Keep Improving Your Patient Collections

Lea Chatham November 29th, 2012

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Improve Your Patient Collections

It isn’t news—patients are paying more of their healthcare expenses. With higher deductibles and more out-of-pocket expenses, your practice may be seeing as much as 30% of your revenue coming from patients now. In 2012, Kareo offered blog posts and webinars that provided tips for improving your patient collections. Did you implement those strategies or are you still struggling with collecting patient payments?

If you are still challenged but this changing landscape, there is no time like the present to start changing the way you handle patient due balances. According to Sara M. Larch, MSHA, FACMPE, you can only expect to collect 50-70% of an  insured patient’s balance after treatment. But she also notes that your chances of collecting are much higher while the patient is in the practice and drop considerably once the patient leaves your office. So create a financial policy that is given to patients, set an expectation with patients that payments are collected at the time of service, and make it easy for patients to pay both at your office and after service. Read more of Sara’s suggestions in her blog post Surviving the Deductible Reset in 2012: How to Collect Deductibles and Improve Self Pay Collections or view her webinar, which provides even more details on patient collection solutions.

In another recent post, Betsy Nicoletti, MS, CPC, also talked about improving patient collections. She provided seven key strategies for improving collections in a time when patient receivables can really impact your bottom line. She also  suggests creating a strong financial policy, setting an expectation of payment, and collecting co-pays consistently. In addition, she recommends surgery/procedure deposits, offering an online option for payments, offering recurring payments,  and being aggressive about collections. For more details on her suggestions, read her post Seven Ways to Improve Your Patient Collections.

Each year, there are new challenges to face in medical practice billing. It can be hard to keep up with the changes and focus on implementing new billing practices like collecting co-pays up front. If your focus has not been on collecting patient
payments, take some time to make a few changes now so you can collect more from patients in 2013. You’ll notice the difference in your financials.

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Reduce Absenteeism at Your Medical Practice

Lea Chatham November 29th, 2012

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3 Easy Ways to Manage Employee Absenteeism

3 Easy Ways

It is the bane of many medical practices: employees who frequently call in sick or don’t show up for work. Employee absenteeism is a huge problem for American businesses. According to the global management company Kronos International, absenteeism costs employers more than 8 percent of their payroll[1]. It also takes its toll on employee morale, not to mention productivity and workflow. While sometimes the employee may actually be sick, more often there are family illnesses or other pressures that make employees miss work. Here are some practical ways to manage employee absenteeism.

  1. Easiest: Be sure you have an absenteeism policy that states how many absences are acceptable in a defined period of time, and for what reason they are allowed. You should also address any personal reasons for which employees may be absent, such as a family member’s illness or home emergency. Delineate the consequences for not complying with the policy.  Every new employee who is hired should receive a copy of the policy and acknowledge in writing that they have received it.
  2. Easier: If absenteeism becomes an issue with one individual, address it directly. Talk with the employee to determine if ongoing adverse circumstances are affecting her ability to meet her work schedule and if so, discuss possible solutions. Of course, if calling in sick continues, be prepared to give a verbal warning and document it in the personnel file. This provides a paper trail should you need to terminate the employee.
  3. Easy:  If absenteeism occurs routinely in your office with more than one employee, there may be other issues at work—literally. According to an article published in the January 2009 “Journal of Organizational Behavior,” increased job demands and decreases in job resources are directly related to absenteeism. Consider meeting with employees, with a promise of non-retaliation, to ask if there are workflow or resource issues that prevent them from doing their jobs effectively.  Or consider bringing in a practice management expert to review your office staffing and workflow. If workplace dynamics make it difficult for employees to do their jobs, you will have a much larger problem: keeping competent qualified employees.

This is the third in an ongoing series of blog posts aimed at helping you manage the day-to-day realities of running a medical practice. Check out our last post on keeping patient information up to date, and be sure to watch Kareo’s Getting Paid blog for more in our “3 Easy Ways…” series.


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Use Your Medical Practice Schedule to Make Money

Lea Chatham November 27th, 2012

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Did you know that your medical practice schedule can be a revenue-generating machine? In her recent webinar, Rochelle Glassman, a nationally-recognized healthcare consultant, explained that while physicians historically haven’t been good  at using their schedules to generate income, they can increase revenue by at least 25% using the scheduling strategies she discussed in 3 Ways to Increase Your Practice’s Revenue.

Time really is money for most healthcare providers so your goal should be to see as many patients as possible each day. Your front office staff need to be strategic in their scheduling process. Every unfilled appointment represents a loss of income.

