Your Top 5 Customer Service Questions Answered

Lea Chatham September 30th, 2013

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Rochelle Glassman discusses the impact of customer service on medical practices

As a follow up to our recent webinar, How Customer Service Impacts Your Bottom Line, speaker Rochelle Glassman and Kareo have answered the many questions posed by participants. Here are the five most common questions you asked:

Q: How do you deal with patients who cancel appointments regularly?
A: Patients who cancel appointments or surgeries at the last minute can be a huge drain on your practice’s cash flow. Consider implementing a strategy to prevent unexpected holes to minimize the impact of last minute cancellations and no shows on your medical practice.
Set a cancellation policy, and be sure it’s communicated to every patient. Ideally, this takes the form of a document that new patients sign when they first come to the practice. Afterward, make it a point to discuss your policy at the time of booking subsequent appointments or surgery, and when reminder calls or emails go out to patients.
In the cancellation policy, many practices require patients to cancel their appointment at least 24 hours before their scheduled appointment time. For surgeries, the required notice time can be even longer. For those patients who do not comply, consider charging a late cancellation fee.
Collecting cancellation fees can be achieved much more easily than you think when your office is set up to bill for cancellations and accept credit card payments. By creating a cancellation code, you can bill the patient using electronic statements. The day of the cancellation or no-show, process a patient statement and direct the patient to pay online by credit card. Enabling patients to pay online can increase patient payments and speed the turnaround on those payments whether it is for the cancellation fee or for standard co-pays and deductible payments.

Q: What is the best way to address patients who keep calling regarding the same bill even after explaining the bill to the patient?
A: Healthcare reimbursement and payment processes are complicated and often patients do not understand their payment obligations. I would recommend that  prior to treating the patient a staff member (financial counselor) explain to the patient their financial obligations (how much they have left to pay prior to meeting their annual deductible, copayment, non-covered services and percentage of the payment the patient is responsible for, etc.). I am a huge advocate of explaining the potential costs upfront rather than having a confused, upset and often angry patient after the fact. Regardless of your efforts to explain the patient’s financial obligations to the patient they still may not understand the payment obligations under their insurance plan, especially  elderly patients who will always need you to explain things more than once. However, if this is a common problem, it may be your staff who are not clear with their communication or how they are explaining the patient’s statements. I always recommend asking patients as you talk if they have questions, do they understand what you are covering, etc. If it is a common problem, you might ask someone to be a test case and call in to ask questions to your staff about their statement. Then, have that person tell you if there were areas where things were not explained well or if something caused confusion. That will allow you to address those issues.

Q: I want to provide good customer service but I also want to ensure HIPAA compliance. How do I do this with phone calls? Is there a best practice for leaving messages?
A: As part of your new patient documentation you need to provide patients with options on how they would like the practice to handle any type of communication related to their treatment and test results. It is recommended that a document be prepared allowing the patient to identify approved methods of communication. This may include but not be limited to email communication, leaving messages at certain telephone numbers, who the practice can speak to related to the patients care, would they prefer communication via text or even snail mail. It is important that the patient sign this document on an annual basis as their circumstances may change.

Q: What is the most diplomatic way of curbing employee gossip, especially when the owner is involved?
A: All new employees on their first day of employment before they start their training or job tasks they must review the practice’s employee handbook. All employees must read and sign an acknowledgement form that requires them to follow all the practice’s policies, procedures and behavior requirements. The employee handbook should also detail the disciplinary action the practice may follow should the employee not follow the policies. It is important to be consistent with your performance expectations and follow the guidelines in the handbook. It is a huge challenge to correct an issue when the owner is part of the problem and not the solution. I would recommend that you meet with the owner first and explain the situation and go over the corrective action plan you would like to implement and make sure you have the owners buy-in and support. If not, the entire exercise is futile and you will be undermined by the owner. If the owner does agree to be part of the solution, I would meet with all the staff and go over the practice’s policies and expectations related to professional behavior and what the consequences maybe if the policies are not consistently maintained. If the gossip continues beyond this point, I would deal with the individual employee based on your established policies, which may include disciplinary action up to and including termination.

