You Could Be Providing $25,000 of Uncompensated Care

Lea Chatham February 27th, 2014

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We all know that the healthcare landscape is drastically changing, from the Affordable Care Act (ACA) and the influx of patients to the way that providers are getting compensated for care. With the passage of the ACA it’s estimated that there will be 32 million new patients entering the healthcare system. This is a huge amount of patients given the fact that there’s a current and impending physician shortage here in the US.


With this influx of patients, healthcare providers have been looking for ways to increase efficiency and improve communication with patients. Technology has played a very important role in this search.

The funny thing is that technology can be both a blessing and a curse. Being more available to your patients is a great thing that can lead to increased patient satisfaction, but it can also impact your bottom line.

According to a Physicians Foundation Report, physicians estimate that they provide $25,000 or more each year in uncompensated care. Tweet this Kareo story

This is typically in the form of phone calls, which have increased 25-50% since 2008, according to this Marketwatch Report. The issue is that insurance companies are not reimbursing for these calls, which cost practices about $15-20 per call!

The good news is that doctors are fighting back with the help of new technology coupled with office policies to increase efficiency and reduce lost revenue opportunities. Some examples include software that helps offices automate appointment reminders, new simple policies around filling out forms and prescription refills, and the introduction of “concierge-light” services that have made doctors’ lives easier and increased patient satisfaction.

Many of these concierge services provide better patient access to doctors, but this type of access is difficult to provide. In addition, doctors are fearful about making themselves more available without getting compensated for it!

The good news is that there are alternatives, one of them is offering patients telephone consultations for an out-of-pocket convenience fee so you can offer access while getting paid for your time. This is not a full-blown concierge model where you’d have to charge patients hundreds of dollars per month for immediate access. It’s simply an elective, “as needed” value-added service. Think of it as offering your patients an a-la-carte premium level of phone access where a patient can pay a small fee for expedited service. These types of calls can keep patients out the ER, save them thousands of dollars, and help them understand if they truly need an in-person appointment. Patients simply indicate that they’re willing to pay a convenience fee to get more immediate service from the doctor they know and trust.

At the same time, phone consultations allow physicians to generate practice revenue and increase office efficiency. With the increasing costs to remain in business as a smaller practice, every bit of revenue counts so why not make revenue from time you’re already spending on the phone? The best part is that by charging an out-of-pocket convenience fee to patients you don’t have to deal with the hassles of paperwork and requesting insurance reimbursement. According to this article from a Los Angeles Cardiologist, “10% of all gross receipts of any practice are spent collecting monies from insurance companies and patients.”

A common concern around phone consultations is whether or not patients will be willing to pay, and the bottom line is that it really boils down to patient education. Letting patients know about the new service, when to use it and why it’s valuable will help them understand that getting immediate and direct access to you is valuable. It will also help your patients understand how important your time is. Understanding that your patients are looking for more convenient, alternative ways for receiving care is instrumental in patient satisfaction.

What services or policy changes have you made at your practice to make sure that you’re compensated fairly? Feel free to add to the comments below!

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Your Top Questions about Innovative Revenue Streams Answered

Lea Chatham February 26th, 2014

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Watch recorded webinarOn Wednesday, February 19, Kareo hosted a free webinar where practice management expert Rochelle Glassman discussed several innovative revenue streams that can be added to medical practices of all types and sizes. Over 1,000 people registered and several hundred attended Is It Time for New Revenue Streams?. As a result, there were many questions about how to get started with these opportunities and how specific specialties can increase revenue. Rochelle and Kareo have answered the many questions posed by participants, and several of those answers are shared here.

Q. Can you provide the list of specialties that can use some of these programs (i.e., drug testing or pharacogenetic testing)?
A: Drug testing is appropriate for (but not limited to) pain management, neurology, anesthesiology, surgeons (postoperative and preoperative), treatment centers, OB/GYN, and internal medicine. Pharmacogenetic testing is most used in primary care, internal medicine, pain management, neurology, and psychiatry, but may be viable in other specialties depending on circumstances.

