Your Top 5 Credit Card on File Questions Answered

Lea Chatham July 29th, 2014

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Patient Collections 101In her recent webinar, Patient Collections 101: Let’s Start at the Very Beginning, speaker Mary Pat Whaley shared her best practices for improving patient collections. She provided a lot of information about the benefits of using a credit card on file program. The, she spent time answering the many questions posed by participants. Here are a few of the top questions asked during the event.

 

Q: What are the security requirements for using credit card on file?
A: Your payment gateway must be PCI-DSS certified. The practice should not photocopy any credit cards or write the complete card information on paper. Take credit card information by phone. If you MUST write the information down, shred the information once it has been entered into the payment gateway. Make sure each user of the payment gateway users has an individual logon and password and require users to change passwords every 90 days. Have a strong security policy for credit card information protection and train all practice staff on the importance of protecting sensitive information.

Q: We’ve tried credit card on file once before. Patients were resistant and angry, my docs and staff were upset. What can we do to implement this program again but with better success?
A: Credit card on file, and good patient collections in general, require a planned rollout with training of all staff. Review the slides or watch the presentation again for the steps to improve patient collections. Before rolling out a program, you need to have your policies completed, have a communication plan for the program, and have your staff well trained and prepared to answer questions. For a deeper dive into the mechanics of CCOF, you can attend a live 90-minute webinar (http://managemypractice.com/services/credit-card-on-file-ccof/) or purchase a DVD (http://bit.ly/CCOFDVD) of the webinar. Both the live and recorded webinars include 12 templates, documents and policies for the implementation of CCOF.

Q: How often do we charge the card on file?
A: For a one-time charge, like a copay or a deductible amount that is within the set limit, you would charge the card at the time that you know the charge. For an ongoing payment plan, you would charge it on a monthly basis. For many practices, it is a combination of a charge at the time of service and any balance remaining after insurance pays about 30 days after the visit.

Q: How do we get patients to sign up for credit card on file?
A: This is where having a good, clear financial policy and a well-trained staff can come in handy. Present the policy to new patients and to all patients once a year. Explain the policy and answer questions patients have. Make sure every staff person can answer questions and explain why you are implementing this policy. Also, make sure patients understand how using credit card on file can benefit them. It allows them to pay their bills with no need to go online, write a check, wait for a statement, etc., and they do not need to worry about bringing a check or credit card to their visit. It is more secure and the staff only see the credit card once when they swipe it to place the card on file, instead of at every visit. Many credit card companies, utilities, and other retailers use this practice. Patients should be familiar with how something like this works, and they should see that you are simply following best practices that are being used in many other industries. If you can’t collect the money you are owed, you won’t be able to stay open. So do whatever it takes to help patients understand this change. It is scary for practices to consider that they might lose patients, but we’ve not had any practices lose any more than three patients, and those patients were problem payers to begin with.

I tell practices “Not every patient will be right for your practice.” With the scarcity of all types of physicians looming, most patients will comply to stay with a physician and practice they like. Tweet this Kareo story

Q: Do patients often dispute charges with their credit card company?
A: This is not very common. If you make sure the patient has reviewed the financial policy and signed a credit card on file agreement and asked any questions, then the patient should not be surprised by charges. Also, be sure the patient knows that they can call and get a copy of charges and payments. Or point them to your patient portal if it offers the ability for patients to see their billing history. We love the email receipt capability of payment gateways. Often the patient gets the receipt while they are in the office so it is not a case of just getting their credit card statement 30 days later and not remembering. Plus, the payment gateway puts the practice name on the charge transaction, so patients are not confused about where the charge came from.

If you missed the webinar, you can watch the recording or download the slides. If you find this information helpful, check out the next webinar from Kareo, AAA for MU: Roadside Assistance for the EHR Incentive Program.

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6 Steps to Use When Sharing an EHR

Lea Chatham July 24th, 2014

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Tweet this Kareo storyBy Jean L. Eaton, B Admin, CHIM, CC

What happens when a physician (or other healthcare provider) leaves a group practice?
Will the remaining physicians assume the ongoing management of the records? If the exiting physician intends to practice elsewhere and requests access to his or her patients’ records, how will this be accommodated? In what media? Hard copy, electronic, image files, text? At what cost? Who will assume the cost? The departing physician, the patient, or the remaining physicians?

