ICD-10 Success Step 3: Identify Top Codes and Map Them

Lea Chatham May 28th, 2015

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Kareo ICD-10 Resource CenterAt this point, you’ve assessed your ICD-10 readiness, downloaded your ICD-10 Success Checklist, and done some budgeting and financial planning for the ICD-10 transition. Now it is time to get into the nitty gritty of ICD-10 coding and documentation. Your first step in this process is to identify your top codes. Then, you’ll map those top ICD-9 codes to their ICD-10 equivalents.

This process is probably easier than you think. Your practice management and billing software should provide the ability to run a top codes report so you don’t have to do this manually. Tweet this Kareo story
Depending on your specialty the number of codes will vary. For a practice that uses the same handful of codes over and over again like Pediatrics there may only by 20 or 30 top codes. However, for a complex practice like orthopedics, there could easily be 100 commonly used codes.

You can purchase top codes lists from sources like AAPC, but keep in mind these are generic to your specialty and may not reflect all of your most commonly used codes. If you choose to purchase a top codes mapping tool, you should still run your own report as well and cross-reference those with the list to see if any of your codes are missing. A top codes and mapping tool can help you do the mapping portion as well because they provide the equivalent ICD-10 codes. Your practice management and billing software or EHR might also provide a code mapping tool. All of these options are helpful in mapping your top codes but you will still need to look up the ICD-10 codes in the ICD-10 Manual.

The manual provides the detail about the documentation requirements for those codes. This is additional valuable information providers will need to document to the correct level of specificity so the encounter can be coded and billed accurately. You might consider creating a spreadsheet with top ICD-9 codes, the ICD-10 equivalents, and then a section for notes about documentation requirements. Think of it as a cheat sheet that providers can start using now to help with changes to documentation ahead of time.

Here is an example of a quick code map for an internal medicine practice:

Kareo ICD-10 Resource Center

Watch for our next ICD-10 post on documentation improvement. To get more tools and resources on ICD-10 now, visit the Kareo ICD-10 Resource Center.


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Meaningful Use Stage 3: A Glimpse behind the Curtain

Lea Chatham May 27th, 2015

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Kareo Meaningful Use Resourcesby Kaili Hawley, Kareo Meaningful Use Expert

After much speculation about what would be included, the proposed rules for Stage 3 of Meaningful Use have been released. We are not through the woods yet when it comes to knowing exactly what the final rules of Stage 3 of Meaningful Use will look like, as these are just proposed rules. It’s like we’re getting a glimpse of what’s behind the curtain.

How is CMS planning to “restructure” the EHR incentive program, and did they listen to the feedback that was given from the healthcare community? Tweet this Kareo story

In reading the proposed rules and lifting that curtain just a bit, some of the key takeaways are that CMS has placed some flexibility into the requirements, restructuring has taken place to better align with other programs, and there is increased interoperability to enable better communication between providers and access to more information for improved patient outcomes.

For Stage 3 there are a total of eight objectives and 16 associated measures that EPs will need to attest with to meet Meaningful Use. The table below outlines the objectives for Stage 3, Meaningful Use.

Objective and Measures for Meaningful Use in 2017 and Subsequent Years

Program Goal/Objective

Delivery System Reform Goal Alignment

Protect Patient Health Information

Foundational to Meaningful Use and Certified EHR Technology*Recommended by HIT Policy Committee

Electronic Prescribing (eRx)

Foundational to Meaningful UseNational Quality Strategy Alignment

Clinical Decision Support (CDS)

Foundational to Certified EHR TechnologyRecommended by HIT Policy CommitteeNational Quality Strategy Alignment

Computerized Provider Order Entry (CPOE)

Foundational to Certified EHR TechnologyNational Quality Strategy Alignment

Patient Electronic Access to Health Information

Recommended by HIT Policy CommitteeNational Quality Strategy Alignment

Coordination of Care through Patient Engagement

Recommended by HIT Policy CommitteeNational Quality Strategy Alignment

Health Information Exchange (HIE)

Foundational to Meaningful Use and Certified EHR TechnologyRecommended by HIT Policy CommitteeNational Quality Strategy Alignment

