Can Small Practices Stay Independent?

Lea Chatham October 7th, 2013

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Kareo is number 1 in Black Book Rankings

There has been a lot of debate recently about the future of the small medical practice and whether these practices can stay independent in changing times. According to some recent studies, technology may be the key to helping these medical professionals maintain their independence and even thrive despite the challenges.

There is no doubt that electronic health records are full of promise. Study after study shows that even though physicians don’t think we are quite there yet, most believe that EHRs have the potential to improve care and reduce costs. But it will take more than EHRs to streamline practices and allow them to improve and/or maintain revenue. In the 2013 Black Book Rankings Survey, over 8,000 physicians and healthcare staff contributed their perceptions. There was a clear trend in their responses. Practices today are using outdated IT solutions, they believe that seamlessly integrated practice management, EHR, and billing solutions are the best bet to help them survive changing times, and many are ready to make a change to a single vendor solution. Here are some of the key findings:

  • 87% of all physician practices agree their billing and collections systems/processes need upgrading
  • 92% of those seeking a PM upgrade are only considering an EHR centric module
  • 71% are considering a combination of software and outsourcing services to improve revenue cycle management
  • 89% of those state a preference for a single source vendor

The reason behind the shift appears to be the desire of small practice physicians to stay independent. About half of all physicians work in practices with fewer than five physicians according the CDC Center for National Health Statistics. While some small practices are selling out to larger practices or hospitals, many want to remain independent. In the 2013 Great American Physician Survey, conducted by Physicians Practice and sponsored by Kareo, nearly 50% of physicians said they wanted to be practicing the same way five years from now.

Find out more about how to maintain your independence as a small practice in the upcoming event offered by Kareo and Physicians Practice, 4 Ways to Keep Your Practice Independent on November 7.

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How Many “Views” Are There for Your EHR Documentation?

Lea Chatham October 7th, 2013

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Barbara Drury discusses EHR documentation for Kareo

In the paper chart world, we’re used to acceptable practices to create ‘good documentation’, such as timely completion, permissions, signatures, a date, and chart tabs that kept contents in reasonable chronological order. For better or worse, that allowed the next reader of the chart, whether in your office, another care provider outside your practice, an insurance payer or an attorney, a framework that could be used to establish a sequence of care. And if there had been a correction or addition or deletion, it was easy to see because providers have been instructed to do a single-line strike through, insert the change and initial and date the change.

In the EHR world of today, some of the traditional acceptable practices don’t translate well. For example, most EHRs do not have a technical tool that permits a user to draw a line (a series of computer pixels) through previously captured documentation. Rather, an amendment becomes another “version” or another “document” which may or may not be attached or associated with the original version of the documentation.

In an EHR, even documentation without changes is presented in a wide variety of possible “views”. Do you know how many “views” your EHR is capable of creating for just one encounter? Here are a few examples:

  1. The entry view as displayed on the screen, which usually shows drop-down options, expanded choices, text entry boxes, etc.
  2. The entire encounter documentation, which might include all the components of a SOAP note including chief complaint, history of present illness, medical history, surgical history, family history, medication history, allergy history, subjective information such as vital signs, review of systems, and the provider’s plan of what to do next for the patient (order tests, make a referral, discharge from care, admit to a hospital, etc.).
  3. Visit Summary printout that is given to the patient at the end of today’s visit, which may not repeat all the history elements (patient knows his own history) but only includes the CC/HPI, and Plan.
  4. Referral, which may include everything just as it was in the entire encounter documentation, or may differ depending on whether the referral is a transfer back to the original physician or  making a new referral to a physician without any prior knowledge of the patient.
  5. Continuity of Care Document (CCD) where the content is dictated by an electronic format, often without opportunity for users to see or to edit.
  6. All or selected information presented for the patient to view through a patient portal or download to a thumb drive or a personal health record.

This is a new era where providers must take into consideration who will see the documentation and how they will see it. Ask yourself what views your EHR may have and does the view reflect the appropriate information for the type of viewer or are there inclusions or omissions that could present a problem—either in care or in an audit or litigation situation? You may find it is time to make some changes.

If you are interested in learning more about which views are used for what reasons and how providers can adhere to best practices for all these view, join me on October 23, 2013 for the free webinar EHR Documentation: Truth or Consequences. I’ll share insights to help you ensure that your EHR documents and reflects the entire and appropriate version of the care provided.

About the Author

Join Barbara Drury to find out what you need to know about meaningful use now

Barbara Drury, BA, FHIMSS, is President of Pricare Inc., an independent health information technology consulting firm founded in 1982. She frequently lectures and writes about the impact of office-based computer systems and electronic medical record systems for entities such as medical societies, healthcare organizations, and others. Ms. Drury is an appointee to the ONC’s Technical Expert Panel on Unintended Consequences of HIT Adoption. She has achieved Fellow Status with the Healthcare Information and Management Systems Society (HIMSS) and currently serves on the HIMSS Public Policy Committee. Ms. Drury is also a frequent speaker at the HIMSS Annual Conference and is the recipient of the December 2004 and the April 2009 Spirit of HIMSS award.

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8 Steps to Safely End a Patient Relationship

Lea Chatham October 7th, 2013

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As a follow up to our recent webinar, How Customer Service Impacts Your Bottom Line, speaker Rochelle Glassman answered many questions posed by participants. We recently posted 5 of the most common questions, but we saved a sixth for it’s own post. Many people asked questions related to terminating a patient relationship without putting the practice at risk. There were several possible reasons from unpaid patient due amounts to repeated no shows and rudeness. Here are Rochelle’s guidelines for “firing” a patient.

