There is a new ICD-10 tool available to help you achieve 100% Success with your ICD-10 transition. The “100% Success Plan” Checklist is now in a write-on, task-based poster format. The post clearly lays out exactly what to do and when with room to assign a project owner and due date. Getting ready to make the change couldn’t be easier with this full size guide. Hang it up in your practice to keep everyone on track and working towards ICD-10 success! Just click here to order yours today.
Lea Chatham March 5th, 2014
Though many injuries are associated with a specific event, back pain is often the result of gradual strain. As many as one in four adults in the United States experience some form of discomfort in their lower back, and given how much time the average American spends sitting down, it’s highly likely that aspects such as posture and positioning play a role in this prevalence.
So, as a chiropractor, is there anything you can do to help your patients ease this strain?
In addition to regular consultations and adjustments…
providing tips about workplace layout can be a great way to give your patients a bit of relief while further establishing you as a trustworthy authority. Tweet This
In terms of chiropractic marketing, sharing such information via your website and social media channels can also serve to draw new clientele.
Standing desks are becoming a popular method for men and women to stay a bit more active and maintain better posture throughout the day. In addition, kneeling chairs and yoga balls can provide seating that also reinforces core back muscles. Recently, the technology news outlet CIO Magazine showcased desktop arms as a way to give users greater control over the placement of their monitors. This seemingly small accessory can make a world of difference for patients who stare at a screen for most of the day, allowing a bit more flexibility and comfort as they work.
Maintaining a consistent level of physical activity and reducing sedentary time in general can have substantial benefits for the overall health of your patients. With chiropractic EHR, you can make note of any lifestyle habits that could potentially exacerbate back issues and other medical concerns.
Lea Chatham March 4th, 2014
By Kacey Burr, Demandforce
According to a Litmus study, more emails are now read on a smartphone or tablet instead of a desktop computer. This means that your patients today are mobile, and your practice should be too. How do you ensure that your practice is “mobile ready”? Being mobile ready means making the most of the innovative technology your patients are already using, and connecting with your patients anywhere, at any time, on any of the devices they use most.
51% of email is now opened on a mobile device. Tweet This
Statistics like this from a Litmus study show it is essential that email communications you are sending your patients—whether they are appointment confirmations, thank-you’s, special offers or newsletters—are optimized for a mobile device. Doing so ensures that your emails not only look as well designed and legible on a mobile screen as they do on a standard desktop, but it also means that they have a better chance of being properly delivered, received, and responded to.
95% of people read text messages within 15 minutes of receiving them. Tweet This
A study published by Informa Telecoms & Media demonstrates the importance of using SMS text messaging as an effective means to reach your patients. Texting patients to confirm upcoming appointments is an easy way to make sure the message is delivered and reduce the risk of no-shows. Incorporating text messaging into your communication strategy is a great way to give your patients more options, and increases their likelihood of being receptive to your practice’s communication efforts.
85% of smartphone owners see value in storing “mobile-wallet” content on their phones. Tweet This
According to a report from Vibes, mobile-wallet technology like Google Now and Apple’s Passbook are increasingly important to smartphone users. These mobile-wallets store information about upcoming appointments, loyalty cards and special offers, contact information and directions to the business all in one easy-to-access location on your phone. If you are working with a marketing solution that enables your appointment confirmation communications to integrate with these kinds of platforms, patients can access all relevant appointment information with ease, in one place.
Maximizing today’s mobile technology to stay top of mind and better reach your patients is one more way to demonstrate that your practice is dedicated to caring for and interacting with your patients in the ways that are easiest and most convenient for them. It is important to stay up to date with the technologies and trends that your patients are following, so you can connect with them efficiently and improve patient relationships.
If you are interested in learning more about solutions that can help you meet this need, check out the Kareo Marketplace partner, Intuit Demandforce. Their newly released Mobile First Suite bundles all of Demandforce’s mobile features and capabilities to help your practice reach patients in the most efficient and effective ways.
