Four Tips to Speed Up Medical Claims Payments

Lea Chatham May 25th, 2016

Leave a Comment Latest by COMMENTOR NAME

Despite increased out of pocket expenses for patients and practices testing direct pay models, most practices still get at least 65% of their revenue from payers. The process of submitting claims and getting paid has always been fraught with errors. To combat this, most payers now accept—and some mandate—electronic submission. Most practices have had some form of billing software as well. Despite these steps, they still struggle to get paid in a timely manner.

Some of the problem lies with payers, but there are best practices that can help you get paid faster. Your practice management system might already offer some of the tools you need.

By implementing some or all of these suggestions, you can get your practice’s medical claims submitted and paid much faster. Tweet this Kareo story

The goal should be to get claims submitted in three days or less from the time of service and then track them through payment. Ideally, if everything is in order you should be able to achieve average days in A/R of 40 days or less and have a net collection rate of 96%.

  1. Capture charges electronically: You can do this with an EHR or with an electronic charge capture solution. Sending claims to the billing system electronically has many benefits in addition to being faster. By using electronic charge capture, you can also reduce coding errors, help prevent over and under coding, and improve accuracy.
  2. Submit claims the day the superbill is received: By using an electronic superbill, there is less data entry for billing staff. So once the superbill is received it should be much faster and easier to submit.
  3. Scrub all claims: Your billing and practice management system should scrub claims for you before submission to let you know if there are problems. Your clearinghouse will do the same. You can generally fix these problems and resubmit. With these two checkpoints, you should be able to submit a high percentage of clean claims.
  4. Monitor claims after submission: Once your claims have been submitted to your payers, you want to watch for any problems and address them quickly. Your ERAs will provide information about what is paid—or not. But there may also be claims that slip through the cracks. Use a no response trigger to alert you to potential problems with those claims. No response allows you to set parameters for payers. For example, if BC/BS always pays in 21 days or less then set the no response alert to let you know if claims aren’t processed in 22 days. Then, you can follow up to see what the problem is.

The combination of process and technology can help you submit claims sooner and cleaner while also helping you monitor for problems. If your practice management and billing system doesn’t offer the tools to support this process, then it might be time to consider a change.

If you are looking for more places where you can look to improve your medical billing, use this Billing Best Practice Checklist to see industry standards and establish goals.

Read More

Video: Don’t Skimp on New EHR Training

Lea Chatham May 24th, 2016

Leave a Comment Latest by COMMENTOR NAME

Many providers are interested in a mobile ‎EHR but are hesitant to adopt a new solution. The key to EHR success lies in the training. In this short video, EHR expert Dr. Tom Giannulli talks about the importance of training when implementing a new EHR. Tweet this Kareo story

If you are considering a new EHR, download this helpful guide on how to ensure you implement it correctly.

Read More

Get Integrated to Improve Efficiency and Prepare for the Future

Lea Chatham May 19th, 2016

Leave a Comment Latest by COMMENTOR NAME

Download Now

Are you still logging into multiple systems to manage your practice? Or entering patient data more than once? Then you are probably losing time and money that could be more useful somewhere else.

It’s probably time for an upgrade to a single integrated platform, but make sure it is the right solution.

Here are some critical things to consider when choosing or updating your medical practice software: Tweet this Kareo story

  1. Look for complete data integration. There is no reason to enter information into multiple systems.
  2. Choose an end-to-end platform that meets all your practice needs. You need a single patient database and the ability to manage your scheduling, billing, clinical documentation, patient communications, and practice marketing.
  3. Make sure it is right-sized to your practice. There are plenty of things that a hospital or large multi-specialty enterprise needs that a smaller independent practice does not. You don’t have time to wade through the extras to get what you need. Look for a platform designed for practices like yours.

A seamlessly integrated platform can make life easier for everyone in your practice. For several years, the research group Black Book has been asking practice managers and physicians about the potential impact of a platform like this. Their most recent survey confirms that 90% of practice managers believe that an innovative, seamless RCM/PM/EHR system would ensure long-term practice independence, and greatly improve productivity and profitability.