Rochelle has several recommendations for how to make the most of your schedule. First look at your patient mix. Are they primarily fee-for-service (FFS) or capitated? Fill your schedule based on the mix of patients. If you have 70% FFS and 30% capitated your schedule should reflect that, and you should triage patients accordingly as well. Try to schedule capitated patients only in your blocked capitated spaces while leaving same day and extended hours open for FFS patients. You don’t want to lose the revenue from FFS patients, and they may go elsewhere if they can’t get in to see you promptly.

According to Medicaid, one on three patients doesn’t show up. Other studies suggest 25-50% of follow up patients cancel or don’t show. Look at your schedule to identify groups of patients who are most likely to cancel or not show up. Consider double-booking those types of patients or appointments. Also, consider changing the way you discuss some of these types of visits with patients. For example, say “See you in five days” and have the patient schedule a follow up versus “Call us if you aren’t feeling better.”

These and Rochelle’s other suggestions require training for staff and providers. To find out more about her strategies and how to prepare your practice download the slide presentation or take a look at the other posts on making money from prescription refills and mining your data to generate more appointments.

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Use Your Own Medical Billing Software Data to Increase Revenue

Lea Chatham November 20th, 2012

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Increase Practice Revenue by 25%

In her recent educational webinar, Rochelle Glassman, President of Phoenix Physician Services and a nationally-recognized healthcare consultant, laid out the truth about physician reimbursement. It is declining, but there are things you do to turn that around. In fact, according to her you have the power to increase your revenue by at least 25% using the strategies she discussed in her presentation, 3 Ways to Increase Your Practice’s Revenue.

Last week, Rochelle wrote an article for Getting Paid on the first of these tools. She discussed how you can reap the benefits—and revenue—from prescription refills. In today’s post we’ll look at the second of her recommendations, which is all about mining your medical billing software data to market your practice.

According to the Medical Group Management Association, you should be spending 1-3% of your practice revenue on marketing. If you aren’t marketing your practice, reaching out to existing patients based on your own data is a good, and essentially free, way to start.

Your practice management and medical billing software is full of information that you can use to increase patient volumes and revenue. Dig into your data and run reports to identify the following types of patients (depending on your practice):

  • Patients with chronic conditions like diabetes, hypertension, and heart disease who are due for a follow up appointment.
  • Patients who may be due for physicals, well-woman or well-child checks, and other preventive care.
  • Anyone who may need immunizations, including annual flu or pneumonia shots.

Once you identify patients you can contact for appointments, be sure you have a process in place to do the reminders via mail, email, text, or phone. Also, make sure your schedule is setup to accommodate an increase in patient volume.

Another thing Rochelle recommends is to create incentives for your staff. Set a goal for your increase in appointments and reward staff for achieving that goal. This will help motivate them to get patients scheduled and to manage the additional work it will entail from them.

Not only will this process result in increased patient visits and revenue but it will also increase overall patient satisfaction. In addition, it may help your practice to tap into free money from health plans that are proving financial incentives for meeting quality indicators.

Find out more about Rochelle’s recommendations for ways to increase your revenue by 25% by reviewing the webinar slides from 3 Ways to Increase Your Practice’s Revenue.

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CMS Urges Physicians to Move Forward with ICD-10, Part 3

Lea Chatham November 19th, 2012

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Why physicians can—and should—learn ICD-10
By Lisa A. Eramo

With ICD-10 comes greater specificity and a seemingly endless list of codes. Some have taken the initiative to understand the changes while others have lagged behind. However, ICD-10 is coming regardless of whether you want it or not. You’ve seen that if you have ready Part 1 and Part 2 of our update on ICD-10.

Why ICD-10 is beneficial
ICD-10 does include more code options and greater specificity; however, the changes are certainly manageable. In fact, physicians are more than capable of adapting to and learning what will be required of them, said Ginger Boyle, MD, CCS, CCS-P, a practicing family physician and physician advisor at Spartanburg Regional Healthcare System. Boyle spoke during a CMS ICD-10 National Provider call held October 25 about the health care system’s plan to educate physicians.

Although providers won’t need to learn ICD-10-PCS, they will need to become more familiar with ICD-10-CM codes, many of which are more specified than their ICD-9-CM counterparts, Boyle said. ICD-9-CM includes approximately 14,500  codes while ICD-10-CM includes nearly 70,000.

Some ICD-10-CM codes may surprise physicians who are accustomed to reporting more general—or even vague—ICD-9-CM codes to denote the same conditions.

For example, let’s look at diabetes in the practice setting. According to Boyle, patients with diabetes can have as many as 10 or 12 other diagnoses on their active problem list. Whereas ICD-9-CM codes remain fairly non-specific, ICD-10-CM codes for diabetes are combination codes. This means these codes include the type of diabetes mellitus, the body system affected, and the complications affecting that body system. Thus, physicians must document all relevant information to  nsure correct code assignment. ICD-10-CM code E11.21, for example, denotes Type 2 diabetes mellitus with diabetic nephropathy.

