What the Heck is Going On with MU?

Lea Chatham January 27th, 2016

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By Beth Onofri

“What the heck is going on with Meaningful Use,” is a phrase that is probably popping up for a lot of people right now thanks to the huge number of conflicting articles that are flooding our inboxes. Is Meaningful Use (MU) ending or not? Even Andy Slavitt, CMS Acting Administrator, tweeted “In 2016, MU as it has existed—with MACRA—will now be effectively over and replaced with something better.” A week later, an article was released to clarify his statements.

There is no doubt that changes are coming once again to the EHR Incentive Program. But it is not just changes to the MU program. Tweet this Kareo story 

There are a number of other programs that will see changes too—PQRS, Value-Based Modifiers, and clinical quality measures. The overall goal is to align all these programs, using the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as a foundation.

Less than a decade ago, the MU initiative began with the objective to bring technology into the healthcare system. Initiatives encouraged providers to collect data electronically. The phased approach allowed us to move into connecting with one another, sharing the information we collected, and beginning the process of outcome measurement.

MACRA focuses on quality, cost, and clinical practice improvement when calculating how Medicare physician payments are determined. In other words, a shift to focusing on patient care and reimbursement for the quality of that care. It is important to point out that this realignment is strictly for Medicare reimbursement and not for Medicaid. Medicaid physicians will continue to be reimbursed in line with the previously established program.

So, What the Heck Is Going on with MU?
Many of you are wondering what does this mean for me and what should I do now. The answer is: Continue with the MU program. If you have not begun Meaningful Use, begin in 2016. The MU program may be replaced at some point, but the concepts, in particular e-prescribing, interoperability, and clinical quality measures, will continue whatever the initiative may be called.

If you have successfully attested to Meaningful Use, continue collecting the necessary data. The October 6, 2015 CMS rule streamlined Stage 1 and Stage 2 into one stage, Modified Stage 2, with ten (10) objectives. All providers use one set of objectives, no differences for the number of years in the program. Additionally, these objectives will remain basically the same for the next two years, through the 2017 attestation year.

Both new and returning participants should take a closer look at the MU clinical quality measures (CQMs) and the Physician Quality Reporting System (PQRS) measures. Although there has been some attempt in the past to align these two programs, they have been relatively distinct. However, these programs will be aligned, and hopefully consolidated, with the coming changes. Providers should begin to look at the results as well, and not just the collection of information. Trending of outcomes is not far in the future.

Watch for more details and updates on MU coming soon.

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5 Tips to Respond to Negative Online Reviews

Lea Chatham January 26th, 2016

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By John Sung Kim

Bad online reviews can happen to any business at some point. So negative reviews are always a looming threat to the marketing and reputation of a medical organization. And while this can hang like a dark cloud over providers, it’s important to understand the best practices to respond when this type of consumer content comes across our profile pages.

The first step is to make a request to the website that the negative review be removed, but most first attempts that I’ve seen don’t succeed. That is why it is important to understand these five tips to handling negative reviews before requesting removal: Tweet this Kareo story

  1. You will, in all likelihood, only get one shot at requesting a review be removed, so it’s critical to have a strategy before contacting the review site.
  2. Reading the Terms of Service (TOS) from that review site will go a long way in helping to determine what that strategy should be. It’s common for these review sites to publish in bullet points what types of content they do not allow, for example mentioning a competing company, naming one of your employees specifically, using profanity, etc.
  3. Once it’s determined that a review could violate one or more of the terms, write that in the subject line of the email to the review site, “Violation of Your Terms of Service,” or “This Review Violates Your Terms of Service.” This will often bring your review removal request to the front of the queue.
  4. It’s also a best practice not to respond to the patient directly as this lowers your brand by having you “stoop to their level.”
  5. It is perfectly acceptable, however, to have your Office Manager respond to the review with a statement that, “This review has been flagged for violating the website’s terms of service and is awaiting moderation for removal.”

Using these strategies the next time you have a negative online review will significantly increase your chances of having it removed. However, if it isn’t removed keep in mind that the occasional negative review isn’t the end of the world, especially if you have a lot of positive reviews. They are only a problem if you don’t have many reviews.

