Free Webinar: Chiropractors, Discover the Secrets to Increasing Profitability

Lea Chatham September 30th, 2015

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Chiropractors, Discover the Secrets to Increasing Profitability
Tuesday, October 6, 2015
10:00 AM PT, 1:00 PM ET

Say goodbye to unnecessary bottlenecks, staff frustration, and compromised service. Say hello to a better-run and more profitable practice. Tweet this Kareo story

Almost any chiropractic practice can increase profitability through improvements in workflow. In this webinar designed for doctors and managers alike, experts Joe Capko and Judy Capko will share the best practices for creating ultimate efficiency, patient care, and profitability in a chiropractic practice.

Judy and Joe will highlight some of the ways that integrated technology can ease your burden, reduce waste and repetition, and empower your staff and share:

  • The most common and easily correctable mistakes and their cures
  • How a few key software features can make managing your chiropractic practice easier
  • Ways to enable your staff to do more while increasing job satisfaction

Register now to learn new ways to become a new best practice!

Register Now

About the Speakers

Judy Capko is the founder of Capko & Morgan, a nationally recognized healthcare consulting firm. She is the co-author of the sensational new book, The Patient-Centered Payoff. For more than 25 years she has specialized in medical practice management and operations, emphasizing patient-centered strategies and valuing staff’s contributions. Judy is also the author of the top selling books Secrets of the Best-Run Practices and Take Back Time: Bringing Time Management to Medicine, and is a popular speaker at national healthcare conferences. Thousands of physicians and administrators have benefited from her practical, innovative, and no-nonsense approach to organizational management and strategic planning.

Joe Capko is partner and senior marketing & market research consultant with Capko & Morgan. He specializes in strategic planning, business development, qualitative/quantitative studies and statistical analysis for healthcare and high technology sectors. He has conducted numerous research projects, patient satisfaction surveys and community needs assessments for the healthcare industry including such impressive clients as Lovelace Health System and The Sage Group, Inc.


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Are Physicians Fed Up with Fee-for-Service?

Lea Chatham September 29th, 2015

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Agile Medical PracticeThe healthcare industry is facing a physician shortage. Patient expectations are changing as they pay more. And, the government and commercial payers are requiring more from providers to get reimbursed.

So are physicians getting fed up? According to recent studies they very well may be. And, many physicians are looking to other models to regain some autonomy and increase their own satisfaction. Tweet this Kareo story

For the last three years in a row, the Physicians Practice Great American Physician Survey has shown that physicians’ top frustration is too much third party interference. Significantly, the percentage who cite this as their top issue has also grown over the same period.

Recently, Kareo and the American Academy of Private Physicians, conducted a survey asking for more detail on the perceptions providers have of different practice models and how they are being used. The data from this survey supported the idea that physicians are increasingly frustrated with conventional healthcare.

There were over 860 responses to the survey, with 682 being from clinical providers. The majority were in small practices of one to five providers. Nearly 25% were already using direct pay, concierge, or some type of membership program in there practice. And over 45% said they were somewhat likely or highly likely to make a change to one of these models in the next three years.

These numbers are higher than what has been seen in other surveys. This may be a result of the way the question was asked. The provider could be using any form of these models—fully or just in part—in their practice. In fact, the second largest group using these models only had 25% or less of their entire patient panel as members.

When asked why they switched to an alternate model, providers cited spending more time with patients as the top reason but it was closely followed by separating from insurance payers. When asked why they might switch, conventional providers cited separating from payers as their top reason. For both groups, improving work/life balance was the next most common answer.

Clearly, providers are looking for ways to reduce that third party interference by transitioning all or part of their practice to an alternate model like direct primary care, concierge, or other membership program. It also clear, that there is no single path to making a change like this.

When current private pay physicians were asked how they define their practice, they were almost equally split between cash practice, concierge, and direct primary care. And, when asked about their billing model, about 30% said based on visit time and 70% said fixed fee based on service type. There was also a wide range of fees charge, with an average of $2,025 per year. In addition more than half, said they still took insurance as out of network providers.

There is no doubt that things are changing, and many physicians are eager to find better, more manageable ways to stay independent. Emerging private pay models are of interest as a possible solution.

See the full survey results or learn more about how to be an Agile Medical Practice.

