ICD-10 Training Camp: A Snapshot of Mental Health Conditions and ICD-10-CM Diagnosis Codes

Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT September 30th, 2011

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 ICD-10 Chapter V: Mental and behavioral disorders is part of the International Classification of Diseases produced by the World Health Organization (WHO). Mental health professionals have long relied on a coding system known as DSM-IV. In the DSM-IV system Psychiatric Diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders, 4th.edition.  The manual is published by the American Psychiatric Association and covers all mental health disorders for children and adults. It also lists known causes of these disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning the optimal treatment approaches.

The coding system used in the DSM-IV is designed to correspond with the codes used in the ICD-10 classification, although not all codes may match at all times because the two publications are not revised synchronously. ICD-10 and DSM-IV diagnoses are comparable for the most relevant points.  The ICD-10-CM diagnosis classification is used to code patient diagnosis with date of service October 1, 2013 and after.

Each chapter of ICD-10 begins with a listing of related code ranges (blocks).  Chapter 5 ICD-10 Blocks include:

  • F01-F09 Mental disorders due to known physiological conditions;
  • F10-F19 Mental and behavioral disorders due to psychoactive substance use;
  • F20-F29 Schizophrenia, schizotypal and delusional, and other non-mood psychotic disorders;
  • F30-F39 Mood [affective] disorders;
  • F40-F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders;
  • F50-F59 Behavioral syndromes associated with physiological disturbances and physical factors;
  • F60-F69 Disorders of adult personality and behavior; F70-F79 Mental retardation;
  • F80-F89 Pervasive and specific developmental disorders;
  • F90-F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence; and,
  • F99 Unspecified mental disorder. 

As you can see, each block begins with the same alpha letter “F”.  There is no requirement for a 7th character extensor in chapter 5.

A number of codes have been significantly expanded in ICD-10

A number of codes have been significantly expanded in ICD-10 (e.g., injuries, diabetes, substance abuse, postoperative complications).  F10.182 – “Alcohol abuse with alcohol-induced sleep disorder” is an example of this expansion.  The block that covers schizophrenia, schizotypal states and delusional disorders (F20-F29) has been expanded by the introduction of new categories such as undifferentiated schizophrenia (F20.3), schizoaffective disorder, depressive type (F25.1), and schizotypal disorder (F21).

Alcohol dependence is defined in the I-10 classification in a way that is similar to the DSM. Category F10.1- F10.99 describes alcohol abuse and dependence.  These categories require 5 or 6 characters to complete the code.  There is no referencing back for a 5th digit (ICD-9 requirement), each code is complete.  Example: code F10.221 “Alcohol dependence with intoxication delirium.”

Bipolar disorder, category F31, includes manic-depressive illness, manic-depressive psychosis, and manic-depressive reaction.  Example: code F31.62 states “Bipolar disorder, current episode mixed, moderate.”  Clinical documentation will require greater detail than physicians have been using for the past 30 years.  Training of both coders and providers will take time and should be factored into the ICD-10 transition budget for years 2012-2013.

October 1, 2013, is the deadline for implementation and use of ICD-10-CM and ICD-10-PCS.  For diagnosis coding purposes, the ICD-10 diagnosis codes will be used to assign codes to documented conditions for a specific patient encounter, in any place of service.  If you are assigning ICD-9 codes now, you will be assigning ICD-10 diagnosis codes on October 1, 2013.  CPT and HCPCS codes will not change for physician billing.  It is recommended that clinicians should follow the general rule of recording as many diagnoses as are necessary to cover the clinical picture.

You may be assigning codes from other chapters in ICD-10-CM

It is very likely you will be assigning codes from other chapters in ICD-10-CM based on medical record documentation.  Chapter 19 contains codes for injuries, poisoning, and adverse effects. Codes from chapter 19 (T40, T51) for example, would be used in conjunction with the F10-F19 codes if a patient has an acute alcohol or drug poisoning, even if the patient is dependent on alcohol or drugs.  Another example involves a code from the nervous system (G30.9).  If the patient has documented dementia due to an underlying condition, the underlying condition (eg, alzheimer’s), is first-listed code (G30.9). The dementia would be second-listed (F02.81).

Chapter 5, Block F01-F09, comprises a range of mental disorders grouped together on the basis of their having in common a demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction. The dysfunction may be primary, as in diseases, injuries, and insults that affect the brain directly and selectively; or secondary, as in systemic diseases and disorders that attack the brain only as one of the multiple organs or systems of the body that are involved. Example, code F06.1, “Catatonic disorder due to known physiological condition”.

