Medical Practice Profitability: “You Never Get a Second Chance to Make a First Impression.”

Betsy Nicoletti, M.S., CPC July 29th, 2011

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Editor’s Note: “Getting paid” involves multiple steps, of course, and one of the first steps is getting patients in the door. And then keeping them as loyal “customers” of your practice. This article from expert Betsy Nicoletti outlines some key considerations for getting paid before you ever touch your medical billing software.

Medical office profitability, medical practice management 

“I was at the Internal Medicine practice the other day, and the waiting room was filthy.”  

The patient’s first impression of a physician office is rarely the physician.  Rather, the first impression is formed long before patient and physician are in the exam room.  The patient has already interacted with two, three or four staff members, knows how easy or difficult it is to talk with anyone by phone, and can see for themselves if the office is dirty, clean, chaotic or professional.  The patient’s perception of the physician comes after that.

Phone system:  Automated attendants, mailboxes, never-ending loops all give one impression: we are too busy to talk with you.  Our work is more important than you, even if the recording says, “Your call is important to us.”  Look at the busiest phone times, and have staff available to answer the phone during those hours.  If patients can’t talk to someone, how can they make an appointment to be seen?  Try calling in on the front line to see how long it takes to reach a staff member.

Check-in:  “If the red light is on, the receptionist is talking on the phone.”  This is how one practice tells waiting patients why the receptionist is not checking them in.  The receptionist is talking on the phone, and that’s more important than talking to you.  It is time to get the receptionist off the phone, greeting the patient.  

The décor: signs on plexiglass:  Some practices took advantage of privacy regulations to put up plexi-glass barriers between check-in and the patient.  Certainly, it makes the check-in process more private, if less personal.  But, as if that wasn’t enough, too many practices tape notice after notice on the glass. “Don’t call us between noon and one.”  “Don’t expect us to renew your prescriptions on a Friday.”  It is reminiscent of the Wizard of Oz: “Go home, Dorothy.”  Imagine a welcoming environment.  The plexi-glass is clean, clear and without anything taped to it.  Policies are written in a patient handout.  Important notices are framed.  Signs about co-pays and referrals can be purchased from a vendor.  The language is positive.  “Please give us 24 hours notice for prescription refills,” rather than “We don’t fill prescriptions on a Friday.”

Dirty, dingy, dusty:  The carpets, the walls, the chairs: are they clean or stained?  Do you want to sit down?  Are the chairs comfortable?  There is no excuse for a dirty reception area.  The exam rooms, hallways, bathrooms and every publically viewed area must be eat-off-the-floor clean.   Take a fresh look at the appearance of the office, particularly if the building is old.  To attract patients who care about their healthcare, the office should care about its appearance.  New paint, new carpets, fresh waiting room furniture and most importantly, cleaning staff that comes frequently enough to maintain an absolutely clean facility.

Chaos through the glass:  Employees like to personalize their work areas.  Everyone has a different idea about how to organize paper work for the next day and current work.  But, a practice must have standards about the visual appearance of work areas that can be seen by patients.  Employees should put away stacks of papers and notes that are not being used.  Better yet, create electronic files.  Sticky notes on computer screens should be outlawed.  Hire an electrician to organize cables and wiring.  The physical space should give the impression of organization and professionalism.

“Did you see her outfit?”:  A professional office has a professional dress code.  This includes standards regarding footwear, skirt length, tightness of pants, denim, visible tattoos, and jewelry.  Everyone in the office represents the practice.  Patients see staff members before seeing the doctor, and each one should represent the practice as professional, caring and up-to-date.  Find a dress policy and institute it in the practice.

As the saying goes, you never get a second chance to make a first impression.  In the case of physician practices, the patient receives multiple impressions before meeting the doctor.   Work to make those impressions good ones.

Betsy Nicoletti is the founder of, a wiki for physician reimbursement.  She is a nationally known speaker and consultant, and can be reached at You can hear Betsy in a recent webinar sponsored by Kareo on What You Can Do to Prepare for Medicare Payment Reductions.