The development and use of a shared Electronic Health Record (EHR) is complex.
The primary purpose of the EHR is to document the care provided to the patient. The maintenance of these records, particularly when more than one user (or custodian) has access to them, is even more challenging and requires proactive communication between the EHR users. Each user must ensure the following:

  • The information is maintained in a confidential and secure manner
  • The data is easily retrievable for continued care
  • The use must meet the physician’s fiduciary and statutory obligations

When a physician documents information in the EHR, he or she becomes the custodian of that specific data. If more than one physician was involved in the care of the patient, this may mean that there are multiple custodians for each record.Tweet this Kareo story

To help manage the use of the EHR and patient records in a group practice, use these six steps:

  1. Have a clear understanding of how patient records in a shared EHR database are controlled.
  2. Have a Business Associate Agreement with the EMR software vendor. Typically, there is one named individual on the contract from which the software vendor can receive instructions on how to manage the records. in the database.
  3. As a group healthcare practice, have a clear understanding and written agreement that sets out how patient records will be collected, used, and disclosed during the group practice and whenever the membership of the group practice changes. This provides direction to the named individual on the contract with the EHR vendor. (see step #2)
  4. Take a pro-active privacy role and inform patients how their information will be protected during the routine practice operations and when healthcare providers are added–or leave–the practice.
  5. Decide how you are going to decide about the on-going operational changes to how the software will be used in your practice.
  6. Identify in the EHR software who is the primary (or default) healthcare provider for each patient. Talk with your software vendor how best to record this. This will help to identify which patient records ‘belong’ to the healthcare provider when they leave the practice.

Meaningful Use Stage 2 is your friend.
The standards for the 2014 Edition certified EHRs have improved your ability to share and transfer records. Patient data should be easily exported in CCDA format for use in any other 2014 Edition certified EHR. Depending on your vendor you may need assistance in exporting and/or importing the data, but to be 2014 Edition certified the vendor must provide this capability.

Conclusion
It’s never too late to start! If you missed any of these steps in your group practice, do them now!

About the Author

OLYMPUS DIGITAL CAMERAJean L. Eaton, B Admin, CHIM, CC is the Practice Management Mentor. She believes that people working in healthcare know that they want to provide good services and have a profitable business. They have a sense of what they need to do to get there, but sometimes need the confidence, details, and resources to help them. She helps with templates, user guides, real-life examples, networking, practical resources, and mentoring. She can give you the confidence to take care of the elephant in the room.

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What’s Your Ideal Medical Practice Staffing Mix?

Lea Chatham July 22nd, 2014

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By Rochelle Glassman

Tweet this Kareo storyThere is no hard and fast rule on how many staff you require for your practice because each specialty and situation may require something different. It is important to understand your medical practice staffing needs based on the job functions required to efficiently operate and manage your practice. Understaffing can cause breakdown in operations that could result in errors, reduction in revenue, and patient dissatisfaction. Overstaffing may cause a loss of productivity and an unnecessary financial overhead burden.


How Many Staff Should You Have?
Many of the medical associations such as Professional Association of Healthcare Office Management (PAHCOM) and Medical Group Management Association (MGMA) benchmark how many full-time employees you need per full-time provider. A full-time employee (FTE) is an employee who works between 35 and 40 hours per week. A practice’s FTEs may include front desk, billing, office management, medical assistants, nurses, and even scribes.

There are many factors that can influence your staffing like patient volume, specialty, and the use of technology.Tweet this Kareo story

Here are some recommendations from MGMA to use as a guide for your practice.

Tweet this Kareo story

Calculating Your Staffing Ratio
Before you calculate your practice’s staff-to-provider ratio, however, it’s essential to know how to do it correctly. It seems simple enough: Count up the doctors in your practice and divide by the number of billing staff, right? Well, not quite.