Organically (meaning passively waiting for reviews to generate), the average medical practice can have anywhere from two to ten reviews a year. That’s far too few to aggressively recruit new patients and have a solid defense against the occasional bad review. Having just four 5 star reviews and one 1 star review means that a single disgruntled patient can drag down a 5 star practice to a 4 star practice.

Many practices are hesitant to ask for reviews because of fears around patient perception and regulatory compliance. A simple way to avoid problems and to consistently generate a healthy volume of reviews is to use practice marketing automation software that integrates into your appointment schedule. In this way, each patient who walks out the door gets a mobile-friendly email that asks them to rate their visit, which makes the feedback request more of a patient survey and not a selective “ask” for positive reviews.

The more sophisticated systems can not only integrate into popular review sites (feeding them your positive reviews) but can also detect unhappy patients and send them down an alternate path (providing private feedback to the doctor) as opposed to giving the patient a chance to write a publicly negative review.

Several studies have shown that patients are looking at reviews of healthcare providers before booking an appointment. So it is worth the investment to put a system in place to increase overall reviews and manage negative feedback.

If you are looking for more tips on managing your online reputation, download 4 Steps to Building and Managing Your Practice’s Online Reputation.

About the Author

John Sung Kim is the technology evangelist at Kareo. He was previously the CEO of DoctorBase, a practice marketing and patient engagement platform that was purchased by Kareo in 2015. He was also the founder and founding CEO of Five9 (NASDAQ: FIVN). He’s acted as a consultant to numerous startups and government organizations including RingCentral, Qualys, Odesk, the city of San Francisco and the California Public Utilities Commission. 


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Billing Companies, Help Customers Reduce Denials Now

Lea Chatham January 21st, 2016

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Do you struggle with having conversations with practice customers about denial management? This short video provides helpful tips from expert Paul Bernard on how to make tough conversations like this easier. Tweet this Kareo story

Looking for more ways to improve and grow your billing company? Check out the resources available here.

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Pain Relief for Next April 15: 4 Tax Saving Tips You Can Use Now

Lea Chatham January 19th, 2016

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By: David B. Mandell, JD, MBA and Carole Foos, CPA

As a physician, do you realize that, after the tax increases of recent years—between income, capital gains, Medicare, self-employment and other taxes—you likely spend between 45 and 55 percent of your working hours laboring for the IRS and your state? Tweet this Kareo story

Given these sobering facts, the purpose of this article is to show you four ways to potentially save and possibly motivate you to investigate these planning concepts early in the year when you can best take advantage of them. Let’s examine them now:

1. Use the Right Practice Entity/Payment Structure/Benefit Plans
These areas are where the vast majority of tax mistakes are made by doctors today—and where many of you could benefit by tens of thousands of dollars annually with the right analysis and implementations. Issues here include:

  • Using the legal entity with maximum tax/benefits leverage—whether that is an S corporation, C corporation, LLC taxed as S, C, partnership, or disregarded entity.
  • Using a multi-entity structure to take advantage of two types of entities and their tax/benefit advantages.
  • Managing the payment of salary, bonus, distribution, and partnership flow-through to take advantage of maximum retirement benefits and minimize income, social security, and self-employment taxes.
  • Considering benefit plans beyond the typical profit-sharing/401(k) with which most medical practices start and end their benefit planning.

2. Don’t Lose 17-44 percent of Your Returns to Taxes; Explore Investment Managers Who Manage with Taxes in Mind
It is quite well known that most investors in mutual funds have no control of the tax hit they take on their funds. What you might not know is how harsh this hit can be. According to mutual fund tracker Lipper, “Over the past 20 years, the average investor in a taxable stock mutual fund gave up the equivalent of 17 to 44 percent of their returns to taxes.”

How to avoid this problem? Consider working with an investment firm that designs a tax-efficient portfolio for you and communicates with you each year to minimize the tax drag on that portfolio. In a mutual fund, you have only one-way communication—the fund tells you what your return is and what the tax cost is. Working with an investment management firm, you get two-way communication, as the firm works with you to maximize the leverage of different tax environments, offset tax losses and gains, and other tax minimization techniques.

