Simple EHR Tools Can Help Engage Patients

Lea Chatham August 29th, 2013

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Reimbursement is changing and so is healthcare—patients expect more and so do payers. Physicians have to find ways to get patients more involved in their own health and wellness. In a series of short videos, Dr. Tom Giannulli, Chief Medical Information Officer at Kareo, talks about some of the ways you can use your EHR to engage patients, educate them, and reinforce treatment compliance. Essentially, you can learn how to use your EHR to make patients partners in their own care.

Improved care coordination, preventive care recommendations, access to physicians via email, and patient portals are things that patients want. Over two thirds of patients say they would consider switching physicians for secure access to their medical record. More than 60% of patients want to correspond online with their physician, and 65% want appointment reminders via email. These are just some of the things that have come up in studies over the past several years. Using an EHR effectively can help you meet these patient expectations so that your practice can stay competitive in a changing healthcare environment.

In one of his video, Dr. Tom specifically discusses the use of:

  • Visit Summaries
  • Patient Portals
  • Online Health Education
  • Preventive Care Guidelines

To find out more, check out Heads-Up Medicine: Engaging Patients Beyond the Exam Room.

Tom Gianulli talks about EHR and heads-up medicine for Kareo


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Your Top Patient-Centered Medical Home Questions Answered

Lea Chatham August 27th, 2013

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Judy Capko provides an overview of PCMH for Kareo

In her recent webinar, Patient-Centered Practice: Meeting the Demands of Health Reform, practice management expert Judy Capko provided an overview of patient-centered care and how it may impact reimbursement along with details about the Patient-Centered Medical Home model. She covered a lot of information, and attendees had many good questions. We’ve selected a few questions to share with everyone.

Q: How do you get started with PCMH?
A: I recommend visiting for a free copy of the PCMH Standards and Guidelines. You can also email me to request the Patient-centered Quality Care Check List to gain a quick understanding of internal processes at

Q: Are there payers who are providing incentives for PCMH?
A:  Under the PCMH model, physicians and other caregivers are collectively financially rewarded for improving outcomes and reducing costs through well-orchestrated coordination of care. Different payers are also continually evaluating payment models to reward the PCMH. NCQA can help you understand this program in more detail. Currently, payers are not increasing payments for practices that are certified as a PCMH, but this is definitely something that this coming. In addition, there are other programs with features related to patient outcomes and engagement that are tied to payments like Meaningful Use. Some commercial payers are also paying incentives for tracking some preventive care measure and outcomes. To find out more, you will need to look at your payers specifically. You can call and talk to them about any programs that they have. You can also contact your specialty society for help with this or contract with a consultant.

Q. How does the patient-centered care concept impact specialists? Can we participate in the Patient-Centered Medical Home (PCMH)?
A: The basic concepts behind being a patient-centered practice apply to everyone. There are many things that any practice can do to be more patient-centered, and, as a result, engage patients more and participate in programs like Meaningful Use. Some of these things may result in higher reimbursement down the road.

While the PCMH is really geared towards the primary care provider, there is another program that is directed more towards specialty providers. It is the Patient-Centered Specialty Practice (PCSP) and focuses on the specialist’s role in coordination of care with the primary care practice. To be involved the provider offers superior access (including electronic when patients need it), has care agreements with the primary care providers, and tracks patient care over time and across clinical encounters. For more on this topic, visit

Q: With the projected shortages of physicians and cuts in reimbursement, how can practices find the time to engage patients to the degree that is expected?
A: Engaging patients is a process of “everyone” in the practice building a strong patient relationship. This includes using clinical support staff well in contributing to engaging the patient pre-and-post physician encounter. This may take some time to get set up on the front end, but pays off with big dividends in the long-run. Maximizing the use of your practice management and electronic medical records software will also contribute to more efficiency throughout the practice. As you get more comfortable, you will become more efficient and improved patient cooperation and engagement will lead to time savings. Patient-centered and shared decision making increases patient satisfaction, which can also be a time-saver in the big picture. The important thing is moving the culture in this direction and getting buy-in from the entire team. I know this can work because I have seen it in my consulting.