Public Health and Clinical Data Registry Reporting

Recommended by HIT Policy CommitteeNational Quality Strategy Alignment


CMS Provides Select Flexibility
Within the proposed rules there are select objectives that give eligible professional (EPs) flexibility to match select measures to a provider’s specialty. The flexibility that CMS has proposed is that “providers would be required to attest to the results for the numerators and denominators of all measures associated with an objective; however, a provider would only need to meet the thresholds for two of the three associated measures.” Those proposed flexible objectives/measures include the following:

  • Objective 6 – Coordination of Care through Patient Engagement
    • Measure 1: 25% of patients are provided access to “view online, download, and transmit their health information, or retrieve their health information through an API, within 24 hours of its availability.”
    • Measure 2: 35% of patients were sent a secure message with relevant health information for their personal healthcare.
    • Measure 3: 15% of patient-generated health data or non-clinical data is incorporated into the EHR.
    • Objective 7 – Health Information Exchange (HIE)
      • Measure 1: 50% of Transitions of Care would have a Summary of Care record that was electronically exchanged.
      • Measure 2: 40% of Transitions of Care of patients that an EP has not seen before a Summary of Care is incorporated “from a source other than the providers EHR system.”
      • Measure 3: 80% of Transitions of Care of patients that an EP has not seen before a Clinical Information Reconciliation has been performed, which includes medications, medication allergies, and current problem list.
      • Objective 8 – Public Health and Clinical Data Registry Reporting
        • Within the objective there are six measures. An EP would need to select from “Measures 1 – 5, and would be required to successfully attest to any combination of three measures.”

Alignment of the EHR Incentive Program
As a way to better align the EHR Incentive program CMS is giving EPs the opportunity to start attesting to Stage 3 objectives/measures starting in 2017. By 2018 all EPs, regardless of their “prior participation in the EHR Incentive Program” will be required to attest to the Stage 3, Meaningful Use objectives/measures. By moving all EPs to the same Stage of Meaningful Use, it will support the goal of CMS to “Align” the EHR Incentive Program with other programs that utilize Certified Electronic Health Record Technology (CEHRT).

Also, CMS is proposing to eliminate the 90-day reporting period to “simplify reporting timelines across all settings.” This would mean that EPs, CAHs, and Hospitals would all be reporting based on a full calendar years’ 365 days, worth of data.

The Goal of Interoperability
Under the Stage 3 proposed rule there are increased requirements for interoperability and communication for providers. One of the goals from Stage 2 was to increase the access and use of healthcare data and sharing across platforms. Stage 3 is building on this groundwork from Stage 2 by not only moving towards more health information being exchanged electronically, but also giving patients easier access to their personal healthcare information and online care tools. One of the proposed tools is an application-program interface (API), which provides more flexibility in giving patients easier access to their personal health information. “If the provider elects to implement an API, the provider would only need to fully enable the API functionality, provide patients with detailed instructions on how to authenticate, and provide supplemental information on available applications that leverage the API.” There is a shift from Stage 2 to Stage 3 that takes the responsibility off the patient to interact with the provider and flips it to the provider to initiate that interaction.

In closing, the proposed rules from CMS are brought down to eight objectives and associated measures that are designed to, “Align with national health care quality improvement efforts, promote interoperability and health information exchange, and focus on the 3-part aim of reducing cost, improving access, and improving quality.”

With all this in mind there is still time to submit comments to CMS on the proposed rules of Stage 3 of Meaningful Use. The comment period will close at the end of this month on May 29, 2015. Then it’s just a matter of waiting for the final rules to be released before we will finally see behind the curtain on the future of Meaningful Use.

For more updates and resources on Meaningful Use, visit the Kareo Meaningful Use Resource Center.

About the Author

Kaili has a background in healthcare, education, and marketing, which has given her the ability to approach projects from multiple perspectives. She has done EHR and Meaningful Use project management for leading EHR vendors as well as the Saint Alphonsus ambulatory clinics across Idaho and Oregon. She graduated from Antioch University with a Masters of Arts in Organizational Management with an emphasis in International Business, which has fueled her passion for learning and technology. Kaili draws on her education and experience to help providers, nurses, office managers, and practice staff understand and achieve Meaningful Use and tackle the transition from paper charts to Electronic Health Records.

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Have the Best Medical Practice Website? Then nominate It to Win!