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5 Steps to Increase Referrals from Patients

Lea Chatham September 22nd, 2015

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By Teresa Iafolla

If you want to grow your practice, there are a hundred strategies out there. You can build a better practice website, send out a direct mail campaign, or plug into a network of other doctors and health systems. Of course, most of these marketing strategies take time and money.


What if you could grow your practice the old-fashioned way, through word of mouth? How do you get your patients to be your very own marketing team? Tweet this Kareo story

It’s no surprise that your patients will be more likely to recommend your name if they’re happy with their care. But increasing your referrals from patients is also a matter of maintaining a strong doctor-patient relationship, and convenience; in other words, the easier you make it for patients to refer their friends and family to you, the better chances you have.

Ready to grow your practice? Here are a few basic tips to start building your patient referral funnel and turn your patients into brand advocates for your practice. You definitely don’t need to do all of these – just a few can go a long way!

1. Ask patients for testimonials. 

Patient testimonials are great marketing collateral to put on your practice brochures, on your website, or in your office. They’re proof to new potential patients that you’ve earned the trust and respect of your current patients and are a doctor who goes above and beyond. And not only that, but actually asking patients for a testimonial in a personal way (like at the end of a visit, or via a personalized email) conveys you respect their opinion. Simply asking for that favor can turn those patients into your strongest advocates. You can also use a practice marketing platform to send a request for review or testimonial via email or text after a visit.

2. Handout business cards.

This tip is so simple and so easy, but many doctors just don’t bother! Consider how easy it is for a patient to share your information with a friend or family member if they can just pull out your business card from their wallet? This little trick is all about making the referral process as simple as possible.

3. Email your patients to check-in on them.

If your patients recently had a procedure, or a stay in the hospital, call them or send them a personalized email to check-in on them. Ask them how they’re doing and suggest some exercises or health information they might find useful. While this is just simply a good way to ensure better patient outcomes, it will also impress your patients – you’re willing to go above and beyond to make sure they’re doing well.

4. Get on social media.

While there’s a lot of hype around social media, it can be an effective and relatively easy way to stay involved in your patients’ daily lives. You can tweet health tips, post exciting practice news on Facebook, and stay relevant. The more you show up in your patients’ newsfeeds and give them the opportunity to engage, the more they’ll feel a stronger connection to you and your practice. Plus, they can simply refer friends and family by suggesting they follow you on Facebook!

5. Create a referral contest.

This one may take a little more work, but it can be very effective. Invite your patients to participate, and offer a prize – like an IPAD mini or a giftcard to a popular local restaurant. Share the news with patients as they come into the office, send out an email, post the details on your website – and make sure you allow enough time to get people participating. After you award the prize to the patient with the most referrals, make sure you thank the other participants too. Just having them involved in the contest will get them more engaged with your practice.

Ready to grow your practice with patient referrals? Pick one or two of these tactics and get started. Then report back on the results! We want to know what worked best for you.

About the Author 

Teresa Iafolla is Director of Content Marketing at eVisit, a physician-first telemedicine solution connecting providers to their patients via secure, video chat. Teresa manages and writes for the eVisit Blog, a resource for physicians and practice managers trying to improve their practices and boost revenue. To contact Teresa with questions or comments, email

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10 Last Minute Tips for ICD-10 Success

Lea Chatham September 16th, 2015

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ICD-10 Resource CenterReady or not here it comes. ICD-10 is only days away. Are you ready? Or as ready as you can be? Or are you still scrambling to prepare for this big change?

Surveys show varying levels of preparedness among practices depending on what, how, and who you ask.

We asked industry experts to provide their top tips for last minute ICD-10 prep. Tweet this Kareo story

Take a minute to read through and see if any of their suggestions can help you in these final days.

For practices who still feel unprepared for ICD-10, what is the one suggestion you would make to help them get ready by October 1?

