Your ICD-10 Success Checklist

Lea Chatham November 26th, 2013

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Kareo ICD-10 resources

ICD-10 will affect your software, your superbills, your workflow, your documentation, and more. Use this checklist to help your practice ensure a successful transition.

  1. Review information about ICD-10 published by CMS (
  2. Order new CMS-1500 (02/12) Paper Claim Forms. Medicare will begin accepting the revised form on January 6, 2014 and on April 1, 2014, will only accept the revised form.
  3. Order ICD-10-CM Coding Handbook for training and evaluating the equivalent codes for your ICD-9-CM codes.  Here are a couple of good tools:
    ICD-10-CM 2014 Codebook from the AMA
    ICD-10-CM Mappings 2014 from the AMA
  4. Identify your 50-100 most commonly used ICD-9-CM diagnosis codes and begin identifying the equivalent ICD-10-CM codes.
  5. Review your documentation.
    - Based on your review of the most commonly used ICD-9 codes and the equivalent ICD-10 codes determine if your current documentation will sufficiently allow you to identify the correct ICD-10 code or if you have to modify your current documentation methods, templates, or forms.
  6. Review your current encounter form or superbill.
    - After reviewing your most commonly used ICD-9 codes, identify the ICD-10 codes that you feel would be ideal to add to your superbill. If the volume of codes exceeds your current superbill, then evaluate other options including laminated cheat sheets.
    - If you use a pre-printed paper superbill, make plans to update and reprint. If your practice management system generates your superbill, then plan to create the replacement form as soon as your vendor is ready to support ICD-10.
    Schedule the review of the new form with your provider(s) prior to the transition.
  7. Analyze your workflow.
    - This is a significant change, and you will need to evaluate your current workflow and where there may be delays (documentation, coding, billing, rejections, etc.) to create contingency plans. Here are some examples to consider:
    - Provider taking longer to do documentation and coding.
    - Coders, billers requesting additional documentation from the provider to complete coding and billing.
  8. Conduct staff training.
    - Identify training vendors that are ideal for your practice (i.e., specialty- or role-specific coding training).
    - Order training materials now and reduce the risk of backorders.
    - Schedule your staff training.
  9. Develop a financial plan.
    - Identify current practice budget (monthly) and determine funding options in the event of payment delays (payer issues, rejections, denials, technical issues, etc.). At a minimum plan for three months but have a contingency plan if it lasts longer.
  10. Begin testing.
    - Your practice management and billing software vendor should contact you when clearinghouses and payers are ready to begin testing claims.
    - Submit test claims to ensure accuracy.

For a download of this checklist and more ICD-10 resources, visit

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Free Webinar: Prepare to Profit from the Changing Payment Landscape

Lea Chatham November 25th, 2013

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Karen Zupko advises how to end the year strong for your medical practice

Do you have questions about how new medical practice payment models may affect your practice? Are you wondering if a new model is right for you?

Discover more about the changing payment landscape!
Wednesday, December 4, 2013
2:00 – 3:00 PM EST
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Payment model evolution is unnerving but exciting. New models promise to be a boon for efficient, well-run practices. The key to managing as payment models emerge and transform is to understand your options—and how they can fit with your practice’s strengths, capabilities, and goals. In this event, presented by Medical Economics and provided by Kareo, you’ll learn about:

  • What’s driving the move towards multiple payment models
  • More about the various payment models practices are using today
  • How to match your payment options to your practice type and goals

Who Should Attend: Practice owners/managers, billing managers and staff, and others interested in learning about changing healthcare payment models.

Register now to learn how new payment models may impact your practice


About the Speaker:

Laurie Morgan discusses changing medical practice payment models

Laurie Morgan is a senior consultant and partner at Capko & Morgan. She managed both start-ups and large-scale operations in the media industry before turning her focus to medical practice management. Her consulting focus is on driving and capturing revenue and operating more efficiently. Laurie has an MBA from Stanford University.

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Your 7 Top ICD-10 Questions Answered!

Lea Chatham November 20th, 2013

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Kareo ICD-10 tools

On Wednesday, November 13, Kareo hosted a great webinar, ICD-10: Don’t Freak Out!, presented by practice management expert Rochelle Glassman. Over 700 practice managers, billers, coders, and providers attended this event. Rochelle discussed how to prepare for the coding change AND how to prepare for possible reductions in revenue and productivity. The attendees had more than 50 questions about the content from that presentation. While we’d love to answer them all in this blog, there just isn’t room. So, Kareo’s team picked seven questions that apply to most practices, and here are the answers…

Q: Should we start processing claims with the ICD-10 codes now or do we need to wait until the actual transition date?
A: Overall, you won’t be able to process ICD-10 claims until October 1, 2014. However, please check with your insurance companies as some of the larger companies may offer the option to submit claims with ICD-10 prior to the current implementation date. In the meantime, continue to submit claims with ICD-9. Again, as mentioned in the presentation, please contact any clearinghouses and at least the top 8-10 payers for your organization as soon as possible. Ask for the next steps on how and when submitting ‘practice claims’ with ICD-10 coding can begin. Being proactive today will allow your organization to work out any issues that come up prior to the deadline. 

Q: What do we do about patients with dates of service (DOS) before and after October 1, 2014?
A: You will use ICD-9 for the DOS before October 1 and ICD-10 for the DOS after.

Q: What about Personal Injury and Workers Comp claims? I have seen information that these carriers will continue to use ICD-9 codes. Is that true?
A: These non-covered entities will not be required to change to ICD-10 however they are encouraged to do so. According to CMS, “Because ICD-9-CM will no longer be maintained after ICD-10-CM/PCS is implemented, it is in non-covered entities’ best interest to use the new coding system. The increased detail in ICD-10-CM/PCS is of significant value to non-covered entities. The Centers for Medicare & Medicaid Services (CMS) will work with non-covered entities to encourage their use of ICD-10-CM/PCS.” Please refer to this CMS document, which addresses many common myths and facts about this and other frequently asked questions. (this answer was updated on 11/25/13).

Q: Will I need the ICD-10 Coding Manual even if I have software that gives me the codes?
A: Yes, you should always have the most current coding manual in your practice. You can’t rely entirely on your EHR or billing software. Your coding will be dictated by your documentation and there will certainly be times when you have to look something up or double check to be sure your coding correctly. You’ll want that reference book handy!Keep in mind that ICD-10 has over 68,000 codes.

Q: Can you please go over what specific office documents need to be updated for ICD-10?
A: You’ll need to update your superbill (if paper), order new CMS HCFA 1500 forms, referral forms, x-ray forms, laboratory forms, authorization forms, and any other forms that use diagnosis codes.

Q. When do we start using the HCFA 1500 form?
A: Medicare will begin accepting the revised form on January 6, 2014 and on April 1, 2014, will only accept the revised form. Use up the old forms and purchase the new ones. Be aware that some states will be converting to electronic-only claim submission. This is already mandated in some states.

Q: Since some payers have a very short time frame to send the claims, what do I do if claims are denied due to ICD-10 issues?
A: Check with all of your payers now and review your contracts to understand timely filing issues with ICD-10. The more testing you do ahead of time the better. Your software vendor and clearinghouse should also provide code scrubbing to help reduce problems. It would be wise to use your billing software to closely monitor rejections on a daily basis during the transition so you can fix problems whether they are caught at the software level, clearinghouse level, or payer level as soon as they happen. Your software vendor may also offer a no response tool to track claims that have not had any response in a specific period of time so that you can look into those before the submission period ends. For example, if most of your payers generally remit in 14 days or less then set your no response for three weeks. That gives an extra cushion for the payer but alerts you that you haven’t been paid or received a denial for those claims. For actual rejections from the payer, you’ll need to follow the same process you use now to resubmit them.

If you missed this event, you can view the recorded presentation ICD-10: Don’t Freak Out! For more tools and resources, you can also visit this ICD-10 resource page, or read more helpful ICD-10 articles.

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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Online Billpay: It Just Makes Sense!

Lea Chatham November 18th, 2013

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medical billing online billpay

You’re a small, independent practice. You know the people you serve. But it’s easy to forget that the patients you care for are just like you.

They have jobs, families, and bills to pay, and they manage all those things with the very same tools that you do—smartphones, tablets, laptops, etc. So if you are using online billpay then it makes sense that your patients are too.

But if you haven’t enabled your patients to pay you this way, an opportunity is being lost.

According to US Banker, nearly 40% of people pay bills online. And if you just look at women—who we know make most healthcare decisions and pay the healthcare bills—the number is over 50%! We also know this:

Once a patient walks out the door, the likelihood of you getting paid drops like a hot potato.

Keeping both of these things in mind, one great option is to make sure your patients can pay you online. And not just pay a bill online but store a credit card on file for future charges. Being able to store a card on file and easily make payment arrangements is more important than ever since the Centers for Disease Control’s 2011 National Health Interview Survey indicates that nearly one in three patients are making payments over time on healthcare bills.

Convinced? Here’s what you’ll need to get started:

  1. The ability to email patients when they have a bill;
  2. A way to provide their statements online;
  3. A secure online billpay tool;
  4. And, an easy-to-use option to pay a paper statement balance (by offering a billing code on the statement that they can enter online to pay that particular bill).

Patients are paying a bigger share of their healthcare costs. The AMA’s Health Insurance Report Card showed that they are paying nearly 25% of the amount that health insurers set for paying physicians. And we don’t need a survey to tell us paying copays and deductibles isn’t patients’ highest priority (although there is some research out there if you want it). Luckily, it isn’t their lowest priority either so the easier you make it to pay in convenient ways, the more likely you are to get paid.

Have questions about credit cards and patient collections? We’ve got answers.

Discover more tools to make your independent practice a best practice.

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5 Ways to Nip Workplace Tension in the Bud

Lea Chatham November 14th, 2013

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medical practice management dealing with office tension

It happens to everyone. For some reason you had a conflict with a coworker. Someone was having a bad day or took offense. It was probably a small thing, but it got out of control, and now there is this workplace tension. Sometimes it resolves itself through a joke or light hearted comment from one or the other. Other times it just passes without further incident. But occasionally it gets worse—it takes on a life of its own. The next thing you know you can hardly work together. You spend at least 25% of your time at work so you need to nip this thing in the bud!

In his article 5 Keys of Dealing with Workplace Conflict, Mike Myatt writes, “While conflict is a normal part of any social and organizational setting, the challenge of conflict lies in how one chooses to deal with it. Concealed, avoided or otherwise ignored, conflict will likely fester only to grow into resentment, create withdrawal or cause factional infighting within an organization.”

You said it! So now what? We’ve compiled our own five strategies to guide you in the right direction towards resolving workplace tension.

  1. Keep an Open Mind: Take a deep breath and think about the other person. Was it just a bad day? Or do they have a different point of view? Can you see where he or she is coming from? If you understand the other person’s perspective then perhaps you can find some common ground.
  2. Make the First Move: Someone has to make the first move. It might as well be you. We are all uncomfortable with confrontation, but look at this as an opportunity to grow and hopefully build a stronger relationship with your coworker. Reach out and ask if the other person has time to chat, go for coffee, or have a drink after work. Just the act initiating forward movement can sometimes be enough to diffuse a tense relationship.
  3. Be Respectful: We all have differences and may not always agree, but we can treat each other with respect. Sometimes we just have to agree to disagree. Show your willingness to work things out and your respect for the other person. Being open to fixing the problem can go a long to helping the other person respond in kind.
  4. Own Your Stuff: There is nothing worse than someone who can’t admit when they are wrong, but we all do it now and again. Own it and admit your role in the problem. It will immediately help alleviate some tension and open the lines of communication because you aren’t putting the other person on the defensive.
  5. Use What You Learned: Once you’ve opened the lines of communications and worked through whatever happened, talk about how to avoid the same thing in the future. Use this as an opportunity to strengthen your relationship and build new skills to use in this and other relationships.

While conflict is a challenge, there is always an opportunity in there too. It is a chance for you to look at your role and learn more about yourself, and it is also a chance to learn more about the other person. With all the hours we spend at work, wouldn’t it be nice to have better relationships with our coworkers? The best part is that the more you work to address tension or conflicts quickly, the easier it gets!

If you’re interested in learning more about hiring the right staff for your practice, check out 3 Easy Ways to Hire the Right People at Your Medical Practice.

Discover more tools to make your independent practice a best practice.

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Get Great ICD-10 Tips and Tools in November Newsletter

Lea Chatham November 12th, 2013

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The November edition of the Getting Paid Newsletter is packed with information about ICD-10. The newsletter also 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 upcoming free educational webinar, ICD-10: Don’t Freak Out presented by Rochelle Glassman. Read all this and more now!

Kareo Newsletter ICD-10 Tips

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Why Do You Have to Change to ICD-10?

Lea Chatham November 11th, 2013

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By Rochelle Glassman

Kareo ICD-10 Resources

Screech! We dig in our heels when hearing the word ‘change’ causing an initial reaction commonly known as freak out! After absorbing more of what the ‘change’ means to us, we make a decision to accept or reject it quickly.

Before we freak out it can be helpful to gather more information. A great example of this in our healthcare world right now is ICD-10. It is a bit scary and overwhelming. And I think the best place to start is with some background. Why is this change happening? What does it mean to your practice? What is your next (or first) step?

First, as a healthcare professional, the acronym ICD-10-CM is somewhat familiar. We’ve heard rumblings about an updated diagnosis coding system set coming for a while. So what is it?

Simply stated ICD-10-CM means International Classification of Diseases 10th Revision Clinical Modification. The United States is not adopting this revised structure to drive you crazy. It is time for us to join in the majority of other industrialized nations who have been using this system for many years now.

The fact is that ICD-9-CM is outdated! We must adapt and change to a system that has proven itself to be more comprehensive. While it can be scary, often change is a good thing. This is the case with ICD-10. As E. Hoffer once said, “In times of drastic change, it is the learners who inherit the future!”

The ICD classification system was revised in 1990 by the World Health Organization (WHO) to allow for updated terminology, diseases, technology, ability to expand diagnosis codes, and assigning one code for combined illnesses. For example, one combination code depicting diabetes with its related manifestations. ICD-10 codes may contain up to seven digits or characters, be alphanumeric, and may include laterality to specify right or left side of the body.

On a positive note, the basic steps to find a diagnosis code do not change!

  1. Identify the main term
  2. Find the code in the index to diseases and injuries
  3. Verify the code in the tabular list
  4. Review any applicable Excludes 1 or 2 notes (new definitions for ICD-10)
  5. Assign appropriately

Now that you understand what ICD-10 is, find out more about how to prepare at the upcoming webinar, ICD-10: Don’t Freak Out or visit These tools and events can help you become one of the people who “inherit the future!”

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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Free Educational Webinar: ICD-10: Don’t Freak Out!

Lea Chatham November 8th, 2013

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ICD-10: Don’t Freak Out
Wednesday, November 13
1:00 PM ET, 10:00 AM PT

prepare for ICD-10

Are you clinically and financially ready for the implementation of ICD-10-CM with a current ‘go-live’ date of October 1, 2014? Get prepared for the changes in this coding system and for a possible dip in your business practice revenue and/or reduction in coding and billing productivity. This webinar offers pre- and post-assessments to check your readiness along with practical tips to ease the transition to ICD-10.

You’ll learn:

  • What ICD-10 is and why the change is happening
  • What to ask your payers about ICD-10 and your claims
  • How to help prevent rejections after October 2014
  • How to prepare for possible reduction in productivity and/or revenue

Join the conversation today!  You don’t want to miss this.

Register now to learn how to prepare for ICD-10


About the Speaker

Rochelle Glassman discusses preparing for ICD-10

The guest presenter is Rochelle Glassman, President & CEO of United Physician Services.  Rochelle brings a passionate, very practical “do it today” approach to making medical practices successful and getting physicians paid more.

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Is a Direct Pay Medical Practice Right for You?

Lea Chatham November 5th, 2013

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There is no doubt that working with health insurance payers is challenging. But does it make sense to go it alone and set up a practice that depends solely on direct payments from patients? What does a direct pay medical practice look like and is it right for you?

According to a recent survey from Physicians Practice, sponsored by Kareo, of over 1,000 providers, nearly 10% were already doing direct pay or planning to switch. Another 43% have considered the model but have not made plans to change. The American Academy of Private Physicians says that last year the number of providers doing direct pay or concierge medicine grew by 25%.

A direct pay practice is generally a practice that offers care to patients who pay their costs out of pocket. The practice does not have insurance contracts or bill insurance—that includes both public and private payers. Essentially, patients are paying for the convenience of personalized care and easy access to their provider. The middle man payer is eliminated from the equation and providers set their rates themselves. Providers who have taken this route say that it frees them from all the time spent on billing and allows them to focus more on patient care.

There are different approaches to the direct pay model. Some providers choose to focus on patients who will pay more for convenience and access. Others opt to focus on markets where there are a lot of uninsured patients who are attracted to a practice that may offer lower cost care but require it to be paid directly.

“Whichever approach you choose, you are becoming a more consumer driven practice,” says Dr. Tom Giannulli, MD, Chief medical Information Officer at Kareo and a practicing physician. “When patients are footing the bill, they have higher expectations. So to be effective, the physician has to meet a higher level of personalized, patient-centric care.”

That patient-centric care may include a higher level of accessibility, a more technology-driven environment, a welcoming patient-friendly office, more focus on customer service, etc. “You really have to be a top notch practice to entice patients who are paying for their own care,” adds Giannulli. “It isn’t for everyone.”

Some of these practice features may also help to keep costs down, making it more realistic to offer services on a direct pay basis. For example, a practice that uses seamlessly integrated practice management, billing, and EHR can expect to see lower costs for supplies and office space and a potential increase in collections of close to 10% according to MGMA.

If you are considering this model or another more consumer-centric payment structure, you really do have to turn your practice into a best practice.

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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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