can have anywhere from two to ten reviews a year. That’s far too few to aggressively recruit new patients and have a solid defense against the occasional bad review. Having just four 5 star reviews and one 1 star review means that a single disgruntled patient can drag down a 5 star practice to a 4 star practice.

Many practices are hesitant to ask for reviews because of fears around patient perception and regulatory compliance. A simple way to avoid problems and to consistently generate a healthy volume of reviews is to use practice marketing automation software that integrates into your appointment schedule. In this way, each patient who walks out the door gets a mobile-friendly email that asks them to rate their visit, which makes the feedback request more of a patient survey and not a selective “ask” for positive reviews.

The more sophisticated systems can not only integrate into popular review sites (feeding them your positive reviews) but can also detect unhappy patients and send them down an alternate path (providing private feedback to the doctor) as opposed to giving the patient a chance to write a publicly negative review.

Several studies have shown that patients are looking at reviews of healthcare providers before booking an appointment. So it is worth the investment to put a system in place to increase overall reviews and manage negative feedback.

If you are looking for more tips on managing your online reputation, download 4 Steps to Building and Managing Your Practice’s Online Reputation.

About the Author

John Sung Kim is the technology evangelist at Kareo. He was previously the CEO of DoctorBase, a practice marketing and patient engagement platform that was purchased by Kareo in 2015. He was also the founder and founding CEO of Five9 (NASDAQ: FIVN). He’s acted as a consultant to numerous startups and government organizations including RingCentral, Qualys, Odesk, the city of San Francisco and the California Public Utilities Commission. 


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Billing Companies, Help Customers Reduce Denials Now

Lea Chatham January 21st, 2016

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Do you struggle with having conversations with practice customers about denial management? This short video provides helpful tips from expert Paul Bernard on how to make tough conversations like this easier. Tweet this Kareo story

Looking for more ways to improve and grow your billing company? Check out the resources available here.

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Welcome to Getting Paid, a weblog by Kareo offering ideas, news and opinions about medical billing and practice management with the goal of making medical billing easier and yes, getting you paid. Visit the Product Blog for more information on our products.

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