  1. Barbara Drury, BA, FHIMSS, and president of a healthcare technology consulting firm, says, “Analyze billing data and find the top ICD-9 codes and any edits that providers are putting on them. Crosswalk your codes and make a cheat sheet you can plaster everywhere.” If you’re really short on time she adds, “Don’t bother with the simpler one-to-one codes, just do the ones that have too many options.”
  2. ICD-10 freelance writer Lisa Eramo suggests letting staff members know that, “during the next 30 days, ICD-10 is a priority. Everyone needs to be on board in terms of familiarizing themselves with ICD-10 coding changes, new documentation requirements, and new templates in the EMR. There are many free resources available, and it doesn’t necessarily need to take a lot of time to understand the basics of ICD-10 and what it requires.”
  3. According to Kathy Young who owns a successful medical billing company, “Watch webinars that help to show you how the book is put together and what the rules are for coding in ICD-10. The certification house of the provider may have webinars that are geared to the specialty. There is little need to understand the entire book when you probably only code from two to three chapters of the ICD-10 book (unless you are a family practice, urgent care, or emergency room doctor where you would need most of the book).
  4. Audrey McLaughlin says her top tip is to recruit help. “Talk with your practice management system vendor to gain an understanding of their plan and ask for their help with roll out in the practice. Do the same with your clearinghouse, payers, and billing services. Have all of these vendors assist you in getting ready for the fast approaching deadline. If your vendor does not have assistance available or a plan for you to follow then perhaps it’s time to switch to different vendor.”
  5. Kareo ICD-10-CM trainer Michelle Cavanaugh encourages all practices to use dual coding in their practice management system to get more familiar with the ICD-10 codes now.

If a practice can only do one or two things between now and October 1 to get ready for ICD-10, what is the most critical task?

  1. Barbara Drury recommends if you are using an EHR that, “towards the end of September, prep tomorrow’s electronic charts by reviewing the problem list from a screen shot of the summary of care. Depending on the EHR, edit the problem list to show just ICD-10 options for this patient, as though the MA/RN was adding the patient for the first time post ICD-10. Or use any other EHR mechanism that would prevent the provider from pulling an ICD-9 from the past problem list because it’s convenient.
  2. Lisa Eramo says, “the most critical task is to look at your most frequent diagnoses, and compare the ICD-9 codes for those diagnoses with the corresponding codes in ICD-10. When additional information is required, ensure that your practice has the tools to collect that information. This includes updating templates in the EHR, superbills, and any other forms that included coded data.”
  3. With a short time available, Kathy Young thinks the most critical task is to map your top 50 codes into ICD-10 and then review your documentation to make certain it supports the code. This is easy with a practice management system that will map the codes for you, then you simply need to verify the documentation. You may need to go to the book to be certain you are choosing the most specific code to your documentation. When all else fails, call a coder.”
  4. Michelle Cavanaugh believes that training is critical. “Get online and find as much specialty specific training as you can for the roles in your practice and train, train, train. It will help you get familiar with ICD-10 and provide tips, tricks and tools to help you navigate it for your specialty.” Look to your specialty society, EHR and practice management vendors, and groups like AAPC for specialty training.
  5. “Watch denials like a hawk!” says practice management expert, Elizabeth Woodcock. “With the medical necessity of many services tied to the diagnoses, this will mean that payers are now relying on ICD10 codes to trigger their payment algorithms. Since there are now more than quadruple the number of diagnosis codes, it may take the payers a while to get their payment formulas correct, which will mean denials for physicians in the interim. Measure and monitor denials carefully, and appeal as appropriate to avoid costly write-offs.”

Looking for more ICD-10 tips and resources? Check out the Kareo ICD-10 Resource Center.


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7 Steps to Hiring the Right People for Your New Medical Practice

Lea Chatham September 15th, 2015

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New Practice Start Up GuideBy Adria Schmedthorst

Starting a new medical practice comes with many new responsibilities. One that many physicians worry about is how to hire the right people to care for patients, increase office revenue, and help the practice grow. Follow these seven steps to hiring the right people, and you will gain not just an employee but a valuable team member, invested in the success of your practice. Tweet this Kareo story

Step 1 – Make a List
List all of the skills, experience, and personality traits you would want in your ideal employee. Remember, you can teach skills but not change personalities. It is always best to choose desirable personality traits over skills to ensure the best team dynamic for your staff.

Step 2 – Write Detailed Application Instructions
Set out very specific instructions for applicants to follow when submitting applications. This will serve as a test to weed out candidates who are not detail-oriented or can’t follow instructions. For example, use a specific email address for submitting applications and require a unique subject line such as “Great New Practice – Hire Me”.

In lieu of the standard resume and cover letter, ask applicants to prepare a document detailing how their experience relates to the skill sets you are looking for. And, always have a hard deadline with a date and time for submissions.

Step 3 – Place Your Ads
There are many places to advertise to attract qualified staff and you should cast a wide net. The more quality applicants you have for each position, the more likely you are to find your ideal fit. Place ads in as many of the options below as possible.