That’s what Josh Bock, DC, Managing Partner at AFC Physical Medicine & Chiropractic Centers, was looking for in a new system. The groups had decided it was time to upgrade at the beginning of 2013 when they found out their billing system wouldn’t be ready for ICD-10. “We wanted to be able to meet any coming changes in the industry,” Dr. Bock says. “We also knew we wanted an integrated practice management, billing, and EHR system.”

They have seen the benefits since they switched. “My expectations have certainly been met, and in some cases, exceeded,” says Dr. Bock. The obvious benefit he says is that they are more efficient and connected across their nine locations. “Kareo has improved efficiency in documenting, scheduling, records requests, and billing,” he adds.

Improving efficiency isn’t the only reason to consider bringing your practice’s software under a single integrated platform. The industry as a whole is moving towards increased interoperability between providers and improved outcomes for patients. More and more reimbursement will be tied to the use of technology, how providers care for patients, and patient experience.

Just having a billing system or using ePrescribing won’t cut it. Practices will need to an end-to-end solution that enables everything from online scheduling to text reminders to patient follow up surveys and credit card on file to claim tracking to electronic statements. They will also need the ability to document visits and engage patients in their care.

Now is the time to make this change before the new programs under MACRA become a reality. Starting in 2017 Medicare payments will be tied to participation in the new Merit Based Incentive Program (MIPS) or Alternate Payment Model (APM). Both require the use of technology to meet the requirements and the both the incentives and the penalties can be steep.

So, if you can’t easily complete tasks and get the data you need from a single system or you are spending a lot of time on manual tasks or re-entering data, it’s time to make a change. Be sure that change is to a fully integrated system, right-sized for your practice.

Choosing the right integrated technology platform for your practice is just one step in ensuring you can stay competitive in today’s healthcare marketplace. For more tips to independent practice success, download 8 Ways to Keep Your Name on the Door.

Read More

5 Best Practices for a Doctor’s Yelp Profile

Lea Chatham May 17th, 2016

Leave a Comment Latest by COMMENTOR NAME

John Sung Kim

Since its inception in 2014, Yelp has grown into a significant consumer force, affecting the purchase decisions of more than 118 million users, globally. When the site first began to get traction, many doctors discounted the site’s reviews, believing that patients would not trust the opinions of other patients for something as important as healthcare.

They were wrong.

Research conducted at both Stanford and Harvard universities indicated that Yelp reviews affected the annual revenue of independent restaurants anywhere from 9% to 12%. While they did not study healthcare businesses alone, such numbers suggest that “Yelpers” do affect the bottom line revenues for healthcare providers in independent practices as well.

As a parallel correlation, recent studies conducted by the technology company Salesforce as well as Nuance Communications showed that a majority of Millennials, Gen X’ers, and even Baby Boomers alike “researched” a doctor by reading reviews online. A high percentage of these consumers interviewed across both studies indicated that reviews, even from anonymous sources, greatly affected purchase behaviors and even convinced patients to switch healthcare providers.

Quite often, independent practice owners are surprised to wake up one morning and find that someone has created a Yelp profile of their business, complete with one or more reviews. Unfortunately, once a Yelp profile for a local business has been created, it is extremely difficult to have Yelp remove this page.

Compounding this issue is the fact that Yelp profiles gain increasing search engine optimization (SEO) properties over time, meaning that this Yelp page may have a tendency to increase its rank in search results (especially in Google) for searches for your name or your practice’s name.

This trend is important for doctors to understand as engineers at Kareo have found (over five years of tracking data on patient-consumers) that the average doctor’s name is Googled anywhere from 20 to over 100 times per month. That means that even existing patients looking for your phone number or fax number will start to read your Yelp reviews and see your Yelp star rating displayed prominently next to your own website’s link.