3. Gain Tax-Deferral, Asset Protection through Cash Value Life Insurance
Above, you learned about the 17-44 percent tax hit most investors take on their investments in stock mutual funds. Similar funds within a cash value life insurance policy will generate NO income taxes—because the growth of policy cash balances is not taxable. Also, nearly every state protects the cash values from creditors, although there is tremendous variation among the states on how much is shielded.

4. Consider Charitable Giving
There are many ways you can make tax beneficial charitable gifts while benefiting your family as well. The most common tool for achieving this “win-win” is the Charitable Remainder Trust (CRT). A CRT is an irrevocable trust that makes annual or more frequent payments to you (or to you and a family member), typically, until you die. What remains in the trust then passes to a qualified charity of your choice.

This article gives you a few tax-saving ideas. For larger practices with $3-5 million or more of revenue, there are additional techniques that could offer significantly greater deductions. These are outside the scope of this article, but are mentioned in the articles on our website and are topics of our free e-newsletter. If you want to save taxes, the most important thing you can do is start looking for members of your advisory team who can help you address these issues in advance. Otherwise, you will be in this same position this April 15…and next April 15 and the one after that.

About the Authors

David B. Mandell, JD, MBA, is an attorney 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 www.ojmgroup.com, where Carole C. Foos, CPA is a principal and lead tax consultant. They can be reached at 877-656-4362 or mandell@ojmgroup.com.

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 visiting www.ojmbookstore.com and enter promotional code KAREO027 free ebook download of For Doctors Only or the shorter For Doctors Only Highlights for your Kindle or iPad.

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 www.ojmgroup.com. He can be reached at 877-656-4362 or mandell@ojmgroup.com.









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 www.adviserinfo.sec.gov.

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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Start the New Year Right with Tips in the January Getting Paid Newsletter

Lea Chatham January 12th, 2016

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The January Kareo Getting Paid Newsletter provides expert tips to start the year off right. Get advice on managing the deductible reset, filling open appointments, reporting for PQRS, and more. The newsletter also offers 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

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Is Quality Improvement Your New Year’s Resolution? It’s Not Too Late to Meet PQRS for 2015

Lea Chatham January 11th, 2016

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By Emily Richmond, MPH

Calendar year 2015 may be over, but it’s not too late for physicians and other eligible professionals to participate in the Physician Quality Reporting System (PQRS) for the 2015 reporting year. Tweet this Kareo story

Whether one of your resolutions in 2015 was to spend more time on quality improvement or simply to take steps to make sure your income stays steady through this tumultuous time in healthcare, you’re lucky that time hasn’t run out for you to meet those resolutions just yet.

Taking action now is very important for physicians who regularly see Medicare patients because reporting 2015 PQRS data to the Centers for Medicare and Medicaid Services (CMS) is the only way to avoid two negative payment adjustments that would impact your Medicare Part B reimbursements in CY 2017:

  • 2.0% negative adjustment for PQRS
  • 2.0%-4.0% negative adjustment for the Value-Based Payment Modifier

It is important to note that the 2.0%-4.0% swing in penalties associated with the Value-Based Payment Modifier is related to practice size. Solo physicians and groups with 2-9 eligible professionals are subject to the 2.0% penalty if they do not report PQRS for CY 2015. The 4.0% penalty would be applied to groups with 10 or more eligible professionals.

No one likes losing up to 6% of their income, especially when that money is taken away based on something that happened (or didn’t happen) two years prior. Unfortunately, CMS is known for this two-year lag in payment adjustments and physicians are stuck making sure they report data appropriately and in time to avoid penalties down the road. While there are multiple ways to participate in PQRS if one gets started earlier in the year, the easiest mechanism for late starters is reporting PQRS Measures Groups to CMS through a PQRS Qualified Registry.

Since the deadline for qualified registries to report PQRS data to CMS is not until March 31, 2016, physicians who have access to data from the 2015 year—either through their billing provider or their EHR—may still be able to validate this data and send it to a registry prior to the deadline. In addition, PQRS Measures Groups are the easiest way to meet reporting requirements this late in the game because physicians are only required to report data for a 20 patient sample, for each measure in the group. The following steps will maximize your chance of successful participation in PQRS for the 2015 year:

  1. Identify a PQRS Qualified Registry that reports measures applicable to your specialty that is still taking new customers for the 2015 reporting year.
  2. Download the CMS PQRS Measures Groups documentation and determine which Measures Group is applicable to your patient population.
  3. Review your available data sources (billing systems, EHR systems, etc.) and determine whether data is available for encounters that occurred between January 1, 2015 and December 31, 2015.
  4. Contact the Qualified Registry of your choice to find out how they receive data from physicians for PQRS, and if needed, reach out to your EHR vendor or billing system vendor to make sure you can access the data in the necessary format.