  • Social Media
  • Your Website
  • Newspapers
  • Nurse Magazines
  • Craigslist
  • Major Online Job Sites

Step 4 – Sort Applicants Into Yes, Maybe, & No
This is where you start weeding out the applications.

  • Yes – These are applicants who have all the skills you wanted and followed all the application instructions.
  • Maybe – These applicants followed all instructions but may be lacking in a desired skill or personality trait.
  • No – Applicants who do not meet your skill requirements and everyone who did not follow your application instructions to the letter.

Step 5 – Contact Your Yes’s
Choose 5-7 applicants per position and contact them. If you have only three in your “yes” pile, choose two to four from your “maybe” pile. But, never reach into your “no” pile.

Step 6 – Narrow It Down
Choose five or fewer applicants per position for interviews. Be sure to include any current team members in the interview process, ask for their opinions, and be aware of personality dynamics.

Step 7 – Keep Weeding
If you still have no clear front-runner, give your top two to three choices a detailed assignment to complete. This will give you deeper insight into how they will work with you and your practice.

After following these seven steps, you should easily be able to choose a new employee with the skills and personality to blend seamlessly into your team. Taking the time to be diligent in your hiring will pay off for years to come with a loyal, skilled staff to buoy the success of your practice.

For more tips on how to start your new practice right, download this helpful guide.

About the Author

Adria Schmedthorst is a writer focusing on the medical device, technology, software, and healthcare industries. Adria is the founder of AMS Copy and a healthcare professional herself with more than 10 years in practice. She now uses her knowledge of the industry to help companies achieve their goals of writing content that speaks to the hearts and minds of medical professionals. She has been featured in blogs, written articles, and other publications for the industry, and ghostwritten books for doctors in both the United States and Australia.

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Get Latest ICD-10 and Medical Billing Tips in September Getting Paid Newsletter

Lea Chatham September 8th, 2015

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The September edition of the Kareo Getting Paid Newsletter takes a look at alternate practice models, tips for ICD-10 success, and more. The newsletter also provides a chance to discover upcoming events, news, and resources from Kareo. Plus, learn about how to register for upcoming webinars. Read all this and more now! Tweet this Kareo story


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6 Tips to Reduce Productivity Loss with ICD-10

Lea Chatham September 4th, 2015

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ICD-10 Resource CenterBy Lisa A. Eramo

It’s a fact: ICD-10 could have a big drain on physician practice productivity. The big unknown is just how much productivity loss will occur. This loss will occur due to the following:

  • Physicians will spend more time documenting the details necessary for ICD-10 diagnosis specificity.
  • Physicians will spend more time sifting through expanded diagnosis code selections in the EHR to find the code that accurately depicts the patient’s condition.
  • Medical coders will spend more time querying physicians for ICD-10 specificity.
  • Medical coders will spend more time verifying the codes that physicians have selected are correct.

Of course, the loss will be even greater if practices haven’t taken the time to truly prepare for this monumental transition. This includes updating EHR templates or superbills, training coders and physicians about specialty-specific changes, and testing externally with payers. However, only 21% of physician practices report that they’re on track with ICD-10 readiness, according to the most recent Navicure study. Other surveys seem to be even bleaker. The Texas Medical Association, for example, found that only 10% of physicians surveyed are confident that they will be able to navigate the October 1, 2015 implementation date successfully.

A lack of readiness will cause a whole slew of data emergencies, says Richard Milam, office productivity expert and president and CEO of EnableSoft, a company that specializes in robotic process automation. The good news is that practices can mitigate productivity loss related to ICD-10 and ward off these emergencies in a variety of ways. Tweet this Kareo story

1. Provide adequate coder training. Ensure that medical coders have received specialty-specific ICD-10 training and that they are comfortable using this new code set. Encourage them to review the 2016 ICD-10-CM coding guidelines, some of which differ from those of ICD-9.

2. Attend physician ICD-10 training. This training should be tailored to your specialty and focus on the documentation and coding changes that affect your practice most directly. Check with your professional association, the Medical Group Management Association, or the American Academy of Professional Coders for more information. CMS also offers a variety of free specialty-specific resources.

3. Update forms and templates to reflect ICD-10 specificity. This includes patient intake forms, EHR templates, insurance forms, and superbills.