Q: You said we don’t want patients to be kept waiting and then you said consider double booking. What happens when everyone shows up and you fall behind?
A: I recommend double booking as an option when you have done an analysis on your no shows and identified patterns that indicate predictable gaps in your schedule. For example, if you know that 30% or more of your Medicaid patients don’t show up then you might consider double booking some of those slots. If you find that you double book and everyone shows and you are running behind, apologize to the patient and let them know you are running behind and they will be seen in XX minutes.
If the owner is not willing to change then you have a problem because without the support of the owner it is very difficult if not impossible to implement change.
If your practice identifies a cancellation or no show pattern, for example on average one is every six patients do not show up. I would recommend that the practice double book every sixth patient to maintain cash flow.

If you missed this great webinar, you can view the recorded event or check out the slides.

About the Speaker:

Rochelle Glassman discusses the cost of bad customer service for Kareo

Rochelle Glassman, a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. Rochelle is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

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What Does the Future Hold for EHR?

Lea Chatham September 25th, 2013

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Technology changes and improves so quickly these days that it is hard to keep up. This is especially true in healthcare. Twenty years ago who would have thought you could use an iPad to document patient visits or take vital signs and download them directly into your EHR. Today, we are hearing about tools like Google Glass that may allow a physician to wear a headset that shows your patient chart or enables the doctor to conference in another provider while talking to you in the exam room.

In several recent studies, physicians have said that they want access to a full EHR on an easy to use mobile device. These solutions are now available, and it is one of the factors driving what Black Book Rankings is calling the year of EHR switch.

In a series of short videos, Dr. Tom Giannulli, Chief Medical Information Officer at Kareo, has been talking about that state of EHR and ways you can use your EHR to engage patients and improve their health. In his third video he talks about what he sees happening in the future with EHR and mobile technology.

Tom Giannulli talks about the future of EHR for Kareo

To watch the full video, check out Heads-Up Medicine: The Future of EHR and Mobile Technology in Healthcare.

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ICD-10 Training: What You Need to Know

Lea Chatham September 23rd, 2013

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By Lisa A. Eramo

CMS has been clear about the fact that October 1, 2014 is the big day for ICD-10. Yet many physician practices are still lagging behind in terms of training, says Deborah Grider CCS-P CDIP CPC CPMA CPC-H CPC-P, senior manager of revenue cycle at Blue and Company in Indianapolis, Ind. and an AHIMA ICD-10-CM/PCS-approved trainer.

Grider, who provides ICD-10 specialty-specific training for providers and staff in the practice setting, says ongoing education is a crucial part of successful implementation. She offers insight into what practices need to do now and how much it may cost.

ICD-10 training: The Who
Many physicians incorrectly assume that only coders require ICD-10 training. However, ICD-10 affects virtually everyone else in the practice, including billers, physicians, secretaries/front desk personnel, and medical assistants. It’s important to understand how ICD-10 may affect each of these roles and then cater training accordingly.

ICD-10 training: The What
Role-based training is the most effective way to prepare your practice. Overall costs for that training will largely depend on the number of individuals who must be trained. Consider the following:


  • Training: Plan for at least two days of in-depth training. The first day should include information about ICD-10 guidelines and code structure. The second day should include hands-on coding using actual case studies. Some coders may also require anatomy and physiology training or at least a refresher. This training is worthwhile because of the clinical and anatomical nature and specificity of ICD-10.
  • Cost: Budget for $695-$1,200 per coder for the two-day training. This fee likely includes a coding manual and workbook. Anatomy and physiology training could cost as much as an additional $1,500 per coder, but it will be well worth the money spent. Also determine whether—and how much—your practice will pay coders for any overtime that’s required to accomplish the training.


  • Training: Plan for a one-day training (6-8 hours) about ICD-10 basics (code structure and logic).
  • Cost: $250-$299 per biller. This fee may or may not include a coding manual and workbook.


  • Training: Physicians require training on clinical documentation requirements related to their specialty as well as tutorials on how to use updated EHR templates that may affect workflow. This training may require one or more days.
  • Cost: $500 per physician.

Secretary/Front Desk Personnel

  • Training: Plan for a one-day training (6-8 hours) about ICD-10 basics (code structure and logic).
  • Cost: $250-$299 per employee. This fee may or may not include a coding manual and workbook.

Medical Assistants

  • Training: Plan for a one-day training (6-8 hours) about ICD-10 basics (code structure and logic).
  • Cost: $250-$299 per employee. This fee may or may not include a coding manual and workbook.

ICD-10 training: The When
ICD-10 training should begin as soon as possible. Not only does this give staff members more time to adjust to the new code set, but it also helps to mitigate any productivity losses during the training period. Training can be incremental and staggered so as not to affect daily responsibilities, particularly in smaller practices.