The lesson to be learned is to acquire the knowledge and understanding of ICD-10 codes used by the practice. This is accomplished by taking a proactive approach and keeping an open mind.  A lesson learned is an experience or outcome of a particular course of action.  A positive outcome follows a positive course of study.

Nancy Maguire discusses coding mental health claims with ICD-10Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT, author of The Nancy Maguire GPS to ICD-10-CM Planning and Implementation Guide, is a nationally-renowned procedural and diagnostic coding instructor, bootcamp trainer, and workshop leader. She has spent more than 30 years as a hands-on coder and has authored countless coding articles and presentations. In her expansive career, she has transitioned from nursing, to coding, to practice management, auditing and consulting. Nancy served as Director of Coding and Reimbursement at UTMB in Galveston Texas for four years. She served the first two terms as president of AAPC in the early 1990s.

Hear Nancy speak in two complimentary archived webinars on ICD-10 presented by Kareo medical billing software: How to Prepare for ICD-10/5010 to Reduce F41.1 (Anxiety Reaction) or Preparing for ICD-10-CM: The Nitty-Gritty of Diagnosis Coding

 

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Customer Service Vs. Patient Care: Is There a Disconnect in Your Office?

Kathy McCoy, MBA September 29th, 2011

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Is your office's customer service affecting your profitability?

I had an educational experience yesterday, and I wanted to share it with you. This was a good reminder to me that Customer Service and Patient Care are not necessarily in sync in some doctors’ offices.

Here’s what happened: I called my doctor in the morning and asked to see the doctor for a sinus infection (I hate those things). They were able to get me in that same day: Kudos. That made me very happy.

However, when I drove to their office, I found the door locked. After a few minutes, I realized they were at the other office that day. Now I was frustrated and knew I was going to be late.

Customer Service Lesson: Please confirm the location of an appointment along with the time if you change offices during the week. I, along with the majority of your patients, have enough trouble remembering MY schedule, let alone yours. You should be able to see in your practice management software that it’s been six months since I was at your practice, so I’m not likely to remember your schedule. And if I’m not feeling well, my memory is not improved.

Next, I called the office to let them know about the problem and that I was going to be late. The person who answered the phone didn’t apologize for the confusion and insinuated that this was my fault. Really? You want to offend someone who’s polite enough to let you know they’re going to be late and who is making a good faith effort to make it to an appointment?

Customer Service Lesson: If you want to guarantee no-shows, it’s a good idea to offend someone who calls to let you know they’ll be late. But if you want them to come in for the appointment and to keep coming back to your practice, it would be better to apologize for the mix-up and help them get to the appointment. For example, I could have used directions from the incorrect office to the correct office. Instead, the person asked me, “How long do you think it will take you to get here?” I responded, “I don’t know; how long does it take to get from this office to that one?” Surely they would know that better than I. Fortunately, the person on the phone did say (after apparently being directed by someone else in the office): “We’ll see you whenever you can get here.” Points for that: You made me feel like less of an idiot and more like a valued patient.

Finally, I arrived at the office and checked in. I tried to explain to the person at the desk why I thought they should confirm with patients which location the appointment was for; she looked at me as if I had two heads. Again, she insinuated that the problem was my fault.

Customer Service Lesson: When someone jumps through hoops (driving from one city to another) to make it to an appointment, let them know you appreciate it. And even if you think the suggestion to confirm location is silly, you can accept it gracefully.

During my appointment, I received excellent care and felt as though my health was the doctor’s and staff’s biggest concern. I appreciate that a great deal; thank you!

Then, I went to check out. I was told that because my deductible hadn’t been met, I was responsible for 60% of the charge, but they were going to have to figure out what that was. That took about five minutes and discussion between approximately three staff members. I was left standing during this process and heard the entire discussion. When an amount was determined, I had to go around the corner to the window to hand my credit card to the staff member…who was sitting 6 feet from me but was apparently not willing to get up and come to me.

Customer Service Lesson: Most importantly, my insurance eligibility and deductible could have been verified when the appointment was made, or when I was on my way to the office. In Kareo, this can be done in seconds. Then the amount owed could have been calculated ahead of time and the confusion avoided. As for the staff person’s refusal to get up and take my credit card out of my hand…she apparently doesn’t understand the relationship between the amount I was paying and her salary.