4. Perform testing with your payers. Your billing system vendor should be able to assist with this process of ensuring that an ICD-10-coded claim flows properly through your practice management system to your billing system, and to the payer. They may even do this process on your behalf. This form of testing also ensures that the payer can accept, process, adjudicate, and pay the claim correctly.

5. Clean up the current discharge not final billed list. Doing so allows coders to focus on ICD-10 accuracy for all new claims going forward. This may require paying coders overtime or hiring additional coding help.

6. Consider automation solutions to boost productivity and efficiency. ICD-10 includes approximately 68,000 diagnosis codes, many of which are far more specific than their ICD-9 counterparts. Although vendors may assist with code updates, some systems (e.g., practice management systems or billing systems) may require manual updates to these codes. Rather than use valuable internal resources to complete these updates, consider technology that uses human-directed scripts to automatically populate and update specific fields within these systems. This same technology can be integrated with the EHR to accomplish the following: ICD-10 conversion/translation; automate credentialing workflows; and provide mass or periodic updates to drug codes, pricing and names.

Monitor productivity in ICD-10
In addition to taking proper steps to mitigate productivity loss, practices should also plan to monitor productivity continually in ICD-10. This includes keeping tabs on the following metrics:

  • Physician productivity—How long does it take physicians to select a code in ICD-10?
  • Coder productivity—How long does it take coders to code a record or verify physician code assignment in ICD-10?
  • Payer communications—Do payers respond to coding questions? If so, how long does it take to get a response?
  • Accounts receivable—How long does it take to send a claim to the payer? How long does it take payers to respond with a payment or denial?
  • Denial rates—What percentage of claims are denied, and why?

The most important takeaway point is to act now. Surround yourself with practice managers, coders, and other staff who are forward-thinkers and motivators. Empower them to embrace the transition to ICD-10 and take the necessary steps to ensure success.

About the Author

LisaEramofreelanceLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She also works as a healthcare content specialist for Agency Ten22. 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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5 Things to Consider When Looking at Alternate Payment Models

Lea Chatham September 4th, 2015

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By Cheryl Bisera

Physicians’ top three frustrations, according to the Great American Physician survey of 2014, are too much third party interference, high stress, and low compensation. As medical reimbursement becomes more challenging, physicians are looking at alternative ways to meet the needs of their patients while thriving as a business and striking the work-life balance.

By looking to non-traditional care delivery and payment models, physicians are finding new ways to obtain career satisfaction, improved work-life balance, and less frustration in dealing with the ever-increasing third-party payer hoops practices must jump through. But important considerations must be made before taking the plunge.

To arrive at a practice model that fits your individual strengths and goals, a great deal of soul searching has to take place. What Dr. Jones down the street is doing, regardless of his apparent success, may be all wrong for you – and your patients.

When considering a change in your practice model, take some time to stop thinking about what you have to do and think about what you’d like to do. Tweet this Kareo story

This can be a tough transition for physicians who have been in a cycle of performance-for-success year after year through school, residency, and employment or practice ownership. Without blocking out adequate time, giving yourself permission to think about what it is you really want, it’s near impossible to clarify or determine the answers to crucial questions. Honest, accurate answers will form the foundation of a successful alternative practice model that fits your needs and plays to your strengths.

Getting away from your day-to-day responsibilities, routines, and environment is a good way to nurture creativity. Tap into your dreams and goals, which may have been buried or dismissed in exchange of more seemingly practical and predictable success strategies.

If you are one of the ever-growing thousands of American physicians considering a non-traditional practice model but don’t know where to start, start with you. Tap into that which drove you to pursue a career in medicine in the first place and what you’ve come to discover while practicing. Create a list of what you find most fulfilling and rewarding as well as a list of what you don’t like, what creates the most frustration. Next create a list of your strengths as a practitioner and as a practice. Here are some prompts:

  1. Do you prefer working solo or having partners?
  2. What clinical services do you enjoy providing most or want to build out?
  3. Have you identified a type of patient you enjoy working with most?
  4. Is there a practice model you’ve heard of that interests you, and why?
  5. Do you enjoy the business management side of medicine or prefer to focus solely on clinical patient care?

These are important indicators of what kind of practice model you will want to research and move toward. This exploration process is only the beginning but critical to achieving the desired outcome when building a new plan for success!