Proactive training also ensures that practices can find a certified and experienced trainer. Currently, there is a shortage of trainers. Always inquire about a trainer’s specific certification and experience when hiring someone.

ICD-10 training: The Where
AHIMA, the American Academy of Professional Coders, and a variety of other educational providers offer training that is specific to coders, physicians, or office/clinic (non-coding) staff members. Opportunities range from online learning to audio conferences to live events, and more.

Many physicians are also relying on their medical societies for training, some of which may include CME credits. It may be more cost-effective for large practices to bring an ICD-10 certified trainer to build a training program and provide that training on-site.

ICD-10 training: The Why
Most physicians understand the need to train coders, as they are the ones who will use the codes most directly and frequently. Properly trained coders can also help answer physicians’ questions about ICD-10 as they arise.

However, consider the following reasons to train other staff members: 

  • Billers: Billers can use basic ICD-10 coding knowledge to properly handle rejected, denied, or suspended ICD-10 claims.
  • Secretary/Front Desk Personnel: These personnel can answer patients’ basic questions about billing matters or diagnoses. They can also catch errors on a superbill, such as a missing character in an ICD-10 code.
  • Medical Assistants: Medical assistants can properly administer Advanced Beneficiary Notices using correct ICD-10 diagnosis codes. Because of their clinical background, they may also be able to assist physicians with clinical documentation necessary to justify the ICD-10 codes.

Other Considerations
Practices will require a cash reserve to accomplish this training. Set aside the money in advance or establish a loan or line of credit. Keep in mind that the initial training may not be sufficient and that additional training may be necessary after go-live.

AHIMA teamed up with the American Medical Association to provide a physician model for implementing ICD-10 that includes a phased-approach as well as training resources.

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 Is the Future of Medical Reimbursement?

Lea Chatham September 19th, 2013

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Medical reimbursement is changing. Patients are paying more of their costs. Medicare payments are being impacted by your participation (or not) in programs like Meaningful Use, eRx, or PQRS. And, on top of that, there are many new and changing models like Patient-Centered Medical Home, Direct Pay, Concierge, and others. In the 2013 Great American Physician Survey, conducted by Physicians Practice and sponsored by Kareo, several questions were asked about whether or not physicians were interested in these models. Here is a great summary:

2013 Great American Physician Survey sponsored by Kareo

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Top 8 Customer Service Tips from 2013

Lea Chatham September 17th, 2013

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As healthcare becomes more patient-service oriented, we’ve been writing more and more about the important of good service, what the impact is on your medical practice, and how to improve customer service. Here is a recap of some of the great tips from 2013:

  1. Change your attitude and the attitude of your staff. In a recent blog post for Physicians Practice, Audrey “Christie” McLaughlin, RN, discussed this topic. Her main suggestion was simple—be grateful for your patients. Say thank you and let them know that you appreciate their business. Say thank you for coming in, thank you for waiting, thank you for your payment, etc. Having an attitude of gratitude can go a long way towards improving a patient’s experience.
  2. Go beyond how you interact with patients to changing how you interact with each other in the office. When staff chitchat and gossip at the front desk or in the halls, patients can hear them. You may need to create a personnel policy about this to reinforce its importance. How patients see staff interacting and behaving impacts how they perceive their professionalism. And remember when it comes to staffing, you are looking for quality personnel. They should want to be professional and good at what they do. If there is an issue that is affecting how patients perceive your practice, your staff should want to change it!
  3. Change your physical environment. By removing clutter and paper, you can create a nicer physical space. You heard me right, remove paper. Walls of charts look outdated and create a perception that you are not up-to-date with the times. Just one more reason to consider going paperless with an electronic health record. Other things you can do to improve your space include removing walls or partitions between the front desk and waiting room and seeing patients in an office for a consultation and moving to an exam room for the physical examination.
  4. Greet patients warmly. Nothing can turn a patient off more than arriving in your office, only to be ignored by the receptionist. Be sure your front line staff members greet visitors warmly as soon as they reach the front desk. Train back office or clinical staff to greet visitors if they see the receptionist is on the phone or attending to another patient when a new visitor presents.
  5. Stay on schedule. No one likes to be kept waiting, and lengthy wait times are one of the most common patient complaints. If the clinical staff is running behind schedule, make sure to inform your patients, apologize for the delay and give an estimated waiting time.
  6. Reassure patients who 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.
  7. Smile. It can be as simple as training your front and back office staff to greet patients by name, smile and end any conversation with simple phrases such as, “was I able to answer all your questions?,” “Is there anything else I might assist you with?,” or “I hope you have a pleasant day and please do not hesitate to call us with any questions you might have.”
  8. Don’t multitask. Your first line of communication, the telephone, should be answered by a friendly employee who is not multi-tasking. Patients can tell when they are not first priority. Have your staff smile when they speak on the telephone. Your gestures are conveyed through your voice.