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Complimentary Medical Billing Webinar: Everything You Need to Know About Maximizing Patient Collections

Kathy McCoy, MBA July 27th, 2011

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Thursday, August 25, 2011
10:00 AM PDT / 1:00 PM EDT

Expert Elizabeth Woodcock will review everything you need to know to maximize the patient collections in your medical practice

In the era of consumer-directed health care, more financial responsibility is in the hands of the patient — and it’s up to you to collect from them.  Industry research reveals that more than 80 percent of self-pay bills are never collected, and more than 50 percent of patient responsibility after insurance ends up as bad debt as well.

Join speaker Elizabeth Woodcock for this webinar to prevent bad debt from sinking your practice into real debt.  Learn everything your practice needs to know to maximize your patient collections performance. By learning from “best practice” trends and real-world examples, improve your bottom line. Discover how pre-visit processes can improve collections and how to structure them, how to improve time of service collections and eliminate billing altogether, tips for improving patient collections after the service is complete, and advice for holding your collection agency accountable.

You will learn how to:

• Recognize how pre-visit processes can improve collections – and customer service — and how to structure them
Increase time of service collections and eliminate billing altogether
Improve patient collections after the service is provided
Hold your collection agency accountable and improve your results
• And much more

Register now to learn how to maximize patient collections in your medical practice

Question-and-Answer Session — Ask your tough questions and get answers to your current concerns about how to maximize patient collections in your medical practice.

Download the handout for the Everything You Need to Know About Maximizing Patient Collections webinar now.

Who Should Attend
Private practice owners, office managers, billing managers, billers, billing service owners and others concerned about improving the profitability of medical practices.

CEU Credit
"Everything You Need to Know About Maximizing Patient Collections" meets the criteria of the Professional Association of Health Care Office Management and is approved for 1 CEU(s).“Everything You Need to Know About Maximizing Patient Collections” meets the criteria of the Professional Association of Health Care Office Management and is approved for 1 CEU(s).

About Your Speaker
Elizabeth W. Woodcock, MBA, FACMPE, CPC
Expert Elizabeth Woodcock has consulted for hundreds of practices and will outline best practices for patient collectionsElizabeth Woodcock is a speaker, trainer and author who is passionately dedicated to helping physician practices achieve and sustain patient satisfaction, practice efficiency, and profitability. An expert at practice operations and revenue cycle management, she is nationally recognized for her outstanding presentations and writings aimed at improving the business of medicine. Her education and expertise, combined with her humor and an engaging delivery, make her popular with physicians and administrators alike.

Register now to learn how to maximize patient collections in your medical practice

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How to Grow Your Medical Billing Service Through World-Class Customer Service – Tips from the Experts, Part I

Kathy McCoy, MBA July 26th, 2011

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Learn how to grow your medical billing service in this informative webinar

Every entrepreneur knows that generating new business means the difference between a company that is vulnerable to even minor shifts in its customer base and an enterprise that can survive–and even thrive–in turbulent times. What are the secrets that make some medical billing services grow consistently, even in a down economy?

In a fast-paced and insightful webinar entitled How to Grow Your Billing Service Through World-Class Customer Service, three sales-savvy professionals share their thoughts for winning new clients and keeping the ones that you have. In a three-part blog series, we’ll be touching on the salient points from each presenter. Kareo often sponsors informative webinars such as this one to help current and prospective clients learn about successful strategies for growing and managing their medical billing service. View the webinar now.