About the Author
Lea Chatham March 3rd, 2014
Patient engagement is the hot topic for 2014 (well right behind ICD-10). Everyone is talking about how healthcare providers can do a better job of engaging patients. And we all know why. People are starting to see healthcare as they see other consumer goods and services. As a result, their expectations are changing. Tack on requirements under Meaningful Use, the need to improve outcomes, and an industry-wide focus on reducing costs, and you have lots of reasons to take this movement seriously.
Social media is a great tool for patient engagement beyond your practice walls, but it requires more than setting up a Facebook page. In fact, it also requires more than just posting things about your practice or responding to patient comments and reviews. To be really effective, you need a broad approach that helps you and your patients stay in touch with what is happening across your community.
Your patients are impacted by many things, and really engaging them means taking those things into consideration. This is where social listening comes in.
What is social listening?
Put simply social listening is about monitoring what is being said online about a specific business or topic. By engaging in social listening, you can become a resource for patients. Here is how to become a go to site for patients by listening to what is happening in your community:
- Monitor Hot Topics: Practice management and patient engagement expert, Laurie Morgan suggests using Google Alerts to track topics of interest to you and your patients by entering specific key words (i.e., the name of your town or specialty). Then, post interesting articles or links on your social channels. You can also use this tool to monitor posts and reviews about your practice so you can manage your online reputation.
- Identify Local Influencers: Let’s be honest the size of your community impacts the scope of this task. If you are in a city like Chicago, this could be something you work on little by little over time while a small town provider might be able to do this in an hour. What you want to do is identify people who have a lot of followers in your community and connect. These influencers can be healthcare related or not. Then, you can share posts as appropriate on your own channels. By commenting and engaging on the influencer’s page you can also increase your own exposure. Building a relationship with influencers can also increase your own legitimacy.
- Connect with Other Providers: Obviously, it is not in your best interest to link up with or repost content from your competitors. But it is in your interest and to the benefit of your patients to connect with local hospitals, the health department, and your referral network. This way you can share urgent news about outbreaks in local schools or free screenings and health fairs available from the hospital. You can also reduce the amount of time you spend creating content by sharing content created by physicians you refer to or who refer to you. The bonus is that you also strengthen that network, which can help build your business.
Think about all the things that might impact a patient’s life and wellbeing. “Many practices don’t understand that social networking is just like face-to-face networking,” says Audrey McLaughlin, a practice management consultant. “You are trying to build a connection, not just hammer people with promotions.”
By taking the time to listen to your community, you can build social networks that are really meaningful to patients. It can enable you to become a true resource for their wellness.
If you’re looking for more tools to engage patients online, visit the Kareo Marketplace. We’d also love to hear about your successful strategies for engaging patients online in the comments section below!
Lea Chatham February 27th, 2014
We all know that the healthcare landscape is drastically changing, from the Affordable Care Act (ACA) and the influx of patients to the way that providers are getting compensated for care. With the passage of the ACA it’s estimated that there will be 32 million new patients entering the healthcare system. This is a huge amount of patients given the fact that there’s a current and impending physician shortage here in the US.
With this influx of patients, healthcare providers have been looking for ways to increase efficiency and improve communication with patients. Technology has played a very important role in this search.
The funny thing is that technology can be both a blessing and a curse. Being more available to your patients is a great thing that can lead to increased patient satisfaction, but it can also impact your bottom line.
According to a Physicians Foundation Report, physicians estimate that they provide $25,000 or more each year in uncompensated care.
This is typically in the form of phone calls, which have increased 25-50% since 2008, according to this Marketwatch Report. The issue is that insurance companies are not reimbursing for these calls, which cost practices about $15-20 per call!
The good news is that doctors are fighting back with the help of new technology coupled with office policies to increase efficiency and reduce lost revenue opportunities. Some examples include software that helps offices automate appointment reminders, new simple policies around filling out forms and prescription refills, and the introduction of “concierge-light” services that have made doctors’ lives easier and increased patient satisfaction.