After you take the steps needed for reporting PQRS in 2015, be sure to keep your eyes out for information on how to participate in PQRS for CY 2016 year as well. Unfortunately the payment penalties will continue to add up, but at least you’ll have more of a head start than last year.

About the Author

Emily Richmond, MPH, is Vice President of Quality and Performance Improvement at Able Health, the pay-for-performance platform for physician organizations. She has as passion for quality improvement and health policy and has led the development and rollout of quality programs for Medicare and private payers.

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An Ounce of Prevention for the Deductible Reset

Lea Chatham January 11th, 2016

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by Laurie Morgan, Capko & Morgan

Does it seem like your practice reception area transforms from Grand Central Station to Old West ghost town in the span of a few days from December to January? Do you find yourself secretly hoping for a flu epidemic to bring in some new Q1 business? If so, you’re not alone. The deductible reset has many practices scrambling to serve patients eager to be seen before December 31—and scrambling to find patients to serve after January 1.

The deductible reset creates challenges for many specialties at the turn of a new year, but if your practice offers preventive services, they can be the antidote to slumping revenues. Tweet this Kareo story

Taking the time to promote preventive care at the beginning of the year is also an excellent way to offer patients more convenient service, while also engaging them and showing you’re concerned about staying on top of their healthcare.

The advantage of promoting preventive care at the start of the year is cost to patients—or lack thereof. Under the ACA, preventive services like annual wellness visits, well-woman OB/GYN exams, vaccines, and preventive tests like colonoscopies and Pap smears are typically covered by most health plans with no copay or deductible. (Grandfathered plans could be an exception—but a relatively rare one, since many plans covered preventive care at no out-of-pocket cost to patients even before the ACA mandated it.)

Patients may not be aware that these services can be had without opening their wallets. They also may not be aware that they’re due for screenings based on their age, risk factors and history. Best of all, they may not realize that getting an appointment at a convenient time could be easier at the start of the year because your practice has more unused capacity.

Identifying and proactively contacting patients for timely preventive services is a great way to get more value from your EHR and patient portal. I’ll be exploring this and other marketing ideas to help you weather the deductible reset and get your practice off to a strong start in 2016 in my upcoming free webinar, 4 Tips to Fill Your Schedule in 2016, on January 14. Register Now!

About the Author

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

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Free Webinar: Tips to Fill Your Medical Practice Schedule in 2016

Lea Chatham January 8th, 2016

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4 Tips to Fill Your Schedule in 2016
Thursday, January 14
10:00 AM PT, 1:00 PM ET

Learn tips to fill your medical practice schedule now and for the rest of 2016 in this free webinar with expert Laurie Morgan Tweet this Kareo story

Is attracting new patients on your list of resolutions for 2016? Are you concerned about the “January effect” of the deductible reset, which has evolved into a Q1 effect for many practices? Or would you just like to learn some efficient, easy, modern ways to market your practice—without a big cash outlay?

Join Laurie Morgan of Capko & Morgan for a lively, practical webinar with five tips you can take advantage of to fill your practice schedule now and for the rest of 2016. She’ll take a look at:

  1. What every practice must know about online reputation management — and how to take advantage of it
  2. How mining your own data can be the key to more revenue during the winter months
  3. Where online scheduling and other self-service tools should fit into your marketing mix
  4. Why too many practices are unknowingly turning patients away — and what you must do today to avoid it

Register now to to join Laurie and start the new year off right.

Register Now

About the Speaker

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


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Video: Tips to Choose the Right Medical Billing Service

Lea Chatham January 7th, 2016

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If you have made the decision to outsource your medical billing then you are half way to streamlining your billing and focusing more on patient care and practice growth. The other half is choosing the right medical billing service for your practice.