This underscores the importance of implementing these five best practices to optimize your business profile page so that over the long term Yelp helps–not hurts–your bottom line revenues. Tweet this Kareo story

  1. Claim Your Profile: You can claim your business on Yelp here. Be sure that all of the information they have on your practice is correct, including your phone number, fax number, address, and suite number. In your business description, articulate a message to your patients that shows the level of care your team provides, including any accolades or awards (e.g., Smith Dermatology was awarded “Best of the Bay” by the SF Guardian three years in a row, and our entire staff is trained to provide the highest quality of aesthetic care including advanced laser therapies). Avoid generic statements, and attempt to describe what sets your practice apart, as more detailed descriptions tend to have higher engagement rates with new patients.
  2. Upload Lots of Pictures: The founders of AirBnB, the largest home sharing site in the world, found that listings with pictures did far better than profiles of homes without pictures. In fact, they found that the more professional pictures a home had, the more people were willing to rent them. An increasing amount of independent practices are hiring local photographers to come into the office and shoot the doctors, staff, and location with post production work in PhotoShop to create professional images. Sites such as EverSnap are great places to hire a local photographer on a budget. Remember to pay for an extra hour of post-production, as not all photographers include this work in their initial invoice. The extra money spent here will go a long way in making sure your images are the best they can (technically) be.
  3. Don’t Ask Patients to Review You on Yelp: Understanding how Yelp’s algorithm treats reviews is paramount to mounting an effective social media campaign on this website. Asking friends, family, and even patients in bulk for a positive review after claiming your Yelp page is a sure fire way of having your profile flagged; meaning your positive reviews become “hidden” under an obscure link until the algorithm is satiated that reviews are coming in “organically.” The major problem with this method is that reviews come in spurts, and this makes the algorithm suspicious that someone from your business is soliciting reviews, a practice that Yelp frowns upon. Instead, use marketing automation software to automatically survey patients after an appointment reminder is sent, thereby giving your practice a more steady rhythm of reviews coming into Yelp and other social media review sites.
  4. Use Caution When Responding to Negative Reviews: While it’s acceptable for an office manager to respond to negative or even positive reviews, ensure that the doctor never responds directly as it may have liability ramifications and dilutes the doctor’s brand. If you believe that a negative review is unfair or unfounded, you can Flag the review, and then submit a request to Yelp to have the review removed.
  5. Understand the Review Removal Policy: It’s a good strategy to have the first sentence of your review removal request say something akin to, “This review violates your terms of service,” as that may help ensure that your removal request gets moved to the front of the queue. You can read Yelp’s reviews policy here. It behooves your practice to understand these rules, and then be able to point out to Yelp that the review in question violates one or more of these guidelines.

Remember that Yelp can cut both ways, either increasing or decreasing your annual revenues as a practice. While many doctors do not like this trend and even find it disturbing, current market forces dictate that those doctors who embark on an aggressive reviews strategy will fair far better than those who remain passive.

For more tips to help you manage your online reputation, download this helpful guide

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. 

 

 

Read More

Getting Paid Newsletter Provides Tips on Practice Success and New Payment Models

Lea Chatham May 11th, 2016

Leave a Comment Latest by COMMENTOR NAME

The May Getting Paid Newsletter provides an update on CPC+ along with some tips on independent practice success and streamlining Worker’s Comp claims. Check out recent events you may have missed and what’s coming. Plus, learn about other recent Kareo news. Read all this and more now! Tweet this Kareo story

 

 

Read More

Keep Your Finger on the Pulse of Your Independent Practice for Success

Lea Chatham May 10th, 2016

Leave a Comment Latest by COMMENTOR NAME

Download NowDo you know how your practice compares to your peers? Are you doing as well as possible? There are key performance indicators (KPIs) you can use to ensure that you are doing as well as you could be. And there are ways to track the results of your efforts. To be successful you need to know where you are, where you are going, and how to adapt.

“Knowing your practice means knowing your position in the marketplace by understanding how you fit in and can thrive in your community,” says consultant Cheryl Bisera. “I’ve seen a physician-owner focused only on ways to increase revenue without looking at the data and the community factors. After making drastic changes and purchases in somewhat haphazard efforts to improve cashflow, their position was compromised and money was lost. Some other examples of adopted changes that I have seen not work out when proper ‘homework’ wasn’t done beforehand include the addition of weight-loss programs and products, building an in-house lab, location change, expensive aesthetic equipment purchases and adopting membership fees. It’s crucial to look at the data and understand your practice, your payers’ contracts, your position in your current market, and your community demographics before making major practice changes.”