Lea Chatham May 26th, 2015

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Do you have a website that wows, or do you know another practice that does? Then Kareo wants to see it! It could be the first winner of the Kareo Best Medical Practice Website Contest. Tweet this Kareo story

Nominate your own practice or another practice you think has done an amazing job of creating an awesome medical practice website. The winner will receive the honor of being named Kareo’s Best Practice Website of 2015 along with a a badge for their site, a cool gift box of goodies, and a $250 Amex gift card.

Looking for tips on how to make your own website awesome? Download 5 Simple Steps to Creating a Website Your Patients Will Love.

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John Lynn Answers Your Questions about Medical Practice Websites

Lea Chatham May 21st, 2015

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Watch NowAs a follow up to his recent webinar, 5 Marketing Tips to Get New Patients Now, speaker John Lynn has answered the questions posed by participants about medical practice websites.

Q: Do you recommend asking/surveying current patients about what they would want to see on an updated website?
A: While it is always nice to get direct feedback from patients, it can be hard to get that input. I recommend asking your staff what questions they get most often and trying to address those issues and items on your website. Those are probably the things patients are looking for most. However, if you do want to also get direct feedback from your patients, I suggest doing it face to face as opposed to through some electronic survey.

Q: Do pictures of practice staff on the website have more impact than stock images? Tweet this Kareo story
A: I think it is great to use pictures of your practice staff on your blog and social channels since they’ll show the human element of your practice, but I’d use some caution on your website. This is often the first impression a potential patient gets of your practice so you want it to impress. Stock photography may be a better fit. However, if you can get professional high quality images of your practice employees, that can be a good option, but be sure the quality is there if you go that direction.

Q: Do you think practices should add a personal number for referring providers and patients on the website to increase accessibility?
A: Sharing a personal number like a cell phone with referring providers is fine and great way to strengthen those relationships but it may not be something you want to share across the board with patients. Use some discretion there. Provide it on more of a case by case basis as you are comfortable but don’t publish it for all to see. Also, keep in mind that when patients call you in off hours you may not have your EHR handy. So have a plan in place for documenting anything that needs to be documented to protect yourself against liability.

Q: Do you recommend reposting blogs from other sources? What about guest blogging?
A: There is some risk with reposting an entire post that your website will get a penalty from Google for what they call “duplicate content” that could do you more harm than good. To avoid this, consider just picking some key highlights from the other source to share on your blog. A paragraph or two is good and you can weave some text around it to introduce and close it out. Getting guest posts is a good strategy as long as they are high quality posts and relevant.

Q: How do you know if a website or SEO vendor is any good?
A: Always look at rating and references. Consider asking another person whose website and online marketing you like who they used. Ask a lot of questions and request that specific key metrics be set out in the contract as a requirement for full payment. If someone isn’t willing to provide references or work towards some specific objectives then look elsewhere.

About the Speaker

John Lynn is the Editor and Founder of the nationally renowned blog network HealthcareScene.com. John also co-founded two companies: InfluentialNetworks.com and Physia.com. Plus, John is the Founder of 10 other blogs including the Pure TV Network and Vegas Startups. John’s 25+ blogs have published over 15,000 blog posts, garnered over 30 million views and had over 122,000 comments. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy and @ehrandhit and LinkedIn.


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The First PQRS Deadline of 2015 is Fast Approaching

Lea Chatham May 19th, 2015

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By Joy Rios, MBA

We’re well into the 2015 reporting year and from changes to the Meaningful Use program to ICD-10 implementation, there’s plenty to keep track of. Well, don’t forget about PQRS.

Providers have several reporting options to choose from, with criteria that vary depending on the choice. However, the decision, particularly for groups, must be made soon.

*cc = At least one Cross-Cutting measure must be reported

Groups must register as a group and commit to a reporting method for PQRS no later than June 30, 2015. Tweet this Kareo story

During registration, group practices must elect and commit to their reporting method for the 12-month period. Once a group has registered for 2015 as a PQRS GPRO, the group will not be able to withdraw its registration.

Remember, a group practice is defined as two or more eligible professionals (EPs), as identified by their NPIs, who have reassigned their Medicare billing rights to the organization’s Tax ID Number.

How do you know if you should use the group practice reporting option (GPRO)? If your organization is multi-specialty and has 25 or more EPs, the GPRO Web Interface is a possible candidate. But so is registry reporting and EHR-based reporting. Also, will you have the option to include patient satisfaction surveys in your report.