Our first speaker, Paul Bernard of Broadleaf Health in Woodland Hills, CA, discussed The Importance of Excellent Customer Service to Sales/Growth. Paul stressed one simple truth: Doctors trust and refer to other doctors. To make that axiom work for Broadleaf Health, Paul empowers his employees to excel during Moments of Truth (MoT) with clients that leave them not just satisfied—but delighted. He defines a MoT as anytime a provider comes in contact with any part of your company and uses that contact to form a broader opinion of your business—good, bad, or indifferent. MoT opportunities should be viewed from the client perspective, not yours. Successfully managing MoTs so that clients walk away delighted is what turns clients into promoters of your business—and motivates them to refer new customers to you. Here’s an example of this concept at work:

Dr. Data calls and asks for a report showing a specific set of metrics. A typical response would be, “Sure, I’ll run that and get it right over to you.” According to Paul, this is a golden opportunity to wow the client. Paul suggests that a better response would be “Sure, Dr. Data, but let me help you by comparing that data to Y and doing a deeper analysis.” This response greatly increases the chances of delighting the client.

Paul shares other valuable tips as well, but feels there is one guiding principle that successful billing entrepreneurs should keep in mind: Never lose the perspective that your clients have put their trust in you. You have been entrusted with managing their income and the livelihoods of everyone who works in the practice. Cultivating and reinforcing that trust through MoTs is what ultimately will win you word of mouth referrals from current clients.

Check back shortly for tips from our other speakers on How to Grow Your Billing Service Through World-Class Customer Service.

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Top Three Ways To Improve Your Medical Billing: Tip #2 – Review Your Billing Process Strategically

Kathy McCoy, MBA July 25th, 2011

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With all the talk about “best practices” in health care, it is puzzling that so many of our in-office processes for documenting that care are antiquated or inefficient. That can certainly be true in the medical billing process, which calls for precision but often gets bogged down under the weight of so many details.

Elizabeth Woodcock, MBA, FACMPE, CPC, makes that point in her recent video for Kareo, Top Three Ways To Improve Your Medical Billing. Elizabeth is a leading expert and author on medical practice management and medical billing. Kareo periodically sponsors webinars featuring Elizabeth and her common-sense strategies for improving your cash flow and reimbursement, along with other experts.

We recently blogged about Tip # 1 from her informative Top Three Ways to Improve Your Medical Billing video. But her second tip from this video is equally important: Review your billing process strategically with an eye toward finding ways to improve the process. Elizabeth says it is important to sit down with each employee to determine which part they play in the medical billing process. From the initial phone call where insurance information is collected from the patient through the submittal of claims, there may be redundancies or inefficiencies that are losing you money. She gives an excellent example of how in one office, the authorization number is collected by one person and put into Excel, then printed off for another staffer to manually enter the number on another form that is then used by the data entry employee. With so many people handling this one number, the chances for an error occurring are threefold! And as you know, one wrong digit can result in a claims denial.

Starting a dialogue with staff members about the process can help reveal ways to make everyone more efficient and your medical billing as streamlined and airtight as possible. To hear Elizabeth’s excellent case for doing the due diligence necessary, watch the video below now.

You can also join Elizabeth on our informative webinar for August, Everything You Need to Know About Maximizing Patient Collections. Register now to insure you don’t miss this useful session!

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Medical Billing Software Update: CMS to Host ICD-10 Implementation Strategies for Physicians National Provider Call

Kathy McCoy, MBA July 22nd, 2011

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CMS will hold a call to help physician practices prepare for the ICD-10 transition in medical billing

 Wednesday, August 03, 2011
1:00 PM – 3:00 PM Eastern Time/10:00 AM – 12:00 PM Pacific Time

Register now

The Centers for Medicare & Medicaid Services (CMS) will host a national provider call on “ICD-10 Implementation Strategies for Physicians.” Is your office preparing for a smooth transition to ICD-10 on October 1, 2013? CMS subject matter experts will discuss ways that physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding. A question and answer session will follow the presentations.

Target Audience: Medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare fee-for-service (FFS) providers

Registration will close at 1:00 PM ET on Tuesday, August 2, 2011, or when available space has been filled.