For more on improving the patient experience, read these and other blog posts here.

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Free Webinar: Customer Service and Your Bottom Line

Lea Chatham September 13th, 2013

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Wednesday, September 18, 2013
1:00 PM EDT/10:00 AM PDT

Speaker: Rochelle Glassman

Did you know that losing a patient because of poor customer service could cost you a minimum of $25,000 to $100,000 over the lifetime of your patient’s care? Historically, employees in small to midsized practices don’t receive training in customer service. Patients may not be acknowledged right away at check in, or they aren’t greeted warmly. Perhaps they are left waiting after check in for an extended period of time without explanation. In this webinar, Rochelle Glassman will talk about how to train your staff on customer service to improve patient retention and how to terminate a patient when all else fails. By the end of this event you will learn how to:

  • Create customer service policies
  • Choose and hire the right staff
  • Train staff for customer service
  • Greet and treat patients
  • Handle difficult patients
  • And more!

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

Who Should Attend Private physicians, practice owners, practice managers, billing managers and others concerned about staying competitive in a patient-driven marketplace.

Rochelle Glassman discusses the cost of bad customer service for Kareo

About Your Speaker:

Rochelle Glassman discusses the cost of bad customer service for Kareo

Rochelle Glassman, a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. Rochelle is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

Rochelle Glassman discusses the cost of bad customer service for Kareo

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Where Is Medicare Headed?

Lea Chatham September 12th, 2013

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It seems the reports of Medicare’s demise have been exaggerated. Those who thought that Medicare might be going the way of dinosaur may be surprised to learn that a recent brief compiled by the Department of Health and Human Services (HHS) indicates that not only is Medicare going strong, but more physicians are accepting Medicare today than in 2005. In 2012, 90.7% of office-based physicians reported accepting new Medicare patients compared to 87.9% in 2005.

The 2013 Great American Physician Survey, conducted by Physicians Practice and sponsored by Kareo, found similar results when it surveyed nearly 1,200 physicians. Only 19% said that they didn’t accept Medicare at all. A small percentage were closed to new patients or considering dropping Medicare in the future, but the majority were still accepting new Medicare patients and planned to keep doing so.

The HHS brief also found that the number of providers accepting new Medicare patients was equal to or even a little higher than those accepting new patients with private insurance. This may not be surprising since Medicare enrollment is increasing as baby boomers reach the qualifying age and enroll in Medicare at rates higher than ever before.

Despite the fact that physicians continue to accept new Medicare patients, some experts believe that there are still challenges for physicians that can create barriers for patients. “Payment rates may be stingy compared to private reimbursements, but few physicians can afford to disengage from Medicare,” David Howard, PhD, associate professor of health policy and management at Emory University in Atlanta, said in an article in MedPage Today. “It covers too many people (46 million) and there are too many dollars at stake (over $550 billion).”

The unfortunate result according to the article is that physicians may be accepting new patients but limiting how many appointments they have open for Medicare patients. This can mean longer wait times—a higher number of Medicare patients said they had an unwanted delay in getting an appointment according to the HHS brief.

A recent survey from Black Book Rankings presented insight into what the solution might be—seamlessly integrated practice management, electronic health records, and revenue cycle management solutions. This poll surveyed 8,000 physicians and medical professionals and found that 87% of all physician practices agree their billing and collections systems/processes need upgrading and 89% of those state a preference for a single source vendor for all RCM PM and EHR modules.

The fact is that by streamlining practice management, billing, and EHR, practices can potentially increase the number of patients they can see in a day and see an annual increase in overall collections of 11% according to the Medical Group Management Association.

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Don’t Miss Medical Billing Tips in Getting Paid Newsletter

Lea Chatham September 11th, 2013

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The September edition of the Getting Paid Newsletter is packed with information about customer service, meaningful use, 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, Customer Service and Your Bottom Line presented by Rochelle Glassman. Read all this and more now!