If you’d like to know more about the Patient-Centered Practice and how it might affect you, check out the recorded webinar.

About the Speaker:

Judy Capko discusses patient-centered care and programs for Kareo

Judy Capko is a practice management and healthcare industry consultant with Capko & Company. Judy is the author of Secrets of the Best-Run Practices, a best-seller in the healthcare market. Her consulting focus is on building patient-centered strategies, improving leadership and valuing staff’s contribution.

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How Will ACA Exchanges Impact Your Medical Practice?

Lea Chatham August 26th, 2013

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By Penny Noyes

This fall, eligible residents in your market will have an open enrollment for Affordable Care Act (ACA) mandated Exchange plans and expanded Medicaid products  that will be effective starting in January 2014. Some of the Exchanges will be run by states and some by the federal government. These new options may  impact some of your patients and your practice. The question is how.

Will you be a provider in an ACA Exchange plan or expanded Medicaid plan when open enrollment occurs this fall? How will you know which plans have been selected to be available on the Exchange or in expanded Medicaid in your state?

Be on the watch for Amendments/Notices from any payers that will have Exchange or new Medicaid products and be aware that your current base agreement with these payers for commercial products may allow rates to change or products to be added with a simple notice from the payer by USPS or email, typically 30 to 90 days in advance. If your practice does not send a written objection within a short period of the notice date, usually 15 to 45 days, the lack of objection to the Amendment is an implied acceptance…no signature needed.

If you get these notices, act swiftly, look at the Amendment provision of your base agreement to discover if there is a specified notice and objection period, ask lots of questions regarding what the exact dollars and cents rates will be for ALL codes that you perform, what the effective date is, how many members are anticipated, and what plan designs will be offered. The new products and reimbursement may be acceptable to you, but make an informed choice about whether it is best for your practice to participate or not.

Find out more general information and how to drill down on what is going on in your state through this link:

About the Author

Penny Noyes Photo 2013 (3)

Penny Noyes brings over 36 years of healthcare-related experience to the table. With 18 years on the payer/network side of the industry and 7 years on the practice management side, in 1999 she founded Health Business Navigators (HBN), a firm dedicated to assisting practices with payer contracting and credentialing.  From 1995 through 1999, she served as Sr. Vice President of Business Development at U.S.HealthWorks. Prior to that she spent over 11 years at Allmerica Financial, where she became chief operating officer of the managed care division, AMM. And, before Allmerica, Ms. Noyes was with Blue Cross of Massachusetts for over 6 years. She is a regular speaker nationwide for MGMA, DecisionHealth, Specialty Boards, HBMA, Medical Societies and others.


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6 Best Medical Billing Tips of 2013 (so far)

Lea Chatham August 22nd, 2013

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Now that we have passed the mid-year mark, it’s a good time to look back at the Kareo Getting Paid blog and educational events. Every month, lots of great industry experts share their insights about medical billing, practice management, and electronic health records. We’ve combed through all of that information and picked our top six favorites of 2013 so far.

  1.  3 Easy Ways to Deal with Difficult Patients: There are many types of difficult patient situations. These difficult patients can test your patience, but there are steps you can take at your medical practice to minimize the impact of these challenging situations.
  2. 10 Questions to Ask before Hiring a Medical Billing Service: If you have decided to hire a medical billing service for your practice, you now have a big decision to make—who will you choose to manage this crucial aspect of your business’s success?
  3. 8 Best Practices for Patient Collections: Rochelle Glassman, a practice management expert, provides her detailed guide for best practices on turning patients over to collections.
  4. HIMSS–The Small Practice POV: Since small medical practices constitute such a large portion of the nation’s healthcare delivery network, we made it our mission to provide our small practice customers and friends with Kareo perspectives on the six  hottest topics of HIMSS 2013.
  5. Don’t Let EHR Tempt You into Non-Compliant Billing: With just a few simple clicks of a mouse, physicians using an electronic health record (EHR) can create quite impressive notes filled with clinical information. The technology certainly saves time, but what effect, if any, does it have on compliant medical billing?
  6. Get Ready for HIPAA Omnibus: On March 26, 2013 the most significant changes to the Health Insurance Portability and Accountability Act (HIPAA) in 15 years went into effect. Here is a quick checklist of items covered entities should take care of before the September 23 deadline.