Q. How much revenue can be generated from a weight loss program?
A: Depending on the practice and program, it can generate upwards of $200,000 per provider.Tweet this Kareo story
You are reimbursed to screen your patients for obesity. If the patients meet the criteria of a BMI over 30 in adults, they can be scheduled for 26 visits in 6 months, and if they lose over 7.5 pounds in 6 months additional visits are permitted. You can also provide nutritional and behavior services as additional revenue streams. Medications can also be provided at the practice for cash, or a prescription may be written.

Q. Is IV Therapy a good revenue generator for internal medicine?
A:  It is a revenue generator and often times saves the payers from having so send patients to the ER or to put them on home care services. For these types of services you should negotiate with your payers as you are saving them facility and home care fees. This should be taken into account when negotiating your reimbursement rate for this higher level of service.

Q. What preventive care services are covered for OB/GYN under the ACA?
A: There are lots of covered preventive services for an OB/GYN acting as a primary care provider.Tweet this Kareo story
The best way to get a better idea of what is now covered without a co-pay or deductible is to review the information provided by the USPSTF. The preventive care services now covered for women include annual exams, mammograms, vaccines like flu and pneumonia, and much more.

Q. Do you have specific recommendations for physical or occupational therapy?
A:  Yes, there are several options to help build revenue in a rehab practice. Partnering with primary care providers and some specialists to offer services can be done in a variety of ways. You can provide services in that physician practice. You can lease a space in your practice to that physician, or market special services in your practice to surrounding providers. Just as a couple of quick examples:

  1. Working with a breast surgeon you could lease your space or space at the surgeons practice and offer services for lymphedema in a private, supportive setting.
  2. Provide specialty services such as, working with primary care and OB/GYN to provide services for incontinence, or offer balance training programs for the elderly with internal medicine and geriatricians. Working with a primary care provider you could offer supervised exercise as part of a weight loss program or nutritional counseling especially for those patients who are morbidly obese.

Q. What recommendations do you have for a gastroenterology practice?
A: That would depend on what types of services you are currently providing to your patients. Without having that information it is difficult to provide specific recommendations. Several of our GI clients are providing laser hemorrhoid treatments. For those health plans that are not approving the treatments, an ABN waiver is signed and the treatments are being provided for cash. Also, I would set up an electronic recall system based on the Medicare and commercial health plan timeline guidelines to recall the practices at risk and not at risk patients. This process will not only increase your revenue and provide outstanding customer service, but will also prepare your practice to be paid on performance as you will meet the criteria. From the examples shared with you on the webinar you could provide pharmacogentic services and look into what research studies are available for participation.

Q: We have a behavioral health practice. Are there other preventive care services we should be offering?
A: Procedure Code(s): 99408, 99409, G0442, G0443 can be used in a primary care setting for the misuse of alcohol. There are other codes for smoking cessation and the misuse of drugs; all have to be face-to-face with a provider. It is recommended that you contact your commercial payers and ask what services they are providing and if a behavioral health provider can bill these services directly or incident to under a physician.
There is a movement to integrate behavioral health with regular healthcare.Tweet this Kareo story

Q: Any recommendations for podiatry? We were considering adding x-ray. Is that a good opportunity?
A: It is recommended that before you add any services to your practice you should contact your local commercial payers and ask for their reimbursement rates for x-ray services and make sure that there is a return on investment and that the reimbursement covers the practice’s variable operating expenses. Medicare will pay for x-ray services. Many of our podiatry practices have built surgery centers and hired podiatrists who are trained to perform complex foot and ankle surgeries historically provided by foot and ankle orthopedic surgeons.

If you missed this great event, you can view the recording or download the slides. And, if you are interested in growing your practice and increasing revenue, register for the next free webinar, 3 Ways to Cultivate Rapid Growth through Referrals.

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New CMS 1500 Form Deadline is Fast Approaching

Lea Chatham February 24th, 2014

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Kareo ICD-10 resources

With only 5 weeks left to switch to the CMS 1500 v02/12 paper claim form, you can’t afford to wait. Tweet This

Delaying the change could impact your claims and reimbursement!