September 2013 Kareo Getting Paid Newsletter

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Your ICD-10 Questions Answered at Kareo TweetChat

Lea Chatham September 10th, 2013

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On Tuesday, September 10, Kareo hosted a live, interactive Tweet Chat about ICD-10. Kareo staff, industry experts, and medical practice staff joined the conversation and answered a lot of questions about ICD-10 and its impact on small, independent practices. For the full transcript check out #KareoChat. Here are some interesting highlights:

  1. What are some tips on preparing for ICD-10?
    - @CapkoandCompany – Get started.  Remember the old line “How do you eat an elephant? One bite at a time” applies here.
    - @Brad_Justus – You Need To Complete An IT, Operations & Finance Assessment Immediately.
    - @modmed_EMA - At this point you should begin asking your clearinghouse, health plans and PM/EMR vendors about ICD-10 readiness as well
    - @CapkoandCompany – Get them learning, do dry runs — e.g., do an ex where you recode a day’s tix, see where documentation is short
  2. Will “unspecified codes” in ICD-10 cause issues for reimbursement.  How do you get physicians to document better? I was informed that unspecified codes will not be reimbursed at all.
    - @modmed_EMA – Smart technology will take care of this.  Otherwise inform them with materials on the increase of audits. I would avoid unspecified codes when you can.  Some believe it will cause a  request for notes. #kareochat #ICD10
    - @GoKareo – ICD-9 allows non-specific codes and will often get paid by the payer. ICD-10 is designed to provide a higher level of specificity that providers will have to learn. There are unspecified codes in ICD-10 & just like ICD-9, there are necessary uses – just be selective.
  3. Recommendations for training and change management
    - @Brad_Justus – It is important to establish a physician champion who can help with education & compliance
    - @CapkoandCompany – EHR vendors can help, but it’s important not to rely on that completely.  Providers still responsible for coding.
    - @Brad_Justus- Every facility should have already established a steering comittee with major stake holders in IT, Finance & HIM
  4. @RobPickell – ICD-10 CM has 68,000 codes. Smaller practices will need to leverage smart technology to make sense of this level of complexity.
  5. @CapkoandCompany - Practices have to prepare for a few months of lower cash flow.

This is just the tip of the iceberg! The conversation provided many great tips and insights. Find out more by checking out the full chat.

Stay in the know on more events (or share ideas for topics) by becoming a fan on Facebook or Twitter.

Kareo tweetchat on ICD-10

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Meaningful Use – Is It Now or Never?

Lea Chatham September 9th, 2013

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Small practice guide to meaningful use

Now or never may be too strong a statement, but the fact is that providers are running out of time to avoid the first Medicare penalty, which will start in 2015 for those who did not attest for Meaningful Use by October 1, 2014. If you plan to attest in 2013 or 2014 so you can get the incentive and avoid that penalty, you need to get started. You must report for 90 days, which means the latest you can get started is July 1, 2014.

If you haven’t begun, you aren’t alone. There are many providers who have put off attestation. According to the Center for Disease Control’s National Center for Health Statistics (NCHS):

  • 72% of physicians use EHR, but only about 40% meet the criteria to attest for Meaningful Use.
  • Just over 65% of office-based physicians have applied or plan to apply for the EHR Incentive program.

Providers cite cost, burden of implementation, concerns about ease of use, and the potential impact on productivity as their main concerns about EHR. These issues seem to outweigh worries about the impending financial penalty from Medicare for those who don’t participate in Meaningful Use.

Perhaps this is because Meaningful Use itself seems overwhelming, an attitude that adds to the overall perception that the burden of an EHR is higher than the benefits. But EHRs are about more than just Meaningful Use—nearly 70% of physicians believe that the patient care benefits of an EHR outweigh its costs. And ultimately EHRs are what patients want. In fact, according to the Optum Institute:

  • 62% of patients want to correspond online with their primary physician about their health
  • 65% of patients want appointment reminders via email
  • 75% of patients are willing to go online to view their medical records

Research conducted by the Deloitte Center for Health Solutions indicates that two thirds of patients surveyed would actually consider switching to a physician who offers access to medical records via a secure internet connection. This is no small number.

Patient expectations are changing and healthcare providers will have to change as well. If you need to meet the rising demands of patients anyway, why not get an incentive for doing it? If you are struggling to get started, download the new Small Practice Guide to Meaningful Use for guidance and useful links.

Note: This Meaningful Use information is subject to change. For the latest updates, visit

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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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