My point here is not just to kvetch; I think we need to consider the disconnect between the customer service and the patient care provided by this practice. Medically, I felt well cared for and was happy with the clinical care. But the customer service provided by the front office definitely seemed lacking. Now, I like these doctors and appreciate the excellent care. But if I didn’t—how many opportunities was I given to become a no-show? I count three for this one appointment alone.

As patients become responsible for more of their medical costs, lack of customer service will become a bigger and bigger problem for practices. Why? If you’re paying directly for a service, you have different expectations. And the problem with calculating how much a patient owes will only grow with the higher deductibles most consumers are seeing.

Make sure these issues don’t affect your practice’s profitability.

What do you think? Am I out of line? Feel free to add your comments in the Comments box.

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Interview with Ron E. Sterling at HBMA Fall 2011: Hot Issues in Medical Billing, EHRs and More

Joann Doan September 28th, 2011

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Ron Sterling discussed hot issues in medical billing with us at the HBMA Fall 2011 Conference

I had the opportunity to speak with Ron E. Sterling at the HBMA Fall 2011 conference after his educational session on “EHRs: A Strategic Perspective.”  Ron Sterling is an expert on the selection and implementation of EHRs and is also the author of the HIMSS book-of-the-year award winner “Keys to EMR/EHR Success.”  We discussed what his thoughts were on issues in medical billing, how to improve profitability and most importantly, EHRs.

JD: What do you think are the top 3 issues in medical billing in 2012? Why?

RS:

Transition to 5010 – The transition to the 5010 format will necessitate a number of operational changes.  But additional efforts will also have to be focused on the evolving strategies of the payers as they increase their 5010 focused edits.  For example, payers may start assigning patient specific numbers instead of subscriber level numbers to take advantage of the 5010 format.

Electronic Health Records – EHR systems pose a number of challenges to medical billing as well as many benefits.  Medical practices will have to dramatically change their end of day and tracking processes to properly audit charges from the EHR as well as benefit from the EHR.  For example, some EHR products calculate the CPT and ICD9 codes, but do not assign modifiers.  Practices are going to need to understand the basis for charge calculations in the EHR and focus their daily audit procedures on reconciling charge activity on the EHR.

Switch to electronic exchanges of information – Electronic exchange of information with payers and other healthcare partners will become a significant challenge since practices will have to interact with so many different parties.  For example, payers will want to move more doctors to electronic explanation of benefits since electronic EOBs are much cheaper than checks.  However, not all billing systems effectively manage and track electronic EOBs.  As important, the proliferation of electronic EOBs will necessitate a dramatic change to the end of day process.  For example, reconciliation of electronic EOBs will have to include accounting for the disposition of unposted payment and preservation of accountability for the payment.

JD: What do you think are the key things medical practices need to do to improve profitability?

RS: Medical practices are going to have to develop a way to use technology to speed up interactions with patients and reduce the cost of managing patients.  Any discussion of profitability has to consider the inefficiency of thrashing through paper records, notes and other materials to address patient issues.  From inefficient triage desks to taking physician time to find the last note, related lab, and therapy order as well as all of the other thrashing of paper to justify a claim or deal with a patient issue, medical practices are inundated with an avalanche of paper.  Time taken to thrash through paper is not time devoted to patient service.

JD: In your recent article “Selecting an EHR That’s Right for Your Practice: Five Important Evaluation Areas,” you mentioned that patient portals are “frequently overlooked.”  Why do you think that is?

RS: Practices are so overwhelmed with the selection of an EHR that they do not have the time to look at the patient portal capabilities and whether the portal supports the practice service needs.  Additionally, patient portals seem like a distant issue that is not a necessity.  However, patient demands and Meaningful Use have pushed patient portals up the requirements list to one of the key components of an EHR.

JD: What do you think of Kareo’s strategy of integrating with multiple EHRs to provide a “best-of-breed” option for our customers?

RS: For the smaller practices, the best of breed options are rapidly disappearing.  Kareo has taken responsibility for creating the interfaces, which opens a wide array of cost effective options for smaller practices to consider.

JD: I’ve noticed that the terms EMR/EHR are used interchangeably in many articles and forums.  I’ve read some responses on what the differences are, but coming from an EHR expert, what’s your take on the differences/similarities?

RS: Electronic Medical Record was the term used prior to the ARRA and the Medicare/Medicaid incentive programs.  They coined the phrase EHR to differentiate the “next generation product.”  As a practical matter, I do not believe that there is any significant functional difference.

Thanks to Ron for meeting with me and letting me pick his brain on such hot topics in the medical billing industry. You can hear Ron speak on What You Need to Know About Selecting the Right EHR in our complimentary webinar on October 18. Register now to reserve your space!