While you have been able to submit the new form since January 6, you aren’t required to submit claims to CMS with the new form until April 1, 2014. Currently, you can use either form. But if you have been putting off the transition, it’s time to get on board.

It’s never a good idea to wait until the last minute for any change related to your medical billing. Implementing the new form now gives you time to ensure all your software settings are correct and working for formatting and printing so you can test print some paper claims on the new form. That will give you some breathing room to fix any issues.

How Is the New Form Different?
The new form is designed to accommodate the change to ICD-10. It provides fields that allow you to use the longer codes and enter more codes. However, not everyone is on the same time line. Here are a few additional things to know about the change to the new paper claim form.

  1. The new form allows support of up to 12 Diagnosis Codes, however, what has not changed is that each procedure will still only allow up to 4 diagnosis pointers. This means that this new form can still only support 4 diagnosis codes per procedure.
  2. On and after April 1, 2014, Medicare will only accept the new form, but other payers may not. You will need to contact your payers to determine which form they will accept prior to the ICD-10 implementation on October 1, 2014.
  3. The revised paper claim form is new for payers as well as providers. As individual Medicaid (by state) and payers begin releasing and publishing their specifications, it may be necessary to make additional changes to process accurate claims. Your practice management software vendor should be monitoring these changes and adapting with regular updates.

In addition to this new form, there are many other changes related to ICD-10. For tools, resources and a success checklist, visit the Kareo ICD-10 Resource Center.

If you’re concerned about keeping up with changes related to ICD-10, it may be time to consider outsourcing your revenue cycle management. To find out if outsourcing is right for you, download this helpful guide.

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What ICD-10 Changes are Coming for Orthopedics?

Lea Chatham February 20th, 2014

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By Lisa A. Eramo

Kareo ICD-10 Resource Center
Are you overwhelmed by ICD-10 changes that will affect your orthopedic practice? Stop. Take a deep breath. Know that everything will be ok. We’ve all survived change, and the transition to ICD-10 will be no different.


Although ICD-10 includes a whole slew of changes for the orthopedic specialty, physicians shouldn’t assume that compliance will be impossible. Tackling the changes head on—and bit by bit—will make the transition much easier.

John F. Burns, CPMA, CPC, CPC-I, CEMC, senior consultant with Doctors Management in Knoxville, TN and an AHIMA-approved ICD-10 Ambassador and ICD-10-CM/PCS trainer suggests several topics on which orthopedists should focus their attention.

Site specificity
Site specificity is a common theme in ICD-10, and many of the orthopedic diagnoses will require this information. Consider the following:

  • Regions of the spine: Many diagnoses, such as spondylosis (M47.-), spinal stenosis (M48.0-), and osteomyelitis (M46.2-), require physicians to document the specific region of the spine. These regions include: occipito-atlanto-axial, cervical, cervicothoracic, thoracic, thoracolumbar, lumbar, lumbosacral, sacral and sacrococcygeal, or multiple sites.
  • Osteoarthritis with or without current pathologic fracture (M80.- and M81.- respectively): Documentation must specify hip, knee, first carpometacarpal joint, shoulder, elbow, wrist, hand, ankle, or foot. Physicians must also document the type of osteoporosis—that is, age-related, localized, or other (drug-induced, idiopathic, of disuse, postoophorectomy, post-surgical malabsorption, or post-traumatic). For drug-induced osteoporosis, identify the specific drug that caused the adverse effect (i.e., the osteoporosis).
  • Chronic gout (M1A.-): Documentation must specify shoulder, elbow, wrist, hand, hip, knee, ankle, foot, vertebrae, or multiple sites. Physicians must also document laterality as well as the type of chronic gout—that is, idiopathic, lead-induced, drug-induced, due to renal impairment, or other secondary chronic gout.

Many of the ICD-10 changes for the orthopedic specialty pertain to laterality—that is, specifying right, left, or bilateral. ICD-9 codes did not capture this information previously. For example, in ICD-10, physicians must specify laterality for osteoarthritis and joint disorders (M15-M25). Documentation of fractures must also specify right vs. left vs. bilateral. Arthopathies and polyarthropathies (M00-M14) also require documentation of laterality.

Type of encounter
When documenting fracture care, orthopedists must provide sufficient information so that coders can glean whether the encounter is initial (i.e., initial ER visit or any surgical care or follow up within the global period), subsequent (i.e., follow-up care rendered after the global period), or sequela (i.e., a residual effect after the normal healing period). This information is reported via the 7th character in the ICD-10 fracture care code. For subsequent encounters, physicians must specify routine healing, delayed healing, malunion, or nonunion. For example, ICD-10 code M84.462G denotes pathological fracture, left tibia, subsequent encounter for fracture with delayed healing.

Combination codes
Although the orthopedic specialty includes few combination codes in ICD-10, physicians should at least be aware of them. For example, ICD-10 code M54.4- denotes lumbago with sciatica. Physicians must link the two conditions and also specify laterality. ICD-10 code M05.1- denotes rheumatoid lung disease with rheumatoid arthritis. Physicians must also link the conditions and document site and laterality.

Place of occurrence codes
Documenting any external causes of injuries, including the place in which the injury occurred, will be important in ICD-10 because it will help paint a more detailed picture for payers. Place of occurrence codes (Y92) are extremely detailed, and physicians should provide as much information as possible. For example, code Y92.126 denotes garden or yard of nursing home. Code Y92.531 denotes healthcare provider office. Code Y92.250 denotes art gallery. These codes could help determine whether certain payers (e.g., worker’s compensation, health insurance, car insurance, etc.) are liable for all or a portion of the costs.

For more tools and resources on ICD-10, visit the Kareo ICD-10 Resource Center.

About the Author

Lisa A. Eramo
Lisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

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Can Too Much Eye Contact Be Bad?

Lea Chatham February 19th, 2014

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When you work in a healing profession, you are interacting with people all day. Kareo’s partners at ZocDoc have shared this great blog post on eye contact. This is something you may take for granted, but it turns out that there is such as a thing as too much.

Starting from childhood, we’re taught that eye contact is important. But when is it too much of a good thing? Tweet This

According to a new study published in Psychological Science, eye contact may not help you win over your audience – and in fact, it may trigger the opposite response.

Participants in the study were shown multiple videos of different speakers. The speakers stated their opinions on controversial topics, and the participants were instructed to focus on the mouth and eyes of the speakers. The study evaluated whether participants were more or less trusting of speakers who maintained eye contact. Based on the results, “people were less likely to shift their opinions when the speakers made direct eye contact.”

Why? Researchers say it depends on the situation. Among friends and family, eye contact can be a good thing, establishing trust between two people. But in other settings, it can stir competition and hostility, potentially dissuading an audience.

“Staring directly into someone’s eyes without looking away is unnatural,” says non-verbal behavior expert Marc Salem, PhD. Rather than focus so much energy on maintaining eye contact, Salem recommends non-threatening cues. “It starts with your posture. Sit or stand in a way that’s open and similar to those around you – for example, if your boss is leaning back in his or her chair, you should do the same. Don’t rush your words, either; when you speak too quickly, your body doesn’t know what to do with itself, and you end up looking awkward.”

But this doesn’t mean you should avoid eye contact completely! The key is appropriate eye contact. An article published by the Michigan State University Extension recommends using the 50/70 rule. “Maintain eye contact for 50 percent of the time while speaking and 70 percent of the time while listening. This helps to display interest and confidence.”

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A Little Presidential Inspiration!

Lea Chatham February 17th, 2014

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In honor of President’s Day here are a few inspirational words from some of our most beloved American leaders.

  1. Old minds are like old horses; you must exercise them if you wish to keep them in working order. – John Adams
  2. Patience and perseverance have a magical effect before which difficulties disappear and obstacles vanish. – John Quincy Adams
  3. You can do what you have to do, and sometimes you can do it even better than you think you can. – Jimmy Carter
  4. Pessimism never won any battle. – Dwight D. Eisenhower
  5. Do you want to know who you are? Don’t ask. Act! Action will delineate and define you. – Thomas Jefferson
  6. That some achieve great success, is proof to all that others can achieve it as well. – Abraham Lincoln
  7. Things do not happen. Things are made to happen. – John F. Kennedy
  8. It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something. – Franklin D. Roosevelt
  9. Believe you can and you’re halfway there. – Theodore Roosevelt
  10. It is amazing what you can accomplish if you do not care who gets the credit. – Harry S. Truman

These words have inspired many over the years. Hopefully, they inspire you too!


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Free Webinar: Is It Time to Look at New Revenue Streams

Lea Chatham February 13th, 2014

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Is It Time to Look at New Revenue Streams?
Wednesday, February 19
1:00 PM ET, 10:00 AM PT

Register new to learn about innovative new revenue opportunities

Are you giving money away to your competitors? If you aren’t considering additional revenue streams for your medical practice, you might be.

Patient expectations are changing and some insurance plans are paying more if you meet new criteria or offer expanded care. Tweet This

In this webinar, Rochelle Glassman will discuss how adding innovative new services can increase revenue while also improving patient care and outcomes.

You’ll learn:

  1. When to add a new service and what type of services to consider
  2. How to evaluate your payers and patients to choose the services that will generate the most revenue
  3. How to add services that labs and other vendors may pay you directly for and that will assist in patient clinical management
  4. And, how to train staff, market new services, and work with third-party vendors

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

Register now to learn about new medical practice revenue opportunities

About the Speaker

Rochelle Glassman

Rochelle Glassman is 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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What Does It Mean to Be a Patient-Centric Practice?

Lea Chatham February 12th, 2014

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Download Engage! today

By Tom Giannulli, MD

In many ways a patient-centric practice is simply applying good customer service principles to the medical practice. While many practices may think they are “patient-centric” in reality they are missing the mark as it is a comprehensive definition. To be truly patient centric your effort has to start with how you represent your practice online and onsite. It extends to how you interact with patients directly in the office, on the phone, and via online services. The bundle of services that you provide needs to be expanded in many cases to offer better care coordination with hospitals and specialists, and offer the patient and their family guidance on wellness and prevention utilizing some new age methods.

Below I have provided a detailed list that can serve as a guide and score card to reaching a high degree of patient centricity. The items are grouped by general classification, and I suggest that practices start by adopting at least one item from each group to build up to a comprehensive offering. Starred items (*) are more advanced options that will differentiate your practice among other patient-centered practices.

Practice Representation

  1. Professional Practice website
    a. Mobile friendly (i.e., can be viewed and navigated on phones and tablets)
    b. Links to your patient portal login (see Patient Portal below)
    c. Link to public email for administrative purposes (not for private health matters)
    d. Links to practice hours, map, and other detailed instructions, including after hours policy on phone calls and patient portal emails
    e. List of your patient-centric services (the items on this list that you support)
    f. Links to review and rating sites that you monitor (i.e, Yelp, *
    g. Concierge or premium services (i.e., house calls, or other high convenience services) for additional fees *
    h. Price transparency and anticipated costs *
    - Website lookup for common procedures, based on payer, and/or mobile app for the same
    - Automated messages advising patients of upcoming encounter costs once scheduled, based on their plan
  2. Patient Reminders
    a. Phone, email, and mailed patient reminders for:
    - Upcoming appointments and procedures
    - Planned follow-up
    - Recommended wellness and prevention
    b. Identify high risk patients to the practice administrator for intensive follow-up *

Practice Experience

  1. Convenient check-in
    a. Online or waiting room Kiosks to capture required information
    b. Reminders for outstanding patient responsible payments and anticipated costs for current encounter
  2. Minimize waiting times
    a. Tracking of encounter flow in real-time
    b. Expose each patient’s total waiting time to staff  to promote timely encounters
  3. Use of electronic health records and information exchanges
    a. Ability to quickly review and drill down to specific tests or  medical information as compared to paper systems
    b. Electronic prescriptions (Reduce errors, waiting time at the pharmacy and reduce costs by selecting eligible medications)
    c. Patient education (Select from a library of patient specific education to be posted to their patient portal account)
  4. Care coordination and electronic referrals *
    a. Complete and timely referral to other providers with a minimum of process or manual paperwork
    b. Receive electronic notification of hospital discharge and related care plans
    c. Leveraging dedicated care coordinator staff to ensure patients are seen shortly after discharge and coordinate specialist activities and sharing of vital clinical information

Patient Portal

  1. Typically offered as part of your Electronic Medical Records system
  2. Secure access to up-to-date patient summaries (Includes Meds, labs, problems, etc. as well as encounter summaries and care plans)
  3. Email access to the doctors private and secure inbox
  4. Prescription refill requests
  5. Pre-visit questionnaires and patient history forms online
  6. Patient specific educational videos and handouts
  7. Patient specific links to online communities
  8. Telemedicine console for virtual visits (Secure video conference capability over the web) *
  9. One-click patient payments (Summary of patient responsible amount and quick online payment options) *

For more on this topic, download our new guide Engage! or join us for our tweetchat on Thursday, February 13 at 9:00 AM PT at #KareoChat.

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Get New ICD-10 and MU Resources in February Newsletter

Lea Chatham February 11th, 2014

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The February edition of the Kareo Getting Paid Newsletter is packed with medical billing tools and tips to help you improve your practice. The newsletter also provides a chance to discover upcoming events, new ICD-10 and Meaningful Use resources from Kareo, and links to connect with Kareo on social media channels. You’ll discover more about how to register for our upcoming free educational webinar, Is It Time to Look at New Revenue Streams, presented by Rochelle Glassman. Read all this and more now! Kareo February Newsletter

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What’s the Economic Impact of Patient Engagement?

Lea Chatham February 10th, 2014

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Discover ways to engage patients and improve your bottom line

In the new guide from Kareo, Engage! 10 Powerful Ways to Engage Patients in Every Aspect of Your Practice, you’ll find many suggestions for ways to engage patients from the moment they call for an appointment to the last test result. But the question always comes up, “Why engage patients?” Of course there are lots of answers from attaining Meaningful Use incentives to improving outcomes, but one that is often left out is your bottom line.

Patient engagement and high patient satisfaction impact your bottom line. Tweet This

Each of your patients represents a lifetime value to your practice. According to the American Academy of Family Physicians, the average patient visits their primary care provider 3.19 times a year. Many patients with chronic conditions see their specialist two to four times a year. Cost per visit varies widely by specialty but the estimates generally fall between $100 and $200 per visit. One study of uninsured gave a total per patient amount for the year of $630.

For this post, we’ll say the average patient sees their doctor three times a year and the doctor is reimbursed around $500. Over a patient’s lifetime, that equals approximately $25,000. This is probably a conservative estimate because patients with chronic conditions such as diabetes, heart disease, or obesity have much higher healthcare costs.

Increasing Engagement Can Boost Revenue

There are many ways that engaging patients and providing improved service can boost your revenue. At the most basic level, it can help you retain existing patients and increase referrals from those patients. Each new patient results in an increase of about $500 a year.

Beyond that, many of the tools discussed in the guide provide other potential revenue benefits:

  1. Appointment reminders can reduce no-shows by half—that’s at least one no-show per day for the average physician.
  2. On-demand online appointment scheduling can fill open appointment slots.
  3. Offering online payment options can speed patient payments, which now make up 30% of practice A/R.
  4. Providing printed education materials, visit summaries and a patient portal, reduces phone calls and other unnecessary patient follow up, freeing staff for other tasks.

If your practice prevents one no-show and is able to fill one open appointment a day, that could result in an additional $200-$300 a day in revenue for the average provider. If you have 1,500 active patients, and you are able to increase that by 10% through patient referrals, you increase revenue by $75,000 a year.

To find out more about all the ways you can engage patients, improve satisfaction, and increase revenue, download Engage! now.

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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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