Many of these concierge services provide better patient access to doctors, but this type of access is difficult to provide. In addition, doctors are fearful about making themselves more available without getting compensated for it!
The good news is that there are alternatives, one of them is offering patients telephone consultations for an out-of-pocket convenience fee so you can offer access while getting paid for your time. This is not a full-blown concierge model where you’d have to charge patients hundreds of dollars per month for immediate access. It’s simply an elective, “as needed” value-added service. Think of it as offering your patients an a-la-carte premium level of phone access where a patient can pay a small fee for expedited service. These types of calls can keep patients out the ER, save them thousands of dollars, and help them understand if they truly need an in-person appointment. Patients simply indicate that they’re willing to pay a convenience fee to get more immediate service from the doctor they know and trust.
At the same time, phone consultations allow physicians to generate practice revenue and increase office efficiency. With the increasing costs to remain in business as a smaller practice, every bit of revenue counts so why not make revenue from time you’re already spending on the phone? The best part is that by charging an out-of-pocket convenience fee to patients you don’t have to deal with the hassles of paperwork and requesting insurance reimbursement. According to this article from a Los Angeles Cardiologist, “10% of all gross receipts of any practice are spent collecting monies from insurance companies and patients.”
A common concern around phone consultations is whether or not patients will be willing to pay, and the bottom line is that it really boils down to patient education. Letting patients know about the new service, when to use it and why it’s valuable will help them understand that getting immediate and direct access to you is valuable. It will also help your patients understand how important your time is. Understanding that your patients are looking for more convenient, alternative ways for receiving care is instrumental in patient satisfaction.
If you’re interested in learning more about offering phone consultations to your patients, checkout the Kareo Marketplace partner Ringadoc.
What services or policy changes have you made at your practice to make sure that you’re compensated fairly? Feel free to add to the comments below!
Lea Chatham February 26th, 2014
On Wednesday, February 19, Kareo hosted a free webinar where practice management expert Rochelle Glassman discussed several innovative revenue streams that can be added to medical practices of all types and sizes. Over 1,000 people registered and several hundred attended Is It Time for New Revenue Streams?. As a result, there were many questions about how to get started with these opportunities and how specific specialties can increase revenue. Rochelle and Kareo have answered the many questions posed by participants, and several of those answers are shared here.
Q. Can you provide the list of specialties that can use some of these programs (i.e., drug testing or pharacogenetic testing)?
A: Drug testing is appropriate for (but not limited to) pain management, neurology, anesthesiology, surgeons (postoperative and preoperative), treatment centers, OB/GYN, and internal medicine. Pharmacogenetic testing is most used in primary care, internal medicine, pain management, neurology, and psychiatry, but may be viable in other specialties depending on circumstances.
Q. How much revenue can be generated from a weight loss program?
A: Depending on the practice and program, it can generate upwards of $200,000 per provider.
You are reimbursed to screen your patients for obesity. If the patients meet the criteria of a BMI over 30 in adults, they can be scheduled for 26 visits in 6 months, and if they lose over 7.5 pounds in 6 months additional visits are permitted. You can also provide nutritional and behavior services as additional revenue streams. Medications can also be provided at the practice for cash, or a prescription may be written.
Q. Is IV Therapy a good revenue generator for internal medicine?
A: It is a revenue generator and often times saves the payers from having so send patients to the ER or to put them on home care services. For these types of services you should negotiate with your payers as you are saving them facility and home care fees. This should be taken into account when negotiating your reimbursement rate for this higher level of service.
Q. What preventive care services are covered for OB/GYN under the ACA?
A: There are lots of covered preventive services for an OB/GYN acting as a primary care provider.
The best way to get a better idea of what is now covered without a co-pay or deductible is to review the information provided by the USPSTF. The preventive care services now covered for women include annual exams, mammograms, vaccines like flu and pneumonia, and much more.