For more great tips along with educational webinars, white and other information, check out the Kareo Resources page.

medical billing and ehr tips from Kareo

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Patient-Centered Care Goes Beyond the Exam Room

Lea Chatham August 20th, 2013

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It is easy to think that patient-centered care all takes place in the exam room. Whether it is the Patient Centered Medical Home (PCMH) or other care coordination and meaningful use programs, the focus is on building a relationship with a primary physician, improving access to that physician or clinic, and coordinating patient care more effectively. But there is really more to it than that.

Patient-centered care is about the entire patient experience. It is designed to improve care and to reduce costs through a wide range of activities across your practice and throughout the healthcare system. As you can see in this graphic, a critical piece of the puzzle is improved practice management, billing and use of technology.

patient-centered care information from Kareo

Essentially, when you choose to participate in a model like this one you are optimizing your practice. Even if you aren’t ready to try to qualify as a PCMH, these strategies can help you improve care so that you can be more competitive in a healthcare market that is more driven be patient satisfaction than ever before. Improved patient engagement, access to medical records via a portal, more open information about cost, and electronic prescribing are just a few of the things patient say that they want.

If it seems overwhelming and you are wondering where to start, consider the area where you already have experience and expertise—billing. Improving revenue and optimizing coding and billing are areas where you can already easily run reports and conduct an analysis of your business. Set clear best practice goals and begin to work towards achieving them one but one. There are general standards for best practice billing across the healthcare industry. Considering using these are your goals:

  • Less than 40 average days in A/R
  • Less than 12% average days in A/R over 120
  • No more than 4% total unpaid claims
  • 96-98% net collection rate
  • 5% or less denial rate

There are many strategies you can use to achieve these results. For some guidance on improving one or all of these areas, visit Kareo’s Resources page, which offers educational webinars, white papers and short videos on these and other topics. You can also register there for our upcoming webinar, The Patient-Centered Practice.

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Free Webinar: The Patient-Centered Practice

Lea Chatham August 15th, 2013

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Judy Capko discusses patient-centered care and programs for Kareo
Wednesday, August 21, 2013
1:00 PM EDT/10:00 AM PDT
Speaker: Judy Capko

Medical practices across the country are experiencing new requirements and changes in compensation based on healthcare reform. Meaningful use is already being addressed as everyone adjusts to implementing electronic health records, but more is on the horizon. There are specific standards for the Patient-Centered Medical Home (PCMH) that will affect practice revenue. This presentation will discuss the rationale behind this focus, what is required, and how to implement a successful patient-centered program that improves the patient experience. You’ll learn about:

  • The seven guiding principles of the PCMH
  • Key program standards and metrics used to determine and measure success
  • How technology contributes to efficiency and reporting needs
  • Appropriating payment based on value-added components
  • And much  more

Register today!  You don’t want to miss this.

Who Should Attend Private practice owners, practice managers, billing managers and others concerned about adapting to changes in the healthcare industry.

Judy Capko discusses patient-centered care and programs for Kareo

About Your Speaker:

Judy Capko discusses patient-centered care and programs for Kareo

Judy Capko is a practice management and healthcare industry consultant with Capko & Company. Judy is the author of Secrets of the Best-Run Practices, a best-seller in the healthcare market. Her consulting focus is on building patient-centered strategies, improving leadership and valuing staff’s contribution.