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EHR Incentives Program Deadline Approaching

Kathy McCoy, MBA September 27th, 2011

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Thanks to HISTalk Practice for the reminder about the impending deadline for the Medicare EHR incentive program:

EHR Incentive Programs Timeline - Providers have until Monday, October 3 to begin their 90-day reporting period for the Medicare EHR program

Tick tock: eligible providers must begin their 90-day reporting period for the Medicare EHR program by October 3, 2011 to receive payment in calendar year 2011. If you miss that deadline, you still have until February 29, 2012 to begin the 90-day reporting period and still participate in the 2011 program.

And if you’re contemplating or in the process of selecting an EHR for your practice, don’t miss our complimentary webinar on Oct. 18 featuring award-winning author Ron Sterling speaking on What You Need to Know About Selecting the Right EHR.

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Everything You Need to Know About Maximizing Patient Collections: Collecting At The Time of Service

Kathy McCoy, MBA September 26th, 2011

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Elizabeth Woodcock offered multiple useful tips on improving your practice's patient collections in this recent webinar

There was a time when no one in the medical billing industry would have been concerned about patient collections. The cost of care was usually covered by insurance and co-payments didn’t even exist.

Times have changed. Insurance plans and the employers who purchase them have shifted the cost of care more and more to patients in an effort to rein in the skyrocketing cost of care. And judging by the attendance at Kareo’s recent webinar, Everything You Need to Know About Maximizing Patient Collections, it’s a very hot topic indeed. The webinar featured a leading authority on medical billing and practice management, Elizabeth W. Woodcock, MBA, FACMPE, CPC. Elizabeth gave an engaging presentation that included lots of great tips on collecting money from patients at every available touchpoint. We will cover some of these savvy suggestions in a series of upcoming blogs. Our first one here will summarize her tips for collecting at the time of service. If you’d like, you can fast-forward and view the entire webinar now.

Elizabeth notes that the best time to collect money from patients is when they come to your office for an appointment. The power of face-to-face communications makes time-of-service collection the greatest opportunity to shore up your cash flow from patients. Of course, it helps to have a frontline staff person who is comfortable with asking for payment. Elizabeth suggests looking the patient right in the eyes while asking, “How would you like to take care of your payment today, Mrs. Jones? Will it be cash, check or credit card?”

Be sure to collect all monies due. Today, that can take the form of unmet deductibles, co-payments, co-insurance and deposits for upcoming procedures. Office appointments are also the time to present the financial arrangements for upcoming surgeries or procedures. When payment is received, write out a receipt for the patient. It underscores that collecting payment is a fundamental business practice in your office.

Elizabeth advises that you accept all forms of payment: debit cards, credit cards, checks and cash. Just be sure you know what you are paying in merchant fees for each type. Some credit cards charge a higher percentage than others, and you may be able to request payment of a less costly type from your patients if you know the differential impact on your cash flow. It could be as simple as asking, “Can we charge your debit card today for your payment?”

Elizabeth had many other pointers to help with time of service collections, as well as back-end collections. Check back soon for additional blog posts based on the webinar. If you would like to be put on our notification list for upcoming informative webinars such as this one, click here. You can also view our archived webinars to find more topics of interest to you.

Elizabeth Woodcock offers practical tips for improving your patient collections in a recent article and webinar.Elizabeth 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.” Read a recent article by Elizabeth on Patient Collections: Optimizing Your Outcomes in our latest newsletter.

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What You Can Do to Prepare for Medicare Payment Reductions: Medicare Incentives, Strategy #2

Kathy McCoy, MBA September 22nd, 2011

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Betsy Nicoletti explains the strategies your practice should follow to prepare for Medicare payment cuts and stay profitable

As turmoil continues to roil the United States economy, the prospects for any improvement in Medicare reimbursement rates appear dim. Practitioners who rely heavily on government payors such as Medicare or Medicaid for reimbursement will need to look elsewhere to shore up their dwindling cash flow. Fortunately, there are opportunities to improve your financial picture that go beyond medical billing.

To help practices capitalize on potential revenue-generating activities, Kareo recently sponsored a webinar entitled What You Can Do to Prepare for Medicare Payment Reductions. Kareo frequently presents webinars that feature industry leaders discussing best practices in medical office management and medical billing. Our latest webinar featured a well respected practice management consultant and author, Betsy Nicoletti, M.S., CPC.