Q. Do you have specific recommendations for physical or occupational therapy?
A: Yes, there are several options to help build revenue in a rehab practice. Partnering with primary care providers and some specialists to offer services can be done in a variety of ways. You can provide services in that physician practice. You can lease a space in your practice to that physician, or market special services in your practice to surrounding providers. Just as a couple of quick examples:
- Working with a breast surgeon you could lease your space or space at the surgeons practice and offer services for lymphedema in a private, supportive setting.
- Provide specialty services such as, working with primary care and OB/GYN to provide services for incontinence, or offer balance training programs for the elderly with internal medicine and geriatricians. Working with a primary care provider you could offer supervised exercise as part of a weight loss program or nutritional counseling especially for those patients who are morbidly obese.
Q. What recommendations do you have for a gastroenterology practice?
A: That would depend on what types of services you are currently providing to your patients. Without having that information it is difficult to provide specific recommendations. Several of our GI clients are providing laser hemorrhoid treatments. For those health plans that are not approving the treatments, an ABN waiver is signed and the treatments are being provided for cash. Also, I would set up an electronic recall system based on the Medicare and commercial health plan timeline guidelines to recall the practices at risk and not at risk patients. This process will not only increase your revenue and provide outstanding customer service, but will also prepare your practice to be paid on performance as you will meet the criteria. From the examples shared with you on the webinar you could provide pharmacogentic services and look into what research studies are available for participation.
Q: We have a behavioral health practice. Are there other preventive care services we should be offering?
A: Procedure Code(s): 99408, 99409, G0442, G0443 can be used in a primary care setting for the misuse of alcohol. There are other codes for smoking cessation and the misuse of drugs; all have to be face-to-face with a provider. It is recommended that you contact your commercial payers and ask what services they are providing and if a behavioral health provider can bill these services directly or incident to under a physician.
There is a movement to integrate behavioral health with regular healthcare.
Q: Any recommendations for podiatry? We were considering adding x-ray. Is that a good opportunity?
A: It is recommended that before you add any services to your practice you should contact your local commercial payers and ask for their reimbursement rates for x-ray services and make sure that there is a return on investment and that the reimbursement covers the practice’s variable operating expenses. Medicare will pay for x-ray services. Many of our podiatry practices have built surgery centers and hired podiatrists who are trained to perform complex foot and ankle surgeries historically provided by foot and ankle orthopedic surgeons.
If you missed this great event, you can view the recording or download the slides. And, if you are interested in growing your practice and increasing revenue, register for the next free webinar, 3 Ways to Cultivate Rapid Growth through Referrals.
Lea Chatham February 24th, 2014
With only 5 weeks left to switch to the CMS 1500 v02/12 paper claim form, you can’t afford to wait. Tweet This
Delaying the change could impact your claims and reimbursement!
While you have been able to submit the new form since January 6, you aren’t required to submit claims to CMS with the new form until April 1, 2014. Currently, you can use either form. But if you have been putting off the transition, it’s time to get on board.
It’s never a good idea to wait until the last minute for any change related to your medical billing. Implementing the new form now gives you time to ensure all your software settings are correct and working for formatting and printing so you can test print some paper claims on the new form. That will give you some breathing room to fix any issues.
How Is the New Form Different?
The new form is designed to accommodate the change to ICD-10. It provides fields that allow you to use the longer codes and enter more codes. However, not everyone is on the same time line. Here are a few additional things to know about the change to the new paper claim form.
- The new form allows support of up to 12 Diagnosis Codes, however, what has not changed is that each procedure will still only allow up to 4 diagnosis pointers. This means that this new form can still only support 4 diagnosis codes per procedure.
- On and after April 1, 2014, Medicare will only accept the new form, but other payers may not. You will need to contact your payers to determine which form they will accept prior to the ICD-10 implementation on October 1, 2014.