About the Author

Cheryl Bisera photoCheryl Bisera is a consultant, author and speaker with extensive experience in marketing and business promotion that spans more than ten years in which she worked with professionals to strengthen their position in the marketplace. She is the founder of Cheryl Bisera Consulting, a California-based image development and marketing company that focuses on the healthcare industry and author of the book, The Patient-Centered Payoff. Cheryl has spoken for regional medical management organizations, conducted customer-service workshops, and written numerous articles for publications such as KevinMD, Physician Magazine, and the Journal of Medical Practice Management.

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Two Ways for New Physicians to Protect Future Income

Lea Chatham September 3rd, 2015

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By David B. Mandell, JD, MBA

As advisors to new physicians across the country, we’re often asked the question: “What is the most important thing I should be doing financially in the first years of practice?” Our answer is simple: “You need to build a solid foundation.”


Young Physicians’ Greatest Asset: Future Value of Income
The most important factor in the building of a foundation is to protect what the young physician has already built. For many young doctors with little savings and large student loan debts, their question is “what have I built? I am in debt!” The answer is that they have actually built a significant asset that needs protecting—the value of their future income.

What is needed to protect this asset? That depends on who they are protecting it for—themselves or others dependent on them. For both types of doctors, they need to protect their ability to earn this income in the future. That is why disability income insurance is so critical—and is tool #1 for young doctors.

Protecting Future Income for the Physician & Dependents
Disability income insurance conceptually is straightforward; if one becomes disabled it will pay the disabled doctor. For young physicians (and doctors typically into their 50s) this protection is critical because they have not accumulated the savings to support themselves and their families in case they cannot work as a doctor.

When looking at purchasing individual disability income insurance, physicians need to determine what their true need is, not how much they can get. If monthly expenses are $3,000/month, but an insurance salesman says you can get $5,000/month, you are over insuring yourself. While having more coverage than what’s needed is not always wrong, controlling expenses in order to build the proper foundation is more important.

Physicians will also want to make sure they’re purchasing adequate coverage. The definition of disability should be occupation specific, thus a physician cannot be forced to go back to work in another field. Residual or partial disability rider is another important part of the contract, in case the physician suffers a partial disability they can still work part-time in their occupation. Typically there has to be an income loss of 20% or greater. Also, in the event of a long-term disability, having a cost of living rider as an inflationary protector is important.

Protecting Future Income for Dependents
For young doctors with financial dependents—typically, children or spouses, but sometimes other family members—they need to focus on protecting their future income value not only against disability, but also against death. This is why life insurance is tool #2 that we typically recommend.

Much like disability income insurance, you need to first determine what your need is from a death benefit perspective to make sure you are being cost efficient. The way to determine your need is to decide what expenses would need to be covered. For example: mortgage, education funding for children, car loans & other debts, income support for spouse.

Young physicians in a position of purchasing life insurance should probably consider term insurance as their best option. Term insurance is inexpensive and provides a death benefit for period of time (10, 20, 30 years). This does not mean term insurance is the only or best type of insurance, it is generally best for a young physician who has a specific need. Permanent life insurance can be a very tax efficient saving vehicle that provides tax-free growth and tax-free distributions, if structured properly, and can provide great asset protection depending on the state of residence. For these reasons, permanent (cash value) insurance is often selected even by young physicians as a wealth accumulation and protection vehicle.

Readers of the Getting Paid Blog can receive a free hardcopy of “For Doctors Only: A Guide to Working Less & Building More” by calling 877-656-4362, or visit and enter promotional code KAREO06 for a free ebook download.

About the Author
David B. Mandell, JD, MBA, is former attorney, consultant and author of five national books for doctors, including “For Doctors Only: A Guide to Working Less & Building More,” as well a number of state books. He is a principal of the financial consulting firm OJM Group He can be reached at 877-656-4362 or


Disclosure: OJM Group, LLC. (“OJM”) is an SEC registered investment adviser with its principal place of business in the State of Ohio. OJM and its representatives are in compliance with the current notice filing and registration requirements imposed upon registered investment advisers by those states in which OJM maintains clients. OJM may only transact business in those states in which it is registered, or qualifies for an exemption or exclusion from registration requirements. For information pertaining to the registration status of OJM, please contact OJM or refer to the Investment Adviser Public Disclosure web site

For additional information about OJM, including fees and services, send for our disclosure brochure as set forth on Form ADV using the contact information herein. Please read the disclosure statement carefully before you invest or send money.