Betsy offered three overarching strategies that can bring more money back into your practice beyond medical billing. In a series of blogs, we will be covering each of these tactics in greater detail. Her first strategy – taking advantage of Medicare incentive programs – was so detailed and informative, we will be doing separate posts on each incentive program. In case you missed that blog or the webinar, those incentive programs for which practitioners can earn dollars include e-prescribing, EHR implementation, and the Physician Quality Reporting System (PQRS). It is especially important to learn about these programs because a failure to engage in them will result in penalties farther down the road.  Our first blog in this series covered e-prescribing. Read on for specifics on EHR implementation.

What EHR Implementation Means for You

In order to increase efficiency and enhance communications within the health care industry, the United States is using a carrot-and-stick approach to moving practitioners to the “meaningful use” of electronic health records (EHR). A practice that installs and uses a qualified EHR  system can earn up to $63,000 from Medicaid or $44,000 from Medicare—but not from both. To qualify for the higher payment from Medicaid, at least 30 percent of a practice’s services must be delivered to Medicaid patients. Once they begin collecting EHR meaningful use dollars, practices cannot continue to receive the e-Prescribing bonus from Medicare. (Again, check our previous blog for detail on payments and penalties under e-prescribing.)

In order to collect the full stimulus payment from Medicare, practices must begin “meaningful use” of an EHR by Sept 1, 2012. A less generous payment of $39,000 would be available to practices that begin “meaningful use” by Sept 1 2013. Any practitioners who still have not migrated to an EHR by 2015 will be hit with a 1 % penalty that rises each subsequent year to a whopping 5% reduction in reimbursement by 2018. For more information, log on to https://www.cms.gov/ehrincentiveprograms/.

Our next blog will focus on the highly complex PQRS. And be sure to check back for subsequent blogs that will cover Betsy’s second and third main strategies. Don’t want to wait? You can watch the webinar in its entirety.   If you would like to be put on our notification list for upcoming informative webinars such as this one, click here.

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Complimentary Webinar: What You Need to Know About Selecting the Right EHR

Kathy McCoy, MBA September 20th, 2011

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Tuesday, October 18, 2011
10:00 AM – 11:00 AM PDT

Learn the experts' methods for evaluating and selecting the right EMR for your practice

Selecting the right EHR for your practice is crucial, but how do you know where to start? What components are vital, and how do you thoroughly evaluate the options to avoid a disastrous implementation?

What You Need to Know About Selecting the Right EHR examines the aspects of EHR products that are critical to your selection process.  This webinar will present the key EHR components as well as important selection issues for your EHR effort.

 You will:

  • Survey Five Key EHR Components
  • Examine Four EHR Types
  • Analyze EHR Relationships With Practice Management Systems and Patient Portals
  • Review Ten Key EHR Evaluation Criteria
  • Discuss EHR Evaluation Strategies
  • And Much More

Register now to learn the experts' methods for evaluating and selecting the right EMR for your practice

Question-and-Answer Session — Ask your tough questions and get answers to your current concerns about how to evaluate and select the right EHR for your practice or medical billing service.

CEU Credit
What You Need to Know About Selecting the Right EHR" meets the criteria of the Professional Association of Health Care Office Management and is approved for 1 CEU(s).“What You Need to Know About Selecting the Right EHR” meets the criteria of the Professional Association of Health Care Office Management and is approved for 1 CEU(s).

Who Should Attend
Private practice owners, office managers, billing managers, billing service owners and others tasked with evaluating and selecting an EHR for a medical practice or medical billing service.

About Your Speaker
Ronald Sterling, CPA, MBA

Ronald Sterling, CPA, MBA, will give you the steps you need to select the right EMR for your practice or medical billing serviceRonald Sterling, President of Sterling Solutions, Ltd., is a nationally recognized expert on the selection and implementation of electronic health record (also known as electronic medical records (EMR) and practice management systems.  He authored the HIMSS Book of the Year, Keys to EMR/EHR Success: Selecting and Implementing an Electronic Medical Record, and publishes the popular EHR issues blog: Avoid-EHR-Disasters.blogspot.com.  He has worked with practices and healthcare organizations in over 40 states.  Mr. Sterling has reviewed electronic medical record and practice management systems from over 150 vendors.

Register now to learn the experts' methods for evaluating and selecting the right EMR for your practice

 

You can download the What You Need To Know About Selecting The Right EHR webinar handout for this session now.

We hope you can join us for this informative event.