- The revised paper claim form is new for payers as well as providers. As individual Medicaid (by state) and payers begin releasing and publishing their specifications, it may be necessary to make additional changes to process accurate claims. Your practice management software vendor should be monitoring these changes and adapting with regular updates.
In addition to this new form, there are many other changes related to ICD-10. For tools, resources and a success checklist, visit the Kareo ICD-10 Resource Center.
If you’re concerned about keeping up with changes related to ICD-10, it may be time to consider outsourcing your revenue cycle management. To find out if outsourcing is right for you, download this helpful guide.
Lea Chatham February 21st, 2014
Starting on January 1, 2014, electronic health records (EHRs) needed to be certified for the 2014 Edition to enable eligible professionals (EPs) to attest for Meaningful Use.
However, this was not the only change that kicked in at the beginning of the year. In addition to using a 2014 Edition certified EHR, EPs need to be aware of some changes to the Stage 1 requirements and understand the requirements for Stage 2.
Here is a quick overview on a few things that have changed or are specific to attesting in 2014:
- For 2014 only, all EPs will attest on three month reporting periods, which must be in a calendar quarter regardless of year or stage. For example, it must be April – June, you cannot start in February.
- Attestation must be completed within two months after reporting period end date. (Please note, there has been an extension for attestation for 2013, the due date has been extended from February 28 to March 31.)
- Stage 1, Year 1 must select a reporting period no later than Q3 of 2014 to avoid 1% penalty in 2015.
- The Stage 1 requirements are now 13 core + 5 menu measures versus the previous 15 core + 5 menu measures.
- Beginning in 2014, EPs will no longer be permitted to count an exclusion toward the minimum of 5 menu objectives on which they must report if there are other menu objectives which they can select.
- EPs may not claim an exclusion toward a menu objective if they are able to attest to another. An EP may claim an exclusion only when all other possibilities have been utilized.
- Stage 2 has 17 core + 3 menu measures.
- For Stages 1 & 2, the Clinical Quality Measures now = 9 menu choices versus the previous 3 core/3 alternate/3 additional.
If you are just getting started there is a lot of help. You can begin with the Kareo Meaningful Use Resource Center, which offers a helpful boot camp plan for your year and stage.
Lea Chatham February 20th, 2014
By Lisa A. Eramo
Are you overwhelmed by ICD-10 changes that will affect your orthopedic practice? Stop. Take a deep breath. Know that everything will be ok. We’ve all survived change, and the transition to ICD-10 will be no different.
Although ICD-10 includes a whole slew of changes for the orthopedic specialty, physicians shouldn’t assume that compliance will be impossible. Tackling the changes head on—and bit by bit—will make the transition much easier.
John F. Burns, CPMA, CPC, CPC-I, CEMC, senior consultant with Doctors Management in Knoxville, TN and an AHIMA-approved ICD-10 Ambassador and ICD-10-CM/PCS trainer suggests several topics on which orthopedists should focus their attention.
Site specificity is a common theme in ICD-10, and many of the orthopedic diagnoses will require this information. Consider the following:
- Regions of the spine: Many diagnoses, such as spondylosis (M47.-), spinal stenosis (M48.0-), and osteomyelitis (M46.2-), require physicians to document the specific region of the spine. These regions include: occipito-atlanto-axial, cervical, cervicothoracic, thoracic, thoracolumbar, lumbar, lumbosacral, sacral and sacrococcygeal, or multiple sites.
- Osteoarthritis with or without current pathologic fracture (M80.- and M81.- respectively): Documentation must specify hip, knee, first carpometacarpal joint, shoulder, elbow, wrist, hand, ankle, or foot. Physicians must also document the type of osteoporosis—that is, age-related, localized, or other (drug-induced, idiopathic, of disuse, postoophorectomy, post-surgical malabsorption, or post-traumatic). For drug-induced osteoporosis, identify the specific drug that caused the adverse effect (i.e., the osteoporosis).