Keeping your finger on the pulse of your independent practice requires the tools to get you the right data in the right format at the right time. Tweet this Kareo story 

Ideally, you need:

  1. A dashboard that provides easy-to-manage tasks so you can stay on top of getting paid
  2. In-depth reporting tools and billing analytics that show you exactly how you are doing
  3. The ability to access your tasks and reporting from anywhere at anytime

“Today’s practice management systems and EHRs make it easier than ever before to track key practice metrics,” says Laurie Morgan, MBA, Senior Consultant and Partner at Capko & Morgan. “But you have to keep the old adage about “garbage in, garbage out” in mind. The reports are only as good as your data capture. One example of a lost opportunity to be able to easily do analysis is uploading scans instead of entering info in a structured format. Another is not entering fee schedules from payers. It’s a bit tedious to do, but once it’s done, it becomes much easier to keep an eye on, and evaluate, your payers.”

Once you know where you are you can set goals to improve. Here are some industry standard best practices you can shoot for:

  1. Less than three days from time of service to claim submission
  2. Average days in A/R less than 40
  3. 85-90% of claims paid in 45 days or less
  4. No more than 15% of A/R over 120 days
  5. Total unpaid claims less than 4%
  6. Denial rate of 4% or less
  7. Net collection rate of 96% or better

By improving the overall efficiency in your practice through automation and mobility, you get to know the true health of your practice. Then, you can work to achieve metrics like these.

If you are looking to get started and do a better job at knowing your practice, ask yourself some initial questions:

  1. Do you know your basic KPIs like days in A/R and denial rate and where to find them? If not, ask your vendor to point you to the right reports. Ideally, your software should offer some standard reports and even a dashboard of key indicators for easy access. Run reports to show your current baseline for the metrics above. Set realistic goals. If your denial rate is 10%, you probably won’t get it down to 4% or less in a month or two. Try six months to a year and create a path to get there.
  2. Are you getting your claims submitted fast enough? It shouldn’t be hard to find out how long it takes to submit claims from the time of service. Again, once you know, set realistic goals to get to three days or less. The best case is getting them in the same day. Your software may have tools that can help. For example, if the delay is because you don’t use an EHR, find out if there is an alternative way to electronically capture charges and speed time to submission.
  3. Are you collecting everything you are owed? As Laurie Morgan mentioned above, it is important to keep fee schedules up to date and review your contracts. Use electronic remittance advice to process insurance payments to help ensure accuracy and catch problems with claim payments. Knowing your payers helps you decide who to stick with and whether or not to cut loose if something isn’t working out.
  4. How are you doing with patient collections? Patient collections now makes up about one-third of your revenue. Are you collecting all you could be? Are you spending too much time collecting after the appointment when you could be doing more a check in? Start with a solid patient financial policy and lay out exactly what is expected from patients. Share it with patients and train your staff. You can even try role playing to help them get more comfortable asking for payments up front.

These are just some of the important questions you need ask yourself about how well you know the state of your practice. And the suggestions here are just a starting point. For more tips to independent practice success, download 8 Ways to Keep Your Name on the Door.

Read More

Understanding New CPC+ Model from CMS

Lea Chatham May 9th, 2016

Leave a Comment Latest by COMMENTOR NAME

By Adria Schmedthorst

The Center for Medicare and Medicaid Services (CMS) just released their newest initiative aimed at improving primary care. The Comprehensive Primary Care Plus (CPC+) payment model is a five year program that will begin in January 2017. Tweet this Kareo story 

Initial implementation will involve up to 20 regions and 5,000 practices, affecting over 20,000 providers along with their 25 million patients.

Set up as a partnership between CMS and commercial payers, as well as state and federal plans, CPC+ will rely on interest from private payers to determine where to launch. CMS will begin taking payer proposals for partnering in the program later this month. In July, they will announce the regions where the model will have its start based on payer interest. If your primary care practice is affiliated with a payer in one of the selected regions, this new payment model could affect you.

With CPC+, providers will be paid a monthly fee to manage patient care. The goal of the program is to allow greater flexibility in how practices deliver care, emphasizing improvements in quality rather than cost reduction.

Providers in selected regions can participate in 2 ways:

Track 1: Doctors and clinicians choosing this track will receive a monthly care management fee for specific services in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for Care. CMS will initially pay providers $15 per beneficiary per month for care management under Track 1.