There are instances where a group may be eligible to report using the GPRO, but decides not to. These circumstances may sway a group to have EPs report individually rather than with the group practice:

  • If an EP’s best performance rates are with quality measures included in a Measures Group
  • If collecting data is particularly burdensome, reporting a Measures Group (which relies on a 20-patient sample) might be a better option
  • If only non-PQRS measures are applicable to the provider, an individual EP may consider reporting through a Qualified Clinical Data Registry (QCDR)

If a group decides not to report PQRS as a group, CMS will still calculate a group quality score for the purposes of determining the Value-based Modifier, but only if at least 50% of the EPs within the group report measures individually and avoid the 2017 PQRS payment adjustment.

The consequences for non-action are steeper than ever. EPs and groups who decide not to participate this year will see an automatic -2% payment adjustment for PQRS in 2017 and CMS will tack on an additional -2% or -4% payment adjustment for the VBM, depending on the size of the organization.

About the Author

Joy RiosJoy Rios, MBA, is a Certified Healthcare Technology Specialist and a subject matter expert in both Meaningful Use and EHRs. She has a unique talent for distilling forbidding materials down to the information providers need to succeed. Joy develops EHR training programs, authors Meaningful Use and PQRS coursework, and is a regular contributor to the HITECH Answers publications. You can learn more about her work at www.askjoy.net or follow Joy on Twitter @askjoyrios. If need help navigating the PQRS maze, pick up a copy of ABC’s of PQRS: Your 2015 Guide to Successfully Participating in the Physician Quality Reporting System, and save 20% off the list price with the code: RIOSPQRS.

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New ICD-10 Guide Now Available for OB/GYNs

Lea Chatham May 14th, 2015

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Download NowThe new eBook, ICD-10: How to Transition Your OB/GYN Practice is now available for download.

While all HIPAA-covered entities need to make the change to ICD-10, the changes to coding and documentation are not the same for every specialty. Each specialty has it’s own unique new codes and documentation requirements for those codes.

For example,for OB/GYNs, the requirement to provide anatomical site or location plays out differently than it might for a pediatrician. If a patient presents with endometriosis, physicians must document precisely where the endometriosis has occurred (i.e., the uterus, ovary, fallopian tube, pelvic peritoneum, rectovaginal septum and vagina, intestine, in cutaneous scar, other endometriosis). Without this specificity the encounter must be coded as unspecified.

Some other changes that specifically impact OB/GYNs include:

  1. Documenting the specific trimester
  2. Providing more specificity for annual exams
  3. Documenting the causes of pelvic pan
  4. Increased detail is required when documenting migraines
  5. Reason for fetus viability scans is required

These are just some of the changes OB/GYNs should be preparing for now. To find out more about these and other ICD-10 changes coming for OB/GYNS, download the eBook, ICD-10: How to Transition Your OB/GYN Practice.

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Free Webinar: Learn More about Kareo Medical Billing

Lea Chatham May 14th, 2015

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Register NowConsidering Outsourcing Your Billing: Check Out Kareo Medical Billing
Thursday, May 21, 2015
10:00 AM PT, 1:00 PM ET

If you are considering outsourcing your billing, don’t miss this webinar on how Kareo Medical Billing can help. Tweet this Kareo story

Many medical practices consider outsourcing their billing at some point. There are a lot of good reasons to look at this option, including staff changes, lack of qualified billers in your area, a complex specialty, and reimbursement changes like ICD-10. When opting to outsource choosing the right partner is critical.  

We’ll cover:

  1. What you should look for when choosing a billing service
  2. How your ICD-10 preparedness plays into the outsourcing decision
  3. The comprehensive solution available with Kareo Medical Billing Services
  4. The latest enhancements to Kareo’s cloud-based web and mobile software
  5. Kareo’s offering if you want to continue to do it yourself

Register now to learn new ways to use your website and social media to reach new patients.

Register Now

About the Speakers
Rossana Fernandez, Kareo Product Marketing Manager and Rachael Ibbetson, Kareo Sales Engineer both have a deep knowledge of Kareo Medical Billing and will walk attendees through the features and benefits and answer questions.