Learn tips to help you find the right medical billing service for your practice in this short video. Tweet this Kareo story

Want more tools to help you make the right choice? Download this helpful guide, To Hire or Not to Hire a Billing Service.

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10 Facts: Billing Telemedicine with Private Payers

Lea Chatham January 5th, 2016

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By Teresa Iafolla 

Whether you’re just getting started with telemedicine or considering adding it to your practice, conquering your telemedicine billing policy is a big step. If you’ve decided to forgo the cash-pay model for telemedicine visits, you’re in the realm of telemedicine reimbursement–a tricky spot if you don’t know all the facts.

Since the three major payer types (Medicare, Medicaid, Commercial) have different guidelines when it comes to getting reimbursed for telemedicine, it helps to review the trends and rules for each one individually. Last month, I did a review of things to know if you’re planning to offer telemedicine to your Medicare population.

Now, it’s time to review what telemedicine looks like with commercial payers. Which private payers cover telemedicine? Do they have the same types of restrictions as Medicare? What kinds of specialties and services do they cover? Do they use the GT modifier too?

Here are the 7 things you should know about telemedicine and commercial payers. Tweet this Kareo story

  1. If your state has passed a telemedicine parity law, it means commercial payers have to cover telemedicine services in your state. A telemedicine parity law is a state law that mandates private payer (and some cases, Medicaid) coverage for telemedicine services, in the same way as in-person medical services. Some states do have restrictions on this (for instance, see Arizona’s partial parity law), so it’s worth reading the fine print. But basically, if your state has a telemedicine parity law, it’s good news for you. Currently, 29 states and DC have telemedicine parity laws.
  2. The Big Five payers all have some sort of telemedicine coverage. Our team has called around to the big five commercial payers (Aetna, Humana, Blue Cross Blue Shield, Signa, United Healthcare) and they all say they cover telemedicine. However, that coverage can vary state-to-state and is often policy-dependent. So while a patient with the top-tier Aetna plan in Maryland may have telemedicine visits listed as a covered service, another patient with a lower-cost plan may have it excluded.
  3. The best way to know if telemedicine is covered by an insurance policy is to call the payer and verify. Since the policy and billing guidelines around telemedicine are still evolving, the best way to confirm a commercial payer’s rules is to call and get a rep on the record. Our team has created this telemedicine insurance verification form that you can use to document the call. It includes the specific CPT codes to ask about, and other potential restrictions (is there a monthly limit to the number of telemedicine visits the patient can do?) Make sure to always record the reference ID from the call on that form. As our eVisit billing expert likes to say – that’s your golden ticket! If the rep from that payer tells you the service is covered and to use a certain billing code on the record, they have to honor that. If at any point you need to go back to hem, all you have to do is read off that reference number.
  4. While some commercial payers will cover store-and-forward and remote patient monitoring telemedicine services, the predominant type of telemedicine is live video. Most private payers are moving first to cover live video telemedicine as a way to do remote doctor visits with patients. Most of their guidelines, as well as state telemedicine parity laws are focused on live video.
  5. If a commercial payer provides coverage for telemedicine, it generally will reimburse for standard evaluative and management services. In many cases we’ve found that a live video telemedicine visit would just be billed with the appropriate E&M code and the GT modifier to show the service was done via telemedicine. However, some payers may advise you to use the telemedicine-specific code 99444. Some commercial payers also cover a much wider range of services, especially related to mental health and chronic care, but E&M services are the default. Again, you have to verify with the payer what their rules are. If you’re curious and looking for an example from a specific payer, check out this telehealth policy from BCBS North Carolina.
  6. Commercial payers will generally reimburse at the same rate as the corresponding in-person medical service. This is especially true if your state has a telemedicine parity law and you’re billing the standard E&M code with a GT modifier tacked on. In most cases, the payer will just reimburse you according to your negotiated physician fee schedule.
  7. The future is looking bright for commercial payers and telemedicine. Many of the big commercial payers have been doing pilot programs with telemedicine to test the touted benefits of cost-savings and care outcomes. As these programs produce results, payers are likely to revise their 2016 policies to offer much broader coverage of telemedicine services.

Want to know more about telemedicine and private payers? You can always send me an email or checkout the reimbursement page on eVisit for more information.

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 tiafolla@evisit.com.

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