Track 2: Under this track, providers will receive payment for monthly care management but instead of the full Medicare fee-for-service payments for evaluation and management services, they will receive reduced Medicare fee-for-service payments on top of an up-front, bundled comprehensive primary care payment. This hybrid payment model will initially pay an average monthly care management fee of $28 per beneficiary per month.

The benefit of Track 2 is that it will provide more flexibility for providers to deliver care outside of the traditional face-to-face encounter. More time can be spent on complex cases and sicker patients with in-office visits while providers can explore telemedicine options for managing care in patients who are healthier.

Providers on both tracks will be eligible to receive up-front incentive payments but could face repayment of these incentives if they do not meet quality and utilization goals.

To be eligible for the incentives offered by participating in CPC+, practices must meet five requirements:

  1.  Make care accessible 24/7 through enhanced in-person, telephone, and electronic access.
  2. Provide proactive care to patients at the highest risk.
  3. Provide comprehensive and preventative care and coordinate with specialists across the healthcare system.
  4. Make care patient-centric and engage patients and their families.
  5. Measure quality and utilization of services and use the data to identify opportunities for improvement.

As the latest initiative by CMS designed to improve the quality of care, CPC+ is still facing some uncertainty. The program may qualify as an alternative payment model (APM) beginning in 2019. If so, participating in CPC+ would grant practices an exemption from CMS’s Merit-based Incentive Payments System (MIPS). However, with no guidance yet from CMS as to what requirements APMs must meet, that is yet to be determined. Either way, the outlook for private practices under the new model is hopeful with CPC+ placing emphasis on improvements of care, which providers have more control over, rather than cost-cutting measures.

About the Author

Adria Schmedthorst is a writer focusing on the medical device, technology, software, and healthcare industries. Adria is the founder of AMS Copy and a healthcare professional herself with more than 10 years in practice. She now uses her knowledge of the industry to help companies achieve their goals of writing content that speaks to the hearts and minds of medical professionals. She has been featured in blogs, written articles, and other publications for the industry, and ghostwritten books for doctors in both the United States and Australia.

 

 

Read More

SEO Basics for Doctors: Keywords

Lea Chatham May 3rd, 2016

Leave a Comment Latest by COMMENTOR NAME

Is your website properly optimized for Google? After your title tags, your keywords are the second most important component of SEO. Learn how to use keywords on your medical practice from SEO expert John Kim in this short video.Tweet this Kareo story

Looking for more ways to have the best website to attract and retain patients? Download this helpful guide.

Read More

How to Raise Your MIPS Score

Lea Chatham April 28th, 2016

Leave a Comment Latest by COMMENTOR NAME

By Adria Schmedthorst

2017 is the first performance year of CMS’s Merit-based Incentive Payment System (MIPS), and now is the time to prepare. Tweet this Kareo story

MIPS replaces existing quality reporting programs in Medicare Part B. It integrates the current Medicare quality and value programs and establishes a combined performance score. Each year, a performance threshold will be set. If your previous year’s average score equals that performance threshold, your Medicare Part B payments will not be affected. However, if you fall below that threshold, you will face a negative payment adjustment. Conversely, high performers can potentially receive significant bonuses.

With the possibility of both increased revenue with a higher MIPS score as well as penalties for falling below the threshold, it is important that you look at 2016 as a rehearsal year for MIPS and do everything you can to improve your score now. So, let’s break down MIPS into its component parts and learn how to raise your score.

Part #1 – Meaningful Use (MU)
For performance year 2017, MU will be 25% of your MIPS score, making it a significant factor in your reimbursement levels. Fortunately, MU is a category that many practices have already been working on. The first step of MU is to successfully attest to demonstrating meaningful use of certified electronic health records (EHRs).

Eligible professionals (EPs) can participate in the Medicare program or Medicaid program. This is the last year to initiate the Medicaid program to access MU incentives. 2014 was the last year to start the Medicare program and receive incentives. For practices that have not attested, penalties on Medicare payments began in 2015 and will increase each year. Since there are increasing penalties and participation impacts your MIPS score, there is value in starting in 2016 and continuing to attest. To learn more about determining eligibility and attesting, visit the Kareo Meaningful Use resource Center.