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Complimentary Webinar: How to Grow Your Billing Service – Having a Successful Sales Conversation

Kathy McCoy, MBA September 14th, 2011

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Wednesday, Oct. 5, 2011

1:00 PM EDT/10:00 AM PDT

Learn how to grow your medical billing company with sales tips from experts

You started your billing service business because you know medical billing inside and out – but are you as good at selling your services as you’d like to be? There are techniques in sales, just as in many other fields, that make the process easier and better; you just have to know what they are and practice them.

Learn from the experts in the second in a series of webinars designed to help billing service owners and sales management develop sales strategies that will grow your business.  This webinar will review key strategies including:

  • Planning for a successful sales conversation
  • Understanding your prospect and their problems
  • Positioning your business as the solution to a doctor’s problems
  • Learning to uncover your prospect’s “pain points”—the problems that keep them up at night
  • And more

Register now to get expert sales tips for growing your medical billing company

 
Question-and-Answer Session — Bring your tough sales and business development challenges and get answers to your current concerns about selling your services in today’s highly competitive economy.

Who Should Attend
Billing service owners, billing service sales management and others responsible for developing new business for a medical billing service.

About Your Speakers
Our panel of speakers includes experts in medical billing sales and business development, some of whom are executives from leading medical billing services:

 Paul Bernard
President/Owner, Broadleaf Health

Scott Cramer
Senior Account Executive, Kareo

Jim Sholeff
Partner, ECCOHealth

Register now to get expert sales tips for growing your medical billing company

 

You can download the How to Grow Your Billing Service–Sales Conversation Webinar Handout for this session now.

We hope you will join us for this informative event.

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Patient Collections: Optimizing Your Outcomes

Elizabeth W. Woodcock, MBA, FACMPE, CPC September 12th, 2011

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Improve your patient collections process with these tips from Elizabeth WoodcockWith the lingering economic recession, the challenges to your collections process continue to mount. At the same time that patients have less income to pay their bills, employers are putting additional financial responsibility into the hands of employees, and more Americans are joining the ranks of the uninsured. It’s the perfect storm – and your medical practice is right in the middle of it.

To get shelter from the storm, try these proven strategies to strengthen the outcomes of your collections process.

Secure financial clearance. Collections, once considered the ultimate “back-end” process in a business office, is now firmly entrenched as a “best practice” at the front end of a high-functioning revenue cycle. Before the patient presents, perform a three-part financial clearance consisting of:

  1. Verification of active insurance coverage
  2. Confirmation of eligible benefits (if applicable to the services that will be rendered)
  3. Validation of unmet deductibles

If possible, use technology to perform the clearance process automatically and document the results for each patient. While you can perform financial clearance at any time, the best opportunity is 36 hours in advance of the appointment – close enough to the date of service to get accurate and timely feedback about the patient, but still enough time to research and resolve problems discovered in the clearance process. Be sure to pull a record of balances for all established patients before the appointment so your staff can request payment with fresh, printed proof of the balance in hand.

Achieve time-of-service collections. Armed with the data gathered during the financial clearance process, your reception staff can request payment of time-of-service balances. These may include copayments and due balances from past services (no matter how old – one, 11 or 111 days!), as well as minimum deposits from uninsured patients. In addition to payment, the staff should request a copy of the patient’s insurance card and driver’s license. Although the exchange of information can be exclusively verbal, it pays to arm your reception staff with one – or all – of these documents:

  1. Results of the financial clearance process confirming the patient’s coverage, benefits, and unmet deductibles
  2. Ledger to show the patient’s balance
  3. An explanation of benefits, if applicable, showing any financial responsibility the insurer assigned to the patient

It also pays if your staff knows how to request payment. You won’t get anywhere if they ask the patient: “Would you like to pay today?” Instead, instruct them to make eye contact with the patient, and politely state: “How would you like to take care of your charges today?” If you can calculate the patient’s charges by the time he or she checks out, you’ll be in the best position to request and collect both coinsurances and unmet deductibles. For more tips, see my recent post on seven strategies to improve your time-of-service collections.

Refine payment plans. A certain percentage of patients will ask to pay what they owe over time. Take care that these requests, which can occur at the time of service or long after the balance is due, do not lead to problematic payment plans. Many times, the problems are rooted in how the plan is established. When patients ask for payment plans, resist suggesting an acceptable payment; instead, ask the patient: “How much can you pay today?” Next, let the patient drive the discussion of the plan’s parameters by asking open-ended questions, such as: “How much more time do you need?” Typically, patients will present a plan with a shorter timeframe than we would have presented to them! If the patient’s payment timeline is unreasonably long, ask for a shorter period. Ideally, the outer boundaries should be six months, with payments of no less than $25 per month.