Judy Capko discusses patient-centered care and programs for Kareo

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Check Out Great Practice Management Tips in August Newsletter

Lea Chatham August 13th, 2013

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The August edition of the Getting Paid Newsletter is packed with information about patient-centered care, preparing for ICD-10, upcoming events, and more. The newsletter provides a chance to catch up on some interesting industry news, get medical billing tips, and find out how you could win for connecting with Kareo on social media channels. You’ll discover more about how to register for our upcomg free educational webinar, Patient-Centered Practice: Guiding Principles for Changing Times presented by Judy Capko. Read all this and more now!

Practice management and medical billing tips from Kareo

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6 Steps to Prepare for ICD-10 Documentation

Lea Chatham August 13th, 2013

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By Lisa A. Eramo

Long gone are the days when medical record documentation was something for physicians’ eyes only. The words that physicians write or type into patients’ medical records are increasingly scrutinized by payers, auditors, and regulators.

This scrutiny will become even more apparent when ICD-10-CM/PCS goes into effect October 1, 2014, says Sandra Draper, RHIT, CCS, director of education and development at Precyse, which provides specialty-specific ICD-10-CM/PCS education and documentation audits for practices nationwide. Draper provides several steps for how to evaluate whether your documentation will hinder your practice or help it thrive going forward.

Step #1: Trend your current denials, and do something about them now. For example, many physicians don’t realize that an incorrect first-listed diagnosis can drive medical necessity denials. This will only worsen with ICD-10-CM when codes are more specific. Trending denials, improving documentation, updating superbills, and keeping a closer eye on payer communications can help today and going forward.

Step #2: Know how many unspecified codes your practice reports. Payers have never been fond of unspecified codes, and they may not tolerate them at all in ICD-10-CM. For example, most superbills list ICD-9-CM code 250.00 (uncontrolled diabetes mellitus, type 2, without mention of complication) as a valid option. However, physicians need to understand that this highly popular code translates to ICD-10-CM code E11.9 (diabetes mellitus, type 2, without complications) – an unspecified code. Payers may deny payment for insulin pumps and other services unless more specific information is provided via the codes.

Step #3: Map your superbill to ICD-10-CM. Mapping your most often-used ICD-9-CM codes to ICD-10-CM can highlight differences and help you familiarize yourself with the new code descriptions. The Centers for Disease Control and Prevention released the 2014 ICD-10-CM code set in July. Pull a sample of charts for each diagnosis to determine whether current documentation includes key words to support assignment of these codes.

Step #4: Consider hiring a clinical documentation improvement (CDI) specialist or consulting company that can help audit your documentation more formally. A CDI specialist is someone—often a nurse or certified coder with a clinical background—who can help physicians improve their documentation so that it accurately reflects patient severity of illness while also meeting regulatory requirements. Although ICD-10-CM won’t require physicians to change the way in which they document, it does require them to be more mindful of specificity. Accountable care organizations (ACO) are engaging CDI specialists to ensure that physicians in affiliated practices are documenting appropriately; however, individual practices can also hire these specialists.

Step #5: Work with your electronic health records (EHR) vendor, but don’t think of the technology as a panacea. The EHR will not solve current documentation problems, nor will it automatically ensure that documentation is up to par for ICD-10-CM. Although templates can be helpful in terms of prompting physicians to document details necessary for the new coding system, physicians must have a basic understanding of what’s required.

ICD-10-CM will undoubtedly affect all physicians; however, some specialties may be hit harder than others. Orthopedics, cardiology, urology, and pediatrics will see the most significant changes. Family practice and internal medicine will also feel the brunt of the changes simply because those working in this setting treat a broader base of patients. Inquire whether your vendor can assist with building specialty-specific templates with ICD-10-CM in mind.

Step #6: Begin testing with payers as soon as possible. Despite payer readiness, very few physician practices are actually testing ICD-10-CM/PCS transactions and documentation. Testing is crucial because it can identify potential challenges in advance and before cashflow becomes problematic.