The good news is that ICD-10-CM allows physicians to make it very clear to payers where and why treatment is rendered, Boyle said.

For example, whereas ICD-9-CM codes for pain in the knee (719.46) and pain in the limb (729.5) are fairly generic, ICD-10-CM codes denote laterality. ICD-10-CM code M25.561, for instance, denotes pain in the right knee. ICD-10-CM code M79.662 (pain in left lower leg) denotes both laterality as well as the specific part of the limb.

The 5010 electronic format—a prerequisite of ICD-10-CM/PCS—also helps physicians more accurately depict patient severity. “One of the most important things from a physician’s perspective is that we’re going to increase the number of codes
we’re submitting. There is more space to describe the patient. Physicians can now outline more level of detail,” Boyle said.

Ultimately, the greater specificity in ICD-10 will only help—not hinder—physicians. “If we’re going to take care of our truly sickest patients, then let’s get credit for it,” Boyle added.

What you can do now

There are many steps that you can take now to ease the transition to ICD-10. According to Boyle, these include:

  • Identify your top 20 diagnoses and determine how ICD-10 will affect the documentation and coding of those conditions.
  • Create specialty-specific cheat sheets that include the most commonly-reported codes.
  • Ensure that coders receive in-depth ICD-10 training so they can educate others within the office about important changes.
  • Establish a process by which you’ll monitor reimbursement, denials, and rejections post-ICD-10 implementation.

If you haven’t yet read the first two articles in this series, check them out: ICD-10 and Coverage Determinations and Updates on ICD-10.

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Book Review – Creative Destruction of Medicine

Terry Douglas November 15th, 2012

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The Creative Destruction of Medicine

What has changed society will eventually change medicine.  It’s a simple, but radical premise from which Eric Topol, MD pens his latest book – The Creative Destruction of Medicine.

Dr. Topol suggests the technology devices revolutionizing our daily lives will soon need to be integrated into how physicians diagnose and treat patients.   It makes practical sense.  I mean, why hasn’t it already happened?

Well, the answer is obvious.  The existing healthcare delivery system is not equipped to integrate and support such transformation.

With patients being forced to make more contemplative choices in how they engage the healthcare delivery system, we’ll have to start making changes in our medical practices where our routines aren’t tailored around our own practice conveniences, but more towards supporting a connected, coordinated and ‘always on’ patient experience.

While those of us working in healthcare will have mixed feelings about how close (or far) digital transformation is for healthcare, there is no doubt that Dr. Topol has written a very forward thinking book that will undoubtedly help shape the path forward.

If you are interested in the wireless future of medicine, the Creative Destruction of Medicine will be a good read.




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Maintaining Patient Information Improves Medical Practice Billing

Lea Chatham November 14th, 2012

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3 Easy Ways to Keep Patient Information Up to Date

3 Easy Ways

Out-of-date patient information can affect several steps in your medical practice billing process. It can mean rejected claims and unpaid patient due balances as well as increased no shows. Don’t let this become a problem for your practice. Using one or more of the three simple tools below, you can help ensure that appointment reminders reach patients, patient eligibility can be verified, claim gets processed quickly, and you get paid.

  1. Easiest: Always confirm contact information when you make an appointment. Even if you only check phone and email, you’ll ensure that you can do a reminder prior to the appointment and reach the patient for follow up.
  2. Easier: When patients check in, don’t just ask if everything is the same. Read through the contact and insurance information or better yet, print it out and ask the patient to review it. You’d be surprised how often the numbers in an address get inverted or a person’s street is spelled wrong.
  3. Easy: If you have the resources, you can send the patient their information ahead of the visit as part of their reminder. Ask them to review and bring in any changes when they check in.

Every time a patient doesn’t show up or a claim is rejected, it costs your practice time and money. Verifying patient information can help reduce both of these problems by enabling you to ensure that reminders reach patients and you can verify coverage, collect co-pays, submit cleaner claims, and send accurate patient statements. The Medical Group Management Association (MGMA) estimates the average no-show rate at about 7%, but studies suggest that with reminders, you can cut that in half or better. That is a big improvement in revenue with very little effort.

This is the second in an ongoing series of blog posts aimed at helping you manage the day-to-day realities of running a medical practice. Check out our first post on minimizing the cost of cancellations, and be sure to watch Kareo’s Getting Paid blog for more in our “3 Easy Ways…” series.

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CMS Urges Physicians to Move Forward with ICD-10, Part 2

Lea Chatham November 12th, 2012

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ICD-10 and Coverage Determinations

By Lisa A. Eramo

One of the big questions in physicians’ minds is: How will ICD-10-CM potentially affect coverage?