Thanks to recent changes in credit card processing regulations, medical practices have another payment option to offer: storing the patient’s credit card information and processing the payments as they come due. Consider contracting with a vendor that can perform these tasks securely and conveniently – for you and the patient. Another payment plan option – one that a few vendors, including your local bank, might offer – is the medical services loan. These plans are still few in number and the terms must be scrutinized carefully. If you establish an internal payment plan, as many practices do, get everything in writing and issue receipts when payments are received.

Compress the statement cycle. Mail patients their first statements as soon as the balance owed is determined. Do not wait until the right “cycle” rolls around – you’ll just inflate your aging accounts receivables. To ensure that patients get your invoices in a timely fashion, train the staff member who posts payments in effective collections techniques. It is this employee who is the first to see the charges applied to the patient’s responsibility – these come in the form of copayments, coinsurance, and deductibles. Batching that information to process at a later date won’t get you anywhere but into a bigger problem because the longer an outstanding amount goes uncollected, let alone unbilled, the lower the chances of collecting. As soon as the insurer alerts you that the responsibility is the patient’s, transfer it.

Does it seem that you send bushels of statements to each patient? Stop the paperwork barrage: mail just three statements – four at most – before beginning the collections process. If you want to send more statements, mail them semi-monthly to coincide with the typical frequency of most workers’ paychecks. Regardless of the specific tactics you take, do not allow more than 60 days or three statements (e.g., the first at 0 days, the second at 30 and the third at 60) to go by with no response. If it does, move to the next step: collections.

Upgrade collections efforts. When patients don’t respond to your mailed statements, up the ante by calling them. If, as so often happens, you get their voice mail, leave a message requesting a return call to the practice in reference to his or her account. Immediately after the conversation (or leaving the voice mail) send a letter to the patient outlining his or her financial responsibility. This final notice of collections letter should also state a specific due date and options for payment.

Often, practices will send two of these final notice letters 15 days apart. If you send your initial collections letter on regular practice letterhead, try something different for the subsequent one: print it on orange paper cut to fit a non-business-size envelope. Use your practice’s initials on the envelope’s return address (M.P.A., for example, versus Medical Practice Associates), handwrite the patient’s name, and use a regular first class postage stamp. Why these seemingly peculiar efforts? Distinguishing this letter from previous attempts will improve the odds that the patient will actually open it. Use the same content as the first letter, although you can display more urgency in your request by printing an alert that this is the final notification prior to transferring the balance to a collections agency. Again, set a firm due date for payment, mail the letter, and place one final telephone call a few days later. If there’s no response after these two “final” letters and two telephone calls over a period of 30 to 45 days, it’s time to move the effort to an external collector.

Engage collections help. The reality is that collecting stubborn accounts is challenging – whether it’s you or a professional collections agency – so don’t expect miracles. A typical recovery rate for delinquent medical accounts is 10 percent. Since you can’t expect a huge pay out, ensure that the process of transferring accounts to the agency doesn’t drain your resources. Ideally, automate the processes of writing accounts off from your active accounts receivable to an agency and remitting any payments received. The more staff time you spend working these accounts, the more they cost you.

Consider working with multiple agencies to ensure that you are getting the best efforts on your behalf. If you have a great partnership, an agency may be able to help you manage your return mail – agencies, of course, have great skiptracing resources. Some collection agencies are capable of handling payment plans efficiently without alienating the patient. Thus, if the patient defaults on a payment, the agency would automatically assume responsibility. Like any vendor, be sure you’re getting the best service – at the best price. If you haven’t done so lately, review the pricing structure of your agency(ies) and determine if there’s room to negotiate.

While 10 years ago, it was common practice to write off patient responsibility without thinking twice, your practice’s bottom line increasingly relies on getting more payments from more patients. Patient collections are a fact of life in the medical practice industry; in these uncertain economic times, you must take extra steps to get them right.

Elizabeth Woodcock provides tips on how to improve your patient collectionsElizabeth 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 recent archived webinar by Elizabeth on Everything You Need to Know About Maximizing Patient Collections.

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Selecting an EHR That’s Right for Your Practice: Five Important Evaluation Areas

Ron Sterling September 12th, 2011

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Choosing an EHR is complicated by the vast array of evaluation criteria and needs of the standard medical practice.  In many cases, the evaluation of EHR features involves a flood of information on an ever expanding list of requirements and features.  Indeed, some practices develop lists that are difficult to use and even more complex to analyze.