So how do you get the ball rolling? First, contact your vendor to find out when your software will accommodate ICD-10-CM codes for testing purposes. Next, contact your clearinghouse(s) and/or specific commercial payers and ask about what help they can provide. The sooner you begin, the more time you will have to get ready.

About the Author

Lisa Eramo Freelance

Lisa A. Eramo ( is a freelance writer and editor based in Cranston, RI who specializes in healthcare regulatory topics, health information management, and medical coding.

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What’s All the Hype about Being Patient-Centered?

Lea Chatham August 13th, 2013

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By Judy Capko

Judy Capko discusses patient centered care for Kareo

Patient-centered? “Of course I’m patient-centered” a physician recently told me. That’s why I’m a doctor. “Since he is a client and I have seen him in action, I couldn’t agree more. He treats his patients well; he is precise, is a great diagnostician and communicates well with his patients. He enjoys his patients and it shows. So should he be concerned about all the hype coming our way with government mandates that focus on providing patient-centered care?

Most healthcare professionals assume they are patient-centered and they will confidently defend this. The problem is each person’s view is subjective and their actual description of what it takes to be patient-centered is quite different. Another equally important consideration is that although physicians and their practice team believe they are patient-centered they may never have talked about it or set specific criteria to deliver it consistently.

It’s a brave new world. Healthcare reform has moved the patient-centered concept to a new level. In the future physician payments from CMS, The Center for Medicare and Medicaid Services, will be based on meeting certain patient care and patient service standards. Patients are now completing surveys to rate the patient experience based on a specific date of service.

CMS does not stand alone in this effort, many private health plans are moving forward with their own initiatives that adjust payment, sometimes offering and added payment bonuses, based on physician ratings.

The most important thing a medical practice or other healthcare organization can do to adjust to this new payment arena is to be prepared. Find out as much as you can about the patient-centered initiatives that impact you and take strategic steps to ensure you are ready for the patient-centered movement. Communicate with your staff and help them understand what is needed to ensure patient care and service is not compromised, no matter how busy the day is.

Line-staff can be so wrapped up in the technical details of what must be accomplished with each patient’s visit that it can be all too easy to forget to properly greet the patient, smile and make them feel welcome—steps that greatly impact how the patient rates their experience. Just think about all the steps employees must complete related to each patient visit:

  • Appointment reminders;
  • Completing patient check-in;
  • Updating insurance information;
  • Collecting co-pays;
  • Answering patients questions;
  • Obtaining an accurate patient history—the reason for the visit and related symptoms;
  • Rooming the patient and making sure they are doctor-ready;
  • Providing post visit instructions;
  • Scheduling ancillary studies; and
  • Scheduling follow-up visits.

It’s easy to see how managing on all these details can become the primary focus of the interaction with the patient, but these are not necessarily what the patient sees as being the primary reason they are satisfied with their patient visit. They want to feel important and be reassured. They want to know you care about them as individuals, and they don’t want to have to wait for an appointment when they are sick.

There are some things you may not even realize can turn an appointment south. For example, the visit will not be viewed well by a patient if they are not properly greeted or if the doctors asks “so why are we seeing you today?” He explained this at the time he scheduled the appointment and just finished repeating it (in detail) to the nurse when he was roomed. His confidence may wane as he wonders why this practice isn’t communicating better and may even wonder if this practice has its act together.

Here are a few things you can do to engage the patient, make him feel more comfortable and make the patient experience much better.

  1. Introduce yourself to new patients
  2. Repeat the patient’s name throughout the visit
  3. Have a morning huddle where you review the schedule and get a clear understanding of why each patient is coming in
  4. Reassure patients that seem anxious, especially when they are new patients. Let them know they picked the right practice and are in good hands. Front desk staff can reduce the patients’ anxiety by simply saying, “Our patients love Dr. Nice and I am sure you will too.” Also, give them an idea how long the wait will be once they are roomed or let the know what to expect. For example, in a retina practice let them know if you will be doing preliminary tests before they see the physician and how much time is involved.
  5. Read the chart note before entering the exam room.
  6. End each visit by saying thank you and asking if there is anything else you can do.