Rather than count each physician individually—a common mistake—practices must make sure to count physician FTEs. To properly calculate the number of physician FTEs within your practice, divide the total number of patient encounters performed during the past year for your entire practice by the average number of yearly physician encounters, (This number will be between 3,600 and 4,800 depending on your specialty. Primary care tends to be on the high end at 4,800 and single surgical specialists, like orthopedics tend to be on the low side at 3,600). The reason that you want to perform your FTE calculation in this manner is to accurately account for physicians who work part-time, job share, work any other less-than-full-time schedule, or manage their time efficiently and therefore are able to treat more patients.

To calculate the number of billing staff FTEs, you’ll want to define an FTE as an employee who has been compensated for 2,080 hours of work (40 hours/week X 52 weeks/year) during the last year. Like the physician FTE calculation, this will take into account any employees who work any schedules more or less than 40 hours per week. Hours to include in this calculation should be related to any personnel who participate in the physician revenue cycle, including insurance verification, data entry, coding, payment posting, accounts receivable follow-up, patient statement processing, customer service, etc.

Once you know your medical practice staffing ratio, compare it to the chart provided above. If you are much higher, it’s probably time to look at your staffing, processes, and technology. The next blog in this series will review areas where you may find inefficiencies and ways that process changes or technology can help.

About the Author

Rochelle_MG_1811Rochelle Glassman is President & CEO of United Physician Services. Rochelle brings a passionate, very practical “do it today” approach to making medical practices successful and getting physicians paid more.

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Get the Medicare Well Visit Right and Get Paid

Lea Chatham July 18th, 2014

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By Kathy Young

Kareo EHR

 

When the Centers for Medicare and Medicaid (CMS) began to allow for well visits, they sold the idea as an opportunity for the primary care providers to increase their revenue. Many providers were excited about the idea and began performing these well visits. CMS decided not to use the CPT codes for preventative services. Instead, they created their own codes, and with the codes, new requirements for the well visit.

 

It is the requirements of the Medicare well visit that have created ambiguity amongst providers.Tweet this Kareo story

In the first 12 months of being a Medicare patient, seniors are allowed an initial visit, which is the welcome to Medicare visit for preventative care (G0402). Then there is the annual initial visit for those patients who never took advantage of the welcome to Medicare visit (G0438). After a year they can come back and have a subsequent well visit (G0439). These visits are not necessarily about the exam (although an exam can be a part of it). They are about the overall health assessment of the patient. When done well and documented well, these visits can give the provider a better road map for the care of this patient. The annual well visit (AWV) can be performed by a physician, PA, NP, CNS, or other provider under the direct supervision of a physician.

If you perform electronic eligibility, you can find out if the patient has already had their AWV. There is no copay or deductible for these visits. V70.0 is the diagnosis to use, demonstrating that it is a well visit. If during the course of the AWV a problem is discovered and addressed, an E&M can be appended but documentation must show the two types of visits and clearly demonstrate that there was a need for an E&M service with medical decision making.

It is the elements of the AWV that are often not understood by the provider. In truth, most of the visit, if not all of it can be performed without the patient undressing. The purpose is to assess their health and risks in order to make a plan of treatment or care. The following must be in the documentation to meet CMS requirements per the Medicare Manual of 42 CFR 410.16. These are not suggestions but requirements.

  • Collect self-reported information about the patient
  • Tailor to and take into account the communication of patient
  • Take no more than 20 minutes to complete

It should address the following:

  • Demographic data like age, gender, race, and ethnicity
  • Self-Assessment of health status, frailty, and physical functioning
  • Psychosocial risks like depression, stress, anger, isolation, pain, fatigue, etc.
  • Behavioral risks like tobacco, physical activity, nutrition, alcohol, sexual health, safety in home or in the car
  • Activities of daily living (ADL) such as can they dress themselves, can they eat, grooming and ambulation
  • Instrumental activities of daily living to ascertain if the patient can shop, prepare food, use the phone, clean home, wash clothes, take medication, and handle their finances

With the well visit orders for colonoscopies, EKGs, or labs can also be done. Other services may include bone mass measurements, diabetes screening, glaucoma screening, and ultrasound screening for abdominal aortic aneurysms. Counseling for tobacco cessation (G0436-G0437) is another tool that has been given to the provider along with weight loss prevention.