You can’t refuse to see a patient because they owe you money. This is especially true during a critical stage of treatment or when the patient is in urgent need. You can reschedule a preventive care appointment if they have a balance.

In all patient challenges, the most important goal is to avoid a claim of patient abandonment and liability of a malpractice claim if a patient’s condition should worsen as a result of the urgent care refused to the patient.[1] Regardless of the reason for your issues with a patient, whether it’s unpaid bills, failure to follow advice, or mistreatment of staff, the same advice applies:

  1. Document any issues you are having with the patient. Make sure not to terminate a patient until there is evidence in the record of the problem(s). Patients should be provided with notice of such problem(s) and an opportunity to modify their behavior. If the particular patient’s issue is an unpaid balance, meet with the patient privately and discuss the issue. Can a payment plan be established? Can the patient demonstrate financial hardship that you are able to document? Document your meeting with the patient, the issues discussed, the patient’s response, and the agreed to modifications moving forward.
  2. It is recommended that all financial agreements and payment plans be put in writing, signed by the patient and witnessed by a manager at the practice. If no agreement can be reached regarding payment of amounts due, follow up in writing and let the patient know that unless a payment plan is established by a certain date, the practice will provide notice of termination.
  3. If efforts to establish a payment arrangement are still unsuccessful, you may need to terminate the patient. Always remember that the patient must be provided with sufficient time to find alternative care before termination from the practice. Reasonable notice can vary depending on the patient’s medical condition and the difficulty which a patient may have in finding alternative care. For example, I recommend that an oncologist not terminate a patient for nonpayment of medical bills until the patient has completed the current course of chemotherapy. Alternatively, a patient of an internist who simply comes in when he or she has a cold or other minor issue may require only 30 days’ notice. There may be state-specific laws regarding minimum notice periods and these must also be observed. There also may be payer contractual termination requirements. It’s not your responsibility to make sure the patient has found a new physician, only to provide sufficient time for the patient to do so. However, in certain circumstances, there may certainly be ethical obligations to provide additional assistance to extremely ill patients to secure continued care.
  4. It is the practice’s responsibility to transfer the patient’s medical records to the new practice in a timely manner. Many health plans require that medical records be provided to the new practice at no charge to the patient. It is recommended that you review your payer contract to be sure that you have met your contractual obligations.
  5. Termination of a patient from the practice should not interfere with your ability to turn over the patient’s bills for collection. However, at all times through the termination process and thereafter, it should be the goal of the practice to attempt to establish a payment arrangement with the patient and to determine if there is a documented financial hardship.
  6. In any notice provided to patients, make sure you clearly note the date on which they will no longer receive care and how they can obtain copies of their medical records. You should also offer assistance in locating a new physician, such as providing contact information for a state medical association or similar organization. Most health plans list their contracted facilities and physician groups online. It is recommended that you provide the patient with that information. The patient should understand that in the event of an emergency or urgent situation (which may depend upon specialty), the practice should take the necessary steps to assure the patient is properly cared for.
  7. Like any other business, physicians should not be required to continue to offer services without payment. However, in medicine it’s not all about the bottom line. Take the time to properly handle each patient and to assure their understanding and continued medical care in order to best protect your medical practice.
  8. I would recommend that the practice establish a written standard termination policy for all employees to follow, this established policy will also ensure that the practice is never accused of patient discrimination if all the patients are treated the same way.


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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Credit Card on File Can Cut Medical Billing A/R

Lea Chatham October 2nd, 2013

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In her recent webinar, How Customer Service Impacts Your Bottom Line, speaker Rochelle Glassman discussed her thoughts on using a credit card on file process in your medical practice. It is becoming a best practice in medical billing to use credit on file for payment plans and even for copays and deductibles. Here are Rochelle’s recommendations:

Credit card on file is essentially a process by which you get authorization from a patient to keep their credit card information securely to be used for a payment plan or recurring expenses like copays. I recommend putting a credit card on file process in place at your practice. It has been well established now as a best practice, and it can help reduce A/R and the costs associated with patient collections. I recommend having a clear payment policy in place and using a credit payment agreement and authorization form.

A payment agreement stays in effect until the balance is paid in full. When an agreement is made, it spells out the length of the agreement and the patient signs that agreement with the understanding of the length of the agreement. Recurring payments can be set up using a payment processing service. If you already accept credit cards, your merchant services department may already have a service in place which you can add to your current plan. Many banks such as Chase and Wells Fargo offer this option to their merchants for a monthly fee. This service is also available through other vendors such as Paypal, Chargify and Authorize.net. It is recommended that you send the patient a receipt for the payment(s).

Many people ask if keeping a credit card on file is a HIPAA violation. It is not, but there are security requirements for keeping a credit card on file. The merchant must be PCI DSS (The Payment Card Industry Data Security Standard) compliant. When compliant, you can legally store credit card information, with the exception of the CVV code. You can never, store the CVV code. Your merchant services provider should meet these standards. If a patient is concerned about security, you can assure them that the practice is maintaining security standards and give them a copy of the practice’s credit card security policy.

For more details on using the credit card on file, you can view an earlier webinar I did with Kareo, 3 Innovative Strategies for Increasing Collections. It provides an overview of the process along with other ways to improve collections and reduce medical billing A/R.

About the Author:

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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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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