- Chronic gout (M1A.-): Documentation must specify shoulder, elbow, wrist, hand, hip, knee, ankle, foot, vertebrae, or multiple sites. Physicians must also document laterality as well as the type of chronic gout—that is, idiopathic, lead-induced, drug-induced, due to renal impairment, or other secondary chronic gout.
Many of the ICD-10 changes for the orthopedic specialty pertain to laterality—that is, specifying right, left, or bilateral. ICD-9 codes did not capture this information previously. For example, in ICD-10, physicians must specify laterality for osteoarthritis and joint disorders (M15-M25). Documentation of fractures must also specify right vs. left vs. bilateral. Arthopathies and polyarthropathies (M00-M14) also require documentation of laterality.
Type of encounter
When documenting fracture care, orthopedists must provide sufficient information so that coders can glean whether the encounter is initial (i.e., initial ER visit or any surgical care or follow up within the global period), subsequent (i.e., follow-up care rendered after the global period), or sequela (i.e., a residual effect after the normal healing period). This information is reported via the 7th character in the ICD-10 fracture care code. For subsequent encounters, physicians must specify routine healing, delayed healing, malunion, or nonunion. For example, ICD-10 code M84.462G denotes pathological fracture, left tibia, subsequent encounter for fracture with delayed healing.
Although the orthopedic specialty includes few combination codes in ICD-10, physicians should at least be aware of them. For example, ICD-10 code M54.4- denotes lumbago with sciatica. Physicians must link the two conditions and also specify laterality. ICD-10 code M05.1- denotes rheumatoid lung disease with rheumatoid arthritis. Physicians must also link the conditions and document site and laterality.
Place of occurrence codes
Documenting any external causes of injuries, including the place in which the injury occurred, will be important in ICD-10 because it will help paint a more detailed picture for payers. Place of occurrence codes (Y92) are extremely detailed, and physicians should provide as much information as possible. For example, code Y92.126 denotes garden or yard of nursing home. Code Y92.531 denotes healthcare provider office. Code Y92.250 denotes art gallery. These codes could help determine whether certain payers (e.g., worker’s compensation, health insurance, car insurance, etc.) are liable for all or a portion of the costs.
For more tools and resources on ICD-10, visit the Kareo ICD-10 Resource Center.
About the Author
Lisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.
Lea Chatham February 19th, 2014
When you work in a healing profession, you are interacting with people all day. Kareo’s partners at ZocDoc have shared this great blog post on eye contact. This is something you may take for granted, but it turns out that there is such as a thing as too much.
Starting from childhood, we’re taught that eye contact is important. But when is it too much of a good thing? Tweet This
According to a new study published in Psychological Science, eye contact may not help you win over your audience – and in fact, it may trigger the opposite response.
Participants in the study were shown multiple videos of different speakers. The speakers stated their opinions on controversial topics, and the participants were instructed to focus on the mouth and eyes of the speakers. The study evaluated whether participants were more or less trusting of speakers who maintained eye contact. Based on the results, “people were less likely to shift their opinions when the speakers made direct eye contact.”
Why? Researchers say it depends on the situation. Among friends and family, eye contact can be a good thing, establishing trust between two people. But in other settings, it can stir competition and hostility, potentially dissuading an audience.
“Staring directly into someone’s eyes without looking away is unnatural,” says non-verbal behavior expert Marc Salem, PhD. Rather than focus so much energy on maintaining eye contact, Salem recommends non-threatening cues. “It starts with your posture. Sit or stand in a way that’s open and similar to those around you – for example, if your boss is leaning back in his or her chair, you should do the same. Don’t rush your words, either; when you speak too quickly, your body doesn’t know what to do with itself, and you end up looking awkward.”
But this doesn’t mean you should avoid eye contact completely! The key is appropriate eye contact. An article published by the Michigan State University Extension recommends using the 50/70 rule. “Maintain eye contact for 50 percent of the time while speaking and 70 percent of the time while listening. This helps to display interest and confidence.”