During the CMS ICD-10 National Provider Call held October 25, Janet Anderson Brock, director of the division of operations and information management for the coverage and analysis group at CMS, reiterated that Medicare coverage should remain unchanged after the transition.

“In order to preserve the coverage that we have on Sept. 30, 2014 and have the exact same coverage on October 1, 2014, we’ve gone through a pretty integrative
process,” Brock said, referring to CMS’ process of converting many of its national coverage determinations (NCD) from ICD-9-CM to ICD-10-CM/PCS.

CMS publishes NCDs that are applied nationally. Thus, the agency, itself, is responsible for converting codes from ICD-9-CM to ICD-10-CM/PCS in selected NCD publications.

CMS is currently in the process of determining which of its approximately 330 NCDs it will translate. Brock said CMS will translate approximately 40% of its NCDs. Some NCDs—particularly those related to non-coverage—may be obsolete and not require translation. Others may relate to durable medical equipment (DME) that either aren’t suitable for translation or that DME contractors will manage directly.

Local coverage determinations (LCD) are a different story. Individual Medicare Administrative Contractors (MAC) issue LCDs that are limited in scope and that cover a specific jurisdiction, Brock explained. “Each individual MAC will be responsible for doing its own translations [converting codes from ICD-9-CM to ICD-10-CM/PCS], and that’s because there is local variation,” she said.

Currently, national policy trumps any local policies in place. This won’t change in ICD-10-CM/PCS, Brock said. “If there is a national policy in place, there cannot be a local policy that comes through and modifies it in any way. Where there is no national policy in place, a local policy can dictate the coverage for that item or service,” she added.

Keeping up with ICD-10-CM

The race toward the ICD-10-CM finish line is nearly impossible if physicians aren’t informed along the way. Consider including these resources in your stockpile

Watch for information on learning how to use ICD-10 in Part 3 of our latest series on ICD-10.  If you missed Part 1 of this series, read about it here.

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Medical Billing Tip of the Month – November

Joann Doan November 12th, 2012

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Our judges (you) have spoken, and we have our Medical Billing Tip of the Month for November. We received a terrific volume of votes! Thank you to everyone who voted on our blog and Facebook. The winner of our Medical Billing Tip of the Month contest this month is…

Billing Tip #3:

3. Creating Cases for Authorization

In Psychiatry specialty, most of the procedure codes would require Authorization, especially from Medicaid, Sierra and Amerigroup insurances. There is an option in Kareo to update the Authorization information alright, but a little more enhancement that I described below will ease the process of submitting the claims with appropriate authorization without any hindrance.

- Create separate cases for each CPT code that require authorization. For eg., if a patient has CPTs 90806 and 90847, we can create 2 separate cases with the names “90806″ and “90847″

- Whenever a service is performed, it can be entered into their respective cases. In cases where a patient has a month-over-month policy, the case can be named with a suffix, for eg., “90806 – Medicaid”, “90847 – Sierra” and so on

- This will actually eliminate assigning an incorrect authorization# for a CPT

-Also, when a “Patient Insurance Authorization” report is generated, this will give a clear picture of which authorization # is valid for which CPT.

Dan Gillmore

Congratulations Dan! We’re throwing out the challenge to our many other fine billers, billing services and billing managers: Send your tips in, and you could win the $250 prize!

Please be sure to submit your Medical Billing Tip of the Month to for inclusion in the next round of judging. We’ll post the top three tips on our Facebook page and on the Kareo blog for your vote! You will win a $250 American Express gift card if your tip is chosen. Good luck!

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Your 2013 Medicare Fee Schedule To-Do List

Lea Chatham November 12th, 2012

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By Rico Lopez, Senior Market Advisor at Kareo

2013 Medicare Fee Schedule To-Do List

Now that the 2013 Medicare Physician Fee Schedule has been finalized, here are three things you will want to put on your to-do list to make sure your practice is ready to go for 2013.

Update your Medicare fee schedule.  Make changes to the latest rates to ensure that your practice is billing correctly and receiving payment for services to Medicare patients.

Make adjustments to your standard fee schedule.  If you base your standard fee schedule on the current Medicare rates, you may also need to make additional fee changes. Some specialties will be receiving an increase and some will see a reduction in 2013 (i.e., Family Physicians will get a 7% increase and Radiation Oncology will get a 7% decrease).

Check your managed care fee schedule.  If you have managed care contracts based on Medicare rates, you will also need to adjust your managed care fee schedules to reflect the upcoming changes and allow your users to continually validate the accuracy of your managed care payments.

Visit the CMS website to get the 2013 Medicare Fee Schedule. For Kareo customers, you can also find tutorials about contracts and fee schedules in the Help Center.

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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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