Subject: ICD-10 Implementation Strategies for Physicians National Provider Call


  • ICD-10 requirements and resources overview
  • Implementation strategies for physician offices
  • Update on coverage conversion activities
  • National ICD-10 implementation issues
  • Update on bill processing, including claims that span the implementation date
  • Update on Home Health Agency Home Health Resource Grouper

Presentation: A presentation will be available on the CMS Sponsored ICD-10 Teleconferences web page at before the call.

Continuing Education Credits Continuing education credits may be awarded by the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) for participation in CMS National Provider Conference Calls. If you plan to request continuing education credit from your professional organization and if this organization requires proof of registration, you will ersonally need to register so that you receive a confirmatory e-mail.

Register now

We’ll be listening in – hope you’ll join us!

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Miss Our Webinar on How to Grow Your Medical Billing Service? Watch It Now!

Kathy McCoy, MBA July 20th, 2011

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Get tips from the experts on in our How to Grow Your Billing Service webinar

Thanks to Paul Bernard of Broadleaf Health and Jim Sholeff of ECCOHealth, who were our guest speakers in our webinar yesterday on “How to Grow Your Billing Service: Sales Strategies Based on World-Class Customer Service.” They both offered excellent tips on selling your billing services, including:

  • Understanding and cultivating “Promoters” of your business
  • Learning to identify and make the most of “Moments of Truth” for your customers
  • Take full advantage of your software to improve customer satisfaction and perception, and include technology in your sales presentation
  • Become an expert in the technology you use
  • How to prep for a sales call and identify the type of prospect you are pitching
  • And much more

Watch the webinar now and learn tips from the experts for growing your medical billing service.

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Ramping Up For ICD-10 Coding In Your Medical Billing – Part 2: GEMS and More

Kathy McCoy, MBA July 14th, 2011

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Learn how to prepare for a smooth transition to ICD-10 in your medical billing in this complimentary recorded webinarThere are a lot of rumors flying around the medical billing industry about the transition to ICD-10 codes and what it will mean for providers, payers and associated vendors. If you’ve heard the number of codes in ICD-10 far outnumber those in ICD-9, it’s true. The ICD-10 manual lists 68,000 codes, versus the 13,000 codes represented in ICD-9. If you’ve heard ICD-10 codes are different than ICD-9—well, that’s true too, although the structure is similar. ICD-10 codes have up to seven digits, in part because they are more detailed and include information on the type of encounter and laterality of the condition. That’s a real departure from the three- to five-digit codes we’ve been using for the last 34 years.

In order to present a “reality check” on the transition to ICD-10, noted coding authority Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT, recently conducted an informative webinar on this life-changing transformation on behalf of Kareo. Nancy is the author of the Nancy Maguire GPS to ICD-10-CM Planning and Implementation Guide, and is a nationally-renowned procedural and diagnostic coding instructor, boot camp trainer, and workshop leader.  Kareo periodically sponsors webinars featuring Nancy and other experts discussing strategies for improving your cash flow through accurate coding and medical billing. The level of interest in her webinar, Preparing for ICD-10-CM: The Nitty-Gritty of Diagnosis Coding, was keen. More than 400 professionals logged on for the event!

Our last blog touched on some of the major differences between ICD-9 and ICD-10 codes and the manuals that explain them. (You can check out our last blog on this subject in the archives below.) Nancy’s presentation also included important information on getting ICD-10 implemented in your practice. First off, anyone who bills for medical care will need to transition to transaction code set 5010 from the current 4010. This should already be in process, according to Nancy, since the compliance date for submitting all claims using 5010 is January 1, 2012. Nancy presented other key implementation guidelines and tips as well.

One important tool that practices will want to tap–after familiarizing themselves with ICD-10 codes–are General Equivalence Mappings, or GEMs. Using GEMs, you can crosswalk your current ICD-9 codes to ICD-10 codes and see the differences in coding structure, documentation needs, education and training. To jumpstart the process, run a report on the diagnosis codes billed 80% of the time in your practice. This will help you hone in on the most common codes you will be using after the transition so you can start getting familiar with them.