This article contains general information that is not suitable for everyone. The information contained herein should not be construed as personalized legal or tax advice.  There is no guarantee that the views and opinions expressed in this article will be appropriate for your particular circumstances. Tax law changes frequently, accordingly information presented herein is subject to change without notice. You should seek professional tax and legal advice before implementing any strategy discussed herein.

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Laterality, Anatomical Specificity Important In ICD-10 Oncology Codes

Lea Chatham September 1st, 2015

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ICD-10 Resource CenterBy Lisa A. Eramo

The transition to ICD-10 has required significant time and resources; however, ICD-10 diagnosis changes—particularly those for oncology—will undoubtedly lead to more accurate clinical research with the hope of improving patient outcomes. ICD-10 capitalizes on anatomical specificity, laterality, and disease process—all of which must be reflected in an oncologist’s documentation and coding. Betty Hovey, CPC, COC, CPB, CPMA, CPC-I, CPCD, director of ICD-10 development and training at AAPC provides an overview of some of ICD-10 changes relevant for oncology practices to help them prepare for the transition.

  1. Breast cancer. ICD-10 code category C50 (malignant neoplasm of the breast) includes anatomical specificity (e.g., nipple and areola, central portion, lower inner quadrant) as well as laterality (i.e., right vs. left) – both of which must be included in medical record documentation. ICD-10 also includes separate codes for male breast cancer, each of which requires anatomical location and laterality.
  2. Benign neoplasm of the colon, rectum, anus, and anal canal. Oncologists probably aren’t accustomed to documenting the specific portion of the colon in which the neoplasm exists; however, ICD-10 includes separate codes for benign neoplasms of the cecum (ICD-10 code D12.0), appendix (ICD-10 code D12.1), ascending colon (ICD-10 code D12.2), transverse colon (ICD-10 code D12.3), descending colon (ICD-10 code D12.4), sigmoid colon (ICD-10 code D12.5), and unspecified (ICD-10 code D12.6). Documentation specificity is key to ensuring the correct code assignment. Report ICD-10 code K63.5 when a patient has a polyp of the colon.
  3. Sickle cell anemia. Sickle-cell disorders (ICD-10 code category D57) are combination codes that include the type of disease, with or without crisis, and the specific type of crisis (if applicable). Types of Sickle-cell disease include Hb-SS disease, Sickle-cell/Hb-C disease, Sickle-cell trait, Sickle-cell thalassemia, or other Sickle-cell disorders. Types of crises include acute chest syndrome or splenic sequestration. Attention to detail is critical with these codes.
  4. Primary liver cancer. ICD-10 code category C22 requires specificity regarding the type of liver cancer, including liver cell carcinoma, intrahepatic bile duct carcinoma, hepatoblastoma, angiosarcoma, or other sarcomas. All of this information is critical for cancer research and treatment.
  5. Lymphoma. ICD-10 includes several pages of codes denoting various types of lymphoma. Oncologists should review codes in this section—i.e., code categories C81 through C88. Not only do these codes denote the type of lymphoma, but many of them also require anatomical specificity. For example, ICD-10 code C83.12 denotes Mantle cell lymphoma, intrathoracic lymph nodes.
  6. Malignancy in pregnancy. Oncologists must look beyond the neoplasm chapter in the ICD-10 book to subcategory O9A.1- for malignant neoplasms that complicate the pregnancy, childbirth, or puerperium. Specify the specific trimester to ensure correct code assignment. Malignancy in pregnancy is always listed as the principle diagnosis per the ICD-10-CM coding guidelines regardless of the reason for admission.

Know these coding guideline changes

Oncologists should also keep the following guideline change in mind related to anemia and malignancy:

In ICD-10, if a patient is admitted for treatment of anemia due to or associated with a malignancy, report the malignancy as the primary diagnosis. Note that this is just the opposite of ICD-9 that requires coders to report the anemia as the principal diagnosis in this instance.

How to prepare

Oncologists and their staff members should consider these ICD-10 tips:Tweet this Kareo story

  • Review ICD-10-CM codes to identify differences in code descriptions and documentation requirements.
  • Revise templates and superbills to reflect most common diagnoses.
  • Create cheat sheets to assist oncologists in selecting the correct code in the EHR.
  • Always specify anatomical location and laterality.

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

About the Author

LisaEramofreelanceLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She also works as a healthcare content specialist for Agency Ten22. 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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