Until 2012, many of these preventive services were denied to seniors by Medicare. Not only are there preventative services now but also counseling that can help seniors achieve better health. Physicians should not miss out on the financial opportunities that these services provide. As with all things Medicare however, there are rules that must be abided by. It would make sense from a practical point of view, to create a well visit template that would walk you through the visit to make certain you have met all the requirements for Medicare.

If you use Kareo EHR, a well visit template is available already. If you don’t use an EHR or you are looking for a new EHR that provides tools designed for practices like yours, register for the next Kareo EHR demo.

About the Author

KathyKathleen Young is the CEO and co-founder of Resolutions Billing & Consulting, Inc., which was founded in 2003. Kathleen is also the owner of Healthcare Chart Audits, which offers auditing to physicians and attorneys. Kathleen has been in healthcare since 1989 and has worked for physicians, large corporations and three billing companies. Kathleen is a CPC and a CPMA with the American Academy of Professional Coders and speaks to many groups on coding, billing, and auditing.

 

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3 Billing Service Questions about Social Media Answered

Lea Chatham July 16th, 2014

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3 Ways to Grow Your Billing ServiceAt the recent free webinar, 3 Ways to Grow Your Medical Billing Service, Tim Tyrell-Smith and Jim Sholeff talked about how billing services can position themselves to meet the increasing demand for outsourcing from physician practices. They touched on some key trends on the marketplace and reviewed sales strategies to close more deals along with some best practices for managing your online presence and marketing your business. Here, Tim answers three questions that came up about social media and online reputation building.

Q: How important is social media in your billing service marketing? What role does it play in recruiting new providers? Tweet this Kareo story
A: These days the majority of people are on social media and online in general. This includes physicians and practice staff. We are now comfortable looking for services online, and we trust the information we find there. If you aren’t online with a strong website and social presence, then those who are looking may go elsewhere. It also allows you to build social credibility. Since we do business with people we know, like and trust, social media can play a role in supporting your reputation. Social media may not be the most valuable marketing tool you have and it may not bring in the most business, but it should be an important piece of your overall strategy.

Q: Are physicians really using Twitter? If so, can you give some best practices for using Twitter?
A: There are a good number of physicians on Twitter, but as you might expect, the bulk of doctors would rather be caring for patients! To find those who are active, you can use search terms like “Dr.” or “MD” and you should get a good list. For all these channels (i.e., Twitter, Facebook, etc.), make sure you are personal and professional, that you engage your followers by posting regularly and responding to mentions and any tweets that you find interesting, and that you post useful information that has a meaningful call to action. If you are actively taking these steps and regularly following physicians and other practice staff, before you know it, you’ll have a new community of potential customers.

Q: You talked about strategies for focusing on local SEO, are there strategies I should use for national approach?
A:  Strategies for local and national search engine optimization (SEO) campaigns are quite similar. The biggest difference is that local SEO relies heavily on location tagging. For example, a national campaign might focus on the keywords “medical billing services” whereas a local SEO version would simply be modified to “Houston medical billing services”. As you might expect, it will be more difficult to “rank” on the best keywords nationally if you are in a competitive industry. This is where a blog or other content on your site can help attract visitors more proactively versus the traffic that will come more passively through Google.

If you missed the presentation, you can check out the slides here, or find out more about the Kareo Billing Partner Program and how it can help you grow your billing service.

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Free Webinar: Patient Collections 101

Lea Chatham July 11th, 2014

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Register now to start improving patient collectionsPatient Collections 101: Let’s Start at the Beginning
Wednesday, July 16, 2014
10:00 AM PT, 1:00 PM ET

When was the last time you took a good look at your patient collections processes? Things have been changing in recent years, and they continue to do so in 2014. Patients are paying as much as 30% of their healthcare costs today out of pocket. While many preventive care services are now covered, there are a lot of people who now have higher deductible plans and higher copays. As a result, having a strong program for effective patient collections is more crucial than ever.

In this webinar, patient collections expert Mary Pat Whaley offers a review of the basics and the best practices for improving patient collections. You’ll learn:

  • How to create and use a payer matrix
  • The value of eligibility and benefits information
  • Why the financial policy is the best patient collection tool you have
  • The role of a credit card on file program in patient collections

Who should attend? Practice managers, billing managers, billing and front desk staff, and