Comparing the differences in the codes will also give you a better idea of the scope of changes that will require your attention in both your medical billing and in-office processes overall. These may include changes to clinical documentation, encounter forms, and quality and public health reporting. The business office of a practice or facility must identify potential changes to work flow and business processes. Pre-authorizations and treatment plans may require additional diagnosis documentation to specify the detail of the patient’s condition(s). Superbills may need a face-lift. Assess whether the documentation currently in your medical records system will support the level of specificity necessary for ICD-10-CM.

Transitioning to ICD-10 diagnosis codes will be like learning a new language. And it is not optional.  Providers will need to be using ICD-10 coding for medical billing on claims based on dates of service from October 1, 2013 going forward–or they will not get paid.

Remember, October 1, 2013 will be here sooner than you think. To get started, listen to Nancy’s educational webinar on ICD-10 Diagnosis Coding.

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Time-of-Service Collections: Seven Strategies for Success

Elizabeth W. Woodcock, MBA, FACMPE, CPC July 11th, 2011

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Seven Strategies for Success with Time-of-Service Collections in the Medical Office
Today, patients are responsible for much larger portions of their medical bills. Copayments are on the rise, as are coinsurance and deductibles. It’s not a stretch to say that patients’ financial responsibility is the largest it’s been since medical insurance came onto the scene in the mid-20th Century.

If you’re relying solely on your business office to respond to this trend, you won’t be successful. Your patients are your worst payers – and asking them for money long after the fact will only result in higher postage costs and ballooning accounts receivable. Engaging your front office to perform time-of-service collections is essential for financial success.

It’s an opportune time to execute these seven strategies used by medical practices that are successfully dealing with today’s reimbursement environment.

  1. Set expectations. Develop a financial policy to distribute to patients when they arrive; make it available on your website, too. Hang tasteful but clear signage in the front office. Don’t beat around the bush by printing signs that say, “Our Practice Expects You to Pay Your Copayment.” Instead, be direct with signs that read, “Your Insurance Company Requires You to Pay Your Copayment.” Send the message professionally, but make it clear that you expect to receive payment at the time of service.
  2. Know how to ask. There is an art to collections, and a large part is knowing how to ask for money. Instruct your staff to stop asking patients, “Would you like to pay?” Replace that request with “How would you like to pay today?” As they ask for payment, staff must make eye contact with the patient (or guarantor) and use his/her name during the conversation. Writing out the receipt while asking the question is a great tactic because it sends the message to patients that your practice expects payment.
  3. Accept all forms of payment. Allow patients to pay by cash, debit or credit card. Personal checks could be an option, but consider using a check verification service if you encounter bad checks – those with insufficient funds. Look at the commission rates on credit card services to make sure you get the best deal possible from card merchants. Don’t hesitate to steer your patients to a particular form of payment. For example, you might get a better rate when patients use debit cards for amounts under $20, but a more favorable rate when patients use credit cards for amounts over $20. Of course, you should not hesitate to accept any form of payment, but it doesn’t hurt to request a particular type of payment depending on which is more advantageous to you. Most patients won’t care one way or another because it is you, not they, who sees the commission going to the card processing company.
  4. Consider pre-authorized credit cards. Pre-authorized cards allow you to accept pre-payments via credit card without encountering the hassle and danger of storing the patient’s credit card information. These systems capture and store credit card information for you to use later when the claim has been adjudicated. These systems also allow you to set up payment plans securely and seamlessly.
  5. Determine what to ask for. If you have a contract with an insurance company, review it to determine whether you can request the payment of the coinsurance and unmet deductible at the time of service – most likely you can. Despite the well-entrenched urban myth that circulates in the medical practice industry, most insurers do allow you to collect the patient’s coinsurance and unmet deductible at the time of service. Once you’ve identified any exceptions, ask for patient for these payments at the time of service. For coinsurance and unmet deductibles, you’ll need to know what services the patient is receiving (because allowances are based on CPT® codes). Thus, you’ll need to perform this collection activity as patients check out of your practice. Some insurers offer a web-based look-up tool to locate the correct rate. There also are software vendors specializing in contract management that can deliver this information to your staff. Alternatively, develop a spreadsheet that lists your top CPT® codes and the corresponding allowances for each code by each of your major payers. Train your check-out staff to look up the codes on this spreadsheet.
  6. Collect a deposit from the uninsured. For patients who do not carry insurance, request a minimum deposit. Set the “deposit” as your full charge, a reduced flat rate, or an average of the copayment that would be expected of your commercially insured patients. You may choose to collect different deposit amounts from new patients versus established patients (typically, deposits required of new patients are higher because there is no relationship or history with your practice), but be consistent within the categories. For patients who can’t afford to pay, offer a financial hardship policy that grants discounts based on the level of hardship. The key to making this work is to take a consistent approach to charging deposits – and have a written hardship policy that you follow consistently.
  7. Don’t forget the balance. Time-of-service collections include the amount owed for that particular visit – and that which is outstanding from a prior encounter. Don’t hold yourself to collecting past-due balances – ask for all balances, regardless of age. Print a statement for all patients at check out that reflects any payments they have made as well as the balance due. Giving these statements to patients at check-out is not only free (other than the cost of the paper), but it reinforces to them your expectations of getting paid. It also eliminates the excuse patients so often give to your business office: “I never received a statement.”