These simple steps are a great beginning for making the patient feel important and also contribute to grounding the patient relationship and improving patient compliance.

Technology will also play an important role in reaching high performance levels with patient care and patient service as it relates to being more patient centric. To learn more, watch my recent Patient-Centered Practice webinar.

About the Author

Judy Capko discusses patient centered care for Kareo

Judy Capko is a practice management and healthcare industry consultant with Capko & Company. Judy is the author of Secrets of the Best-Run Practices, a best-seller in the healthcare market. Her consulting focus is on building patient-centered strategies, improving leadership and valuing staff’s contribution.

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Online Patient Engagement & HIPAA

Lea Chatham August 8th, 2013

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Yesterday, Physicians Practice and Kareo hosted a webinar where Dr. Tom Giannulli discussed the importance of patient engagement and how practices can use technology to improve it. His focus was on using electronic health records (EHR) and patient portals to help patients get more involved in their own care, improve the actual visit, and extend the connection outside of the practice.

There were several great questions from attendees about privacy and security and how you utilize some of the tools patients want while ensuring that you are also HIPAA compliant.

The fact is that patients want their physicians to use an EHR. Two out of three people would consider switching to a physician who provides secure access to their medical record online.[i] In studies almost the same number of physicians believe this is beneficial, but many are still hesitant to adopt portal technology.

Regardless of your feelings about adopting Health IT, you can’t change the tide, and it is moving in the direction of more connectivity with patients. Practice management and EHR vendors know this and have been working to develop secure, compliant solutions that will enable practices to interact more with patients online.

“We take security and privacy very seriously,” said Dr. Tom on the webinar. “Our solutions use several features to ensure that practices can use them and stay compliant, and this is pretty standard across the industry.” These features include user name and password protected access to the patient portal, password protected and permission-based access to the EHR itself in the practice, and the ability to track records access in the practice through an audit trail.”

Dr. Tom does caution practices to keep HIPAA regulations and other considerations in mind when communicating electronically with patients. “Emailing with patients can open a can of worms if you aren’t careful,” he says. “It’s important have a clear policy in place that is shared with patients and defines what kinds of communications are ok via email, your response time, when they should call the office directly, etc. And you need to consider whether or not you’ll get paid for this service. It can take up a lot of time and may not be worth it right now if you can’t get reimbursed.”

Reimbursement for e-visits is in its infancy. There are some payers who will reimburse a small amount for email visits and others that are considering it. To find out more, each practice needs to look at their payer contracts or contact payers directly. It’s also important if you are using email to communicate and not messaging through a secure portal that you alert patients to the level of security and get them to sign off on any non-secure communications. There are some third-party software solutions that can secure your email and create what is essentially a password protected portal for patient communications.

Fear of security and privacy issues is not a reason to avoid implementing a portal or other online communication tools with patients. Just be sure you that you have clear policies in place, the solutions you choose are compliant, and you communicate your capabilities and what patients should expect clearly.

To hear more of what Dr. Tom had to say about patient engagement and heads-up medicine, check out the recorded webinar on Physicians Practice today.

About the Speaker

Tom Giannulli, M.D., M.S. is the chief medical information officer at Kareo. He is a respected innovator in the medical technology arena with more than 15 years of deep experience in mobile technology and medical software development. Previously, Tom was chief medical information officer at Epocrates and he was the founder and chief executive officer of Caretools, which developed the first iPhone-based EHR. Prior to that, Tom drove a number of key mobile healthcare technology innovations as VP of Advanced Research for Data Critical and the founder and CEO of Physix. He holds a M.S. in biomedical engineering from the University of Utah and earned his M.D. from the University of Texas at Houston where he completed his residency in internal medicine.

[i] 2011 Survey of Health Care Consumers in the United States, Key Findings, Strategic Implications, Deloitte Center for Health Solutions, 2011

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