Part #2 – Physician Quality Reporting System (PQRS) / Value Based Modifier (VBM)
The Physician Quality Reporting System (PQRS) and Value-Based modifier (VBM) Quality portion will account for an additional 50% of your MIPS score for performance year 2017. If you have not been reporting PQRS measures, now is the time to start. You will need to select 2017 PQRS measures and start monitoring.

VBM borrows from the PQRS program to set minimum reporting requirements. To achieve the highest VBM score, you will need to either (1) register and report as a PQRS Group Practice Reporting Option (GPRO) or (2) report at least 50% of the group’s eligible professionals (EPs) for PQRS on an individual basis.

The GPRO method is available to practices with two or more eligible professionals billing Medicare and operating under the same tax identification number (TIN). The benefit of choosing GPRO reporting is that if at least one member of the group has eligible patient visits to report, every member of the group will avoid the penalty for non-reporting. GPRO method reporting is due June 30, so be sure not to miss your deadline if you choose to self-nominate for GPRO.

Part #3 – VBM Cost
A maximum of 10% of your MIPS score will be determined by VBM cost measures. There are no minimum reporting requirements with respect to your VBM cost measures since they are calculated by CMS based on submitted Part B claims.

Part #4 Clinical Practice Improvement
Clinical Practice Improvement (CPI) is the new addition in the quality improvement efforts introduced by CMS with MIPS. It will be 15% of your score for 2017. The best way to improve your MIPS score in this area is to apply for or renew your status as a Patient Centered Medical Home (PCMH). PCMH certified practices automatically receive the full 15 points in this category, making it a great option for improving your overall score.

2016 is the year to prepare for MIPS. A higher MIPS score means higher Medicare Part B payments, potential bonuses for high performers, and increased revenue for your practice. With at least 75% of your first year’s score based on MU and PQRS/VBM measures, adopting a certified EHR and participating in MU and PQRS should be your first steps. Next, consider applying for PCMH status to take advantage of the 15 points it guarantees in the Clinical Practice Improvement category. 90% of your MIPS score is found in these three areas. Focusing on improving these areas will maximize your payout.

About the Author

Adria Schmedthorst is a writer focusing on the medical device, technology, software, and healthcare industries. Adria is the founder of AMS Copy and a healthcare professional herself with more than 10 years in practice. She now uses her knowledge of the industry to help companies achieve their goals of writing content that speaks to the hearts and minds of medical professionals. She has been featured in blogs, written articles, and other publications for the industry, and ghostwritten books for doctors in both the United States and Australia.

Read More

24th Annual AAPC Conference Delves into Coding and Billing Hot Topics

Lea Chatham April 26th, 2016

Leave a Comment Latest by COMMENTOR NAME

HealthCon 2015 logo, brought to you by AAPCBy Lisa A. Eramo

ICD-10, device-generated data, value-based payments, and EHR compliance were just a few of the timely topics discussed during HEALTHCON 2016—the 24th annual conference sponsored by the American Academy of Professional Coders (AAPC). Nearly 2,700 billing and coding professionals attended the event that took place in Orlando earlier this month.

This year’s event drew attendees to a wide variety of sessions, reflecting a larger trend toward expansion of coder skillsets into various aspects of practice management.

During an inspirational general session, Stephanie Cecchini, CHISP, CPC, CEMC, encouraged attendees to take advantage of industry changes by climbing the career ladder to a six-figure income. In particular, she urged coders to follow their passions, commit to lifelong learning and networking, and constantly sell the importance of medical coding to others in the healthcare profession—particularly physicians.

Similarly, other speakers empowered coders to strengthen compliance and mitigate risk for the practices in which they work.

During a presentation about denial management, Yvonne Dailey, CPC, CPB, CPC-I, told coders that 90%-93% of claims rejections are preventable. She encouraged coding and billing staff to “learn the lingo” of denials to ensure that they have carrier-specific edits in place. She also encouraged attendees to track denials, analyze the root cause, and develop corrective action plans.

In addition, Dailey reiterated the importance of a financial policy that clearly explains patient financial responsibility in the event of non-coverage. She reminded attendees that claim submission is a technically a courtesy that practices extend to patients. “Get patients involved ASAP if claims aren’t being paid,” she added.

During a session on policies and procedures, Dailey reminded coders to remain vigilent in terms of denial management and develop policies and procedures that continually evolve as new transmittals and rules are published. “Appoint someone to monitor [this information],” she said. “Don’t wait until you find out on the revenue side that there’s a problem.”

Compliance was also a theme during a session about billing for transitional care management (TCM) and chronic care management (CCM). Speaker Stephen Canon, MD, reminded coders of specific requirements for TCM and CCM and provided strategies for overcoming reporting barriers associated with discharge notifications, scheduling follow-up visits, and meeting all documentation requirements.

ICD-10 compliance was a topic of discussion as well. Vince Kobayashi said unspecified codes continue to challenge coders, although many practices have yet to see an influx of denials. “The problem is documentation. It’s the ‘data in,’” he said.

As the industry continues to progress with ICD-10, Ann Bina, COC, CPC, CPC-I, reminded coders to focus not only on productivity but also quality. During this interactive session, many attendees stated they kept their quality standard at 95% despite the transition to ICD-10. One attendee stated that her quality standard remained at 98%.

In addition to coding and billing compliance, various sessions touched on challenges associated with EHRs. During a panel discussion featuring six healthcare attorneys, several questions pertained to EHRs directly: Tweet this Kareo story

  • How should practices generally handle auto-population in the EHR? Michael D. Miscoe, Esq., CPC, CASCC, CUC, CCPC, CPCO, CPMA, CHCC, said auto-population affects the credibility of the work performed and that practices definitely shouldn’t pull information forward simply to drive an E/M score.
  • Should practices copy and paste all lab results received during the last six months? Timothy P. Blanchard, JD, MHA, FHFMA, urged attendees to consider whether the labs are truly relevant to the current visit or whether this information will simply add to the volume of data in the record without adding any clinical insight.
  • Will auditors begin to ask for an EHR audit trail? Several panels stated that some Medicaid contractors and commercial payers are already asking for this information. They encouraged attendees to work with their EMR vendor to ensure that it can provide this information when requested.

Angela Jordan, CPC, spoke about challenges associated with EHR templates and encouraged coders to serve as front-line support to catch errors related to speech recognition and to validate appropriate diagnosis and service codes, add-on codes, and modifiers.

In looking ahead, speakers touched on new technologies and shifting reimbursement models. Tweet this Kareo story

For example, Scott Klososky urged coders to embrace the effects of technology—particularly mobile technology and wearables—on healthcare. “Wearable data will improve preventive medicine,” he said. “The more data that spins off our mobile devices, the more addicted we’ll become to these data streams.”

As EHRs continue to evolve into continual live databases, he urged attendees to consider the following questions:

  • How must privacy and security models evolve?
  • How might having access to deeper health histories and real-time data affect clinical decisions and workflow?
  • How might mobile/real-time data affect the business side of healthcare? For example, Klososky said subscription-based healthcare plans may offer additional revenue streams for physicians. With these plans, physicians would monitor device-generated data and provide proactive and personalized interventions in exchange for a fee.

Dan Schwebach, MHA, CPPM, said “data, frankly, is becoming the new currency.” He encouraged coders to look ahead at how healthcare will likely evolve over the next two decades to include population health management, greater use of telemedicine and remote monitoring, pricing transparency, consolidation, and competition based on value. As value-based healthcare continues to mature, he reminded attendees that coded data drives risk adjustment as well as outcomes and quality data.

About the Author

LisaEramofreelanceLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

Read More

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.

Subscribe to the Newsletter

Enter your email address to receive "Getting Paid" as a monthly email newsletter. Privacy Policy

Subscribe to RSS Feed

CDW 2015 TOP 50 Health IT Blog

Follow Kareo

Find Kareo on LinkedIn Find Kareo on Facebook Find Kareo on Twitter Find Kareo on YouTube Find Kareo on Flickr

Search the Blog

Categories

Monthly Archives

Web–Based Software by Kareo

Practice Management

Simplify the daily essential tasks of your medical office from patient records, to scheduling and more.

Electronic Medical Records

Improve patient care with electronic charting, electronic prescribing and medical labs interfaces.

Medical Billing & Collections

Streamline your entire medical billing and collections process from charge entry to reporting.

Clearinghouse Services

Integrated electronic claims, electronic remittance advice and insurance eligibility services.

Analytics & Data

Store and access data with insightful reports, document management and faxing, and an integration