These days, more insured patients owe higher deductibles, copayments and coinsurance amounts. You can no longer afford to let these patients walk out the door of your practice without paying. Administrative costs and low collection rates make after-the-fact collections a losing proposition for most medical practices. Update your practice’s operations and financial policies and look for other ways to improve the revenue cycle in your practice so that you collect 100 percent of patient time-of-service payments due every day.

Elizabeth Woodcock teaches you the seven steps for improved time-of-service collections in your medical practiceElizabeth Woodcock, MBA, FACMPE, CPC, is an expert, author, speaker and trainer in practice management operations and revenue cycle management whose clients include Kareo medical billing software. She is a co-author of “The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid.” Watch a video by Elizabeth on the Top 3 Ways to Improve Your Medical Billing.

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From Mad to Glad: Talking with Clinicians about Coding

Betsy Nicoletti, M.S., CPC July 11th, 2011

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Learn how to talk with clinicians to improve the medical coding process

Too many coding meetings with physicians end badly: the physician is frustrated and annoyed, the coder worried and angry. The result is that too little information is exchanged. It’s understandable; physicians want to practice medicine and are not always interested in the intricacies of Medicare and payer rules. The coder wants to protect the practice and submit a claim that complies with coding and reimbursement policies. How can these meetings be productive and positive? Here are my best strategies to go from mad to glad when talking about coding:

    Let the physician talk first: Always listen to the doctor first. “Dr. Abbott, thank you for making time to meet with me. Before I start on my agenda, which includes review of the global surgical package, E/M services and use of modifier 25, are there any coding issues you’d like to discuss first? I want to make sure your questions are answered in the hour we have together.” Many clinicians have a burning issue to discuss right off the bat. This approach tells them that their agenda is paramount. Sometimes, the clinician wants to vent their frustration at the reimbursement system. Don’t respond defensively or personally, and acknowledge the frustration. If the physician has no questions or issues, another good start question is “Can you tell me about your practice, and the kind of patients you treat?” Not all practices are alike, even within the same specialty group. It’s important not to lose control of the meeting, but answering the physician’s questions first will make the physician more receptive to the organization’s agenda for the meeting.
    Bring specialty-specific information and examples: Each physician specialty has a different list of most frequently billed CPT and ICD-9 codes. Most physician specialties bill for Evaluation and Management codes, but the procedures and other services performed vary widely. Bring that specialty information to the meeting. “One agenda fits all” doesn’t work. The physician’s own specialty society is the best source of accurate, specific coding information. Using the specialty society as a resource is the most credible for the physician. Nothing alienates a specialist more than primary care coding examples, and the reverse is equally true.
    Start with the good news: When discussing the audit results, start with the good news. Review the codes that were audited as correct and accurate, and move from there to examples of coding disagreement. If there are two services, one of which was coded as “Agree” and one coded at a different level than selected by the physician, show them next to each other, lead on a positive note. Sometimes, it is effective to start with the low level codes in the sample, and move up to the higher-level codes. Group the feedback into categories: reviewing all new patients, for example, and then reviewing the established patients. This allows the coder to concentrate their comments about a particular category of code or use of modifiers. If there are coding changes or new codes to review, starting with those is a good tactic.
    Avoid percentage error rates for the first audit: Physicians didn’t get to the top of their classes in biology, chemistry and math, didn’t get high scores on their Medical College Admission Tests (MCATs) in order to be told they are failures. “Doctor, you may be smart, but I’ve rated you at 30%.” I’d be mad too. Large organizations often establish a passing threshold or accuracy rate. While this is importance for compliance, concentrate on education for the first audit, and calculate error rates later.
    Use source citations: When the coder and the physician cannot agree on correct coding, here are a few statements to avoid making:
    “I don’t look good in orange.”
    “I went to a seminar, and the consultant said….”
    And, “I called my friend in another OB office, and she said…”
    Look for source documentation to answer coding questions. For strictly coding questions, the source is the CPT book, the CPT Assistant and the CPT Insiders View, Changes, published each year. For Medicare, look on the Medicare Administrative Contractor’s website or CMS’s website. Reimbursement policies by payer are often answered in their on line policy manuals. Specialty specific questions can often be answered by the physician’s specialty society. Many societies allow physician members 3-5 free coding questions per year. Carefully draft the question, and ask the physician to submit it to their society.
    Admit mistakes: Sometimes, in reviewing a note with the physician, I find that I was wrong about a note. When that happens, apologize briefly and without embarrassment, and amend the report.
    Don’t take criticism about the coding system personally: Although I avoid saying, “Hey, I didn’t make these rules,” or “Don’t shoot me, I’m only the messenger,” reasonable physicians know this. Some are very frustrated and unhappy with the state of medicine or their employment. If they express that forcefully in a meeting, I never take it personally. Then, there’s a good chance the meeting will recover, get on track and end in a productive exchange of information.

Betsy Nicoletti provides tips on how to talk to clinicians about medical codingBetsy Nicoletti, M.S., CPC, is the founder of, a wiki for physician reimbursement. She is a nationally known speaker and consultant, and can be reached at You can hear Betsy live in a complimentary webinar presented by Kareo on July 26 on “What You Can Do to Prepare for Medicare Payment Reductions.”

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Best Practices: The Financial Mindset – Improving Operations and Profitability

Judy Capko July 11th, 2011

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Keeping staff productive, managing the day and caring for patients clearly takes center stage for most medical practices. This can make it difficult for physicians and managers to dedicate enough time to studying the financial side of running a business – and a medical practice is a business. The Financial Mindset offers key essentials to stay on top of the practice’s financial performance and improving profitability.

Step I: Capturing Charges
Capturing the most revenue for what you do starts with having insurance contracts that pay a reasonable rate for the services you provide.

Evaluate payer performance based on the insurance plans that account for the highest volume of revenue to the practice. Examine and compare their reimbursement rates for the top CPT codes utilized in the practice. This will identify under-performing contracts that compromise practice profits.

Other factors in evaluating payer performance include:

  1. The level of cooperation and support the plan’s provider relations department gives;
  2. How promptly claims are adjudicated;
  3. The number of errors in paying claims; and
  4. The number of denials that require the practice to fight for its money.

Next, establish procedures and ensure all charges are captured through accurate and timely documentation and coding for services, both CPT and ICD-9. Monitor time lag for reporting charges for both office and hospital care. Inputting data within 24 hours of providing the service reduces the potential for failing to report a service and will help to get you paid without delay, often within 10-15 days of clean claims submission.

Step II: Revenue Recovery

Collecting patient payment at time of service expedites payment and reduces the cost to chase the money down the road. It is also the best time to collect on old balances. Don’t ask the patient if she wants to pay the balance, simply say “Mrs. Nice, you have a $360 balance on your account. Would you like to pay that by check or credit card today?” If there is resistance, suggest she give credit card approval and offer to delay submitting the charge for a week or ten days to help her out. If she seems uncooperative, your financial department can talk with her and work out an agreement before she leaves the office.

Since you will be sending some patient statements, it’s important to scrutinize your patient statement form. Does it make sense? Can the patient determine what portion is pending insurance payment and what you expect of him? Also, send statements throughout the month to keep the cash flowing rather than sending them all out at the end of the month. This also smoothes out the workflow for incoming telephone queries from patients about their statement.

Optimizing reimbursement from third party payers requires a dedicated and knowledgeable employee. Do you have a resident insurance expert who can identify when a claim has not been paid or payment is incorrect?

The biggest portion of the accounts receivable is owed by insurance plans, so closely monitor unpaid claims, pursue inappropriately denied claims and analyze claims payment by scrutinizing the explanation of benefits when payment is made. Insurance companies bank on medical practices not taking the time to analyze claims reimbursement and appeal incorrect payments or denials. According to Health Business Advisors, 30% of insurance claims are denied and of those 15% are never resubmitted! According to Medicare, 65% % of claims denied are paid on appeal. So be diligent in going after these payments.

Do you have consistent collection processes? If more than 15% is 120 days aged or more, you need to investigate the reasons why. If adjustments spike out of norm it is a red flag that needs explaining. You may have one payer that has become delinquent in paying claims or perhaps staff just isn’t making those patient collection calls. Once the cause is identified appropriate action can be taken. Remember, the longer a balance is on the books the less chance you have of getting paid.

Step III. Profitability

The final step in the Financial Mindset is managing costs and improving profitability. This requires operational efficiency: providing proper training and job tools to minimize redundancy and duplication. Technology is the practice’s best friend when it comes to improving efficiency. Adding more sophisticated practice management software and making the website more patient-interactive through use of a patient portal pays big dividends.

Benchmark practice expenses by comparing them against the national average for your specialty. If some expenses are high, start digging deeper. The most common culprits or rising expenses include:

  • Overtime pay: Not only will you be paying time and half for the employee, but you are paying it at the end of the day when they are likely to be less productive.
  • Medical supplies: Keep close tabs on both medical and office supplies and do some comparative shopping to make sure the practice is getting the best prices. There are also co-op buying services that can negotiate on behalf of more physicians and because they represent a higher volume they are likely to get better cost reductions.
  • Health insurance: They keep going up and become a challenge for the average medical practice. You want to provide competitive benefits, but many practices are finding it necessary to obtain higher deductible policies and ask the employee to pay a reasonable share of the premium.
  • Rent: Rent remains consistent when you have a lease or even a loan if you own the facility. Just the same, it is important to use the space wisely. For example, it is better to have one more exam room and use an outside storage service for medical records that to have inactive records occupying valuable space. Also, if space is tight consider expanding clinic hours to optimize use of clinic space and provide better patient service in the process.

When a financial mindset guides a practice it is likely to improve finances and help it remain stable during economic downturns that threaten the practice’s financial future.

Judy Capko teaches how to use a financial mindset to improve the profitability of your practice

Judy Capko is a healthcare management and marketing consultant, speaker and author or the best-selling book: Secrets of the Best-Run Practices. She is based in Thousand Oaks, CA, and can be contacted at

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