The Certified EHR program under the Office of the National Coordinator Health Information Technology does not make this effort any simpler.  Although you should focus on EHR products that are certified, that still leaves over 700 products that have attained some level of certification.  Note that Certified EHRs are measured against the features needed to attain Meaningful Use and do not necessarily represent an effective tool for a particular practice.

In order to effectively structure your evaluation process, you should consider building your evaluation around five important areas:

    • Patient Portals – Patient portals are becoming a more important, but frequently overlooked aspect of EHRs.  Patient portals can be useful for getting information from patients and fulfilling some Meaningful Use requirements.  Note that patient portals also serve as a conduit to interact with patients on administrative matters including bill payment and demographic updates.
      • Patient reminders and clinical summaries can be delivered through a patient portal.  Stage 2 of Meaningful Use includes secure messaging through a patient portal.
      • Patients and the practice can exchange messages on clinical issues and matters.  Note that such messages may need to be included in the patient’s medical record.
      • Patient portals can be used to gather clinical information such as patient history and problem specific information.  The information can be accepted into the EHR and refined by the doctor in much the same way that doctors work from a paper patient history questionnaire.
      • Patient portals can be used to request refills, appointments, and other services.
      • Patient portals can be used to access selected information from the patient’s record.
    • Clinical Content – Clinical content consist of documents, templates and forms that allow you to document patient visits and activities in the EHR.  Not all EHRs contain clinical content for all areas of medicine.  If an EHR does not have clinical content for your area of medicine, you may have to invest a lot of effort to develop the forms, documents, and other setups needed to serve your patients.
      • Clinical content consists of an adequate array of detailed content appropriate to the practice.  For example, a general orthopedic practice requires a broad array of relevant content, while a spine surgeon requires more detailed content focused on spine related orthopedic services.
      •  Supports charting tools for well and sick visits associated with your area of medicine.
      • Includes documentation tools for procedures commonly performed by the practice.
      • Creates appropriate documents for patient services such as consent forms, immunization records, exam notes, and disability notices.
    • Image Management Tools– Image management tools are used to track and work with scanned images of the paper chart, newly received paper documents and even diagnostic images.  For example, many specialists need to annotate the scanned image to highlight important information or document a finding on a diagnostic image.
      • Indexing tools include a description of the image and a classification as well as relevant date information.
      • Annotation tools have presentation and drawing options to meet the needs of the practice.  For example, color coded lines and areas may be used to document patient issues on a diagnostic image.
      • Presentation tools display user selected images.  Users can view multiple images on the same screen.  For example, a doctor may want to review a previous visual field test with the current results.
      • Thumbnail views facilitate the selection of specific images from an array of images in the patient record.
    • Treatment Plans– Treatment plans include tests, exams, or procedures that may be performed during the current visit or in the future.  For example, a treatment plan could consist of a pre-procedure therapy order followed by the procedure and post procedure check-up.
      • Tools to manage the due date for the treatment plan items reinforce the physician’s medical recommendations and follow-up efforts.
      • Services provided by other providers may be included in the treatment plan.  The EHR supports producing referral documents to forward to other providers.
      • Surgery in a treatment plan is managed through a process that includes coordinating care with the facility, and other parties such as payers, anesthesiologists and implant vendors.
      • Plan item status tracking should offer options to assign appropriate statuses to plan items including pending, reviewed, and completed.
    • Workflow – Practices need to track patient activities in the office as well as the wide array of incoming communications and collaborative activities in the practice without the paper chart to indicate patient location and status.  For example, a paper chart in bin may indicate that a patient is waiting for a radiology study.
      • Accepts a location and status for a patient to support patient activities.  For example, patient roomed, nurse needed, and lab test pending could be patient statues in the workflow tool.
      • Support for groups of physicians and staff that may work together on various issues.
      • Management tools to monitor the status of patient activities in the practice.  For example, you may want to identify refill requests that have been outstanding for more than 2 days.

Using these five areas to organize your EHR evaluation will provide a focus for your evaluation and analysis.  When comparing products, these classifications will help you summarize the relative strengths and weaknesses of the products you are considering.  Thereby, you will have a better view of the strategic fit of a particular product to the needs of your organization.

Ron Sterling (800-967-3028, www.sterling-solutions.com) publishes the popular EHR Blog Avoid-EHR-Disasters.blogspot.com, and authored the HIMSS Book of the Year Award winning Keys to EMR/EHR Success.  He is an independent EHR consultant.

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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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