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Read Latest Tips & News in Kareo May Getting Paid Newsletter

Lea Chatham May 12th, 2015

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The May edition of the Kareo Getting Paid Newsletter has great tips on patient retention, ICD-10 success, and improving your medical billing. The newsletter also provides a chance to discover upcoming events, news, and resources from Kareo. Plus, learn about how to register for upcoming webinarsRead all this and more now! Tweet this Kareo story


Read Kareo Getting Paid Newsletter Now

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Free Assessment: What Is the State of Your Medical Billing?

Lea Chatham May 11th, 2015

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The quality of your medical billing can make or break your practice. An inexperienced biller, poor processes, or the wrong technology can all impact your bottom line. As a small business you can’t afford to have problems with your medical billing. Take this free assessment to get a detailed analysis of some of the key areas that impact your billing success. You’ll quickly be able to see if you need to make changes to processes, staff, or technology and even whether or not to consider outsourcing to improve billing quality.

Take this free medical billing assessment now to get a detailed billing report and see how you are doing! Tweet this Kareo story


Take the assessment now

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Hack Patient Retention with These 4 Tips

Lea Chatham May 11th, 2015

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Tweet this Kareo storyBy Molly Maloof, MD

Is your practice plagued with no shows, cancellations, and a schedule filled with blanks? Are your waiting rooms only half-filled? Well, let me ask you this question, do you have the contact information for all of your patients in a place that is easily accessible? I’m guessing it’s somewhere in your medical record going unused. In this article I’m going to teach you how to hack one of the most important things to a successful practice: patient retention.

I promise if you follow these instructions, you will be well on your way to marketing automation and this will keep your patients in your practice long-term. Tweet this Kareo story

Okay, so let’s get started.

  1. Make a list of the four most important data points you need for every patient:

    • Your patient’s name: If you don’t have a list of every single patient that has ever walked into your practice, you’re losing patients. Every single piece of communication needs to be personalized to them. Period. Look for a marketing solution that can do this automatically.
    • Your patient’s cell phone number: Patient’s don’t actually want to be called. Most of them would prefer to get a text message than a phone call from their doctor.
    • Your patient’s email address: Did you know patients check their emails on their phones an average of 34 times every day?
    • Your patient’s birthday: Who doesn’t love getting a reminder they are getting older? Just kidding. But, seriously, getting a happy birthday shout out from you is really sweet and says how much you care.

    It’s astonishing the number of doctors who do not have this information handy, and it doesn’t surprise me that their retention rates are so low. Task one of your staff to see if your EHR provides the ability to easily export this data. If it doesn’t, you can make an Excel spreadsheet, but it might be better to change your EHR!

  2. Automate Your Patient Appointment Reminders Via Email & Text: Now that you have your patient list, it is time to consider a solution that can automate your communications. This solution should allow you to quickly upload your patient data so you can send automatic reminder emails or texts and follow up requests to review your practice. Most patients don’t miss appointments because they don’t want to see you, they miss them because their lives are busy and they forget. Reminders can cut no shows in half.
  3. Schedule Their Next Visit Before They Leave the Office: Take a tip from the dentists who are GREAT at this: At every preventive visit, make a habit of scheduling the patient’s next annual visit before they leave the office. You save the time and hassle of follow up calls for recalls, keep your schedule filled, and with automated reminders, you can also make sure the patients show up.
  4. Send Out A Monthly Newsletter With Health Education & Practice Updates: If you don’t have a way to securely communicate via email to your entire patient panel, you are missing out on one of the easiest ways to reactivate patients–the monthly newsletter. In this newsletter you can explain all of the interactions a patient should be having with your practice including all services and touch points. This newsletter can be your conduit for teaching patients how to engage with your practice online through social media, making appointment requests, and receiving text and email reminders.

Automating patient communications and marketing is really very easy. I set up my own DoctorBase account in less than an hour. To see for yourself, schedule a DoctorBase demo.

About the Author

Dr. Molly Maloof is passionate about using technology to improve the lives of patients and health care providers. She graduated from the University of Illinois College of Medicine and was a pediatric resident in the Kaiser Permanente Oakland/Berkeley MPH program before making a career shift into digital health. She advises and directs early stage health technology startups with her carefully honed skills in communication, strategy, research, and product development. She is a licensed California physician and runs a boutique medical practice in San Francisco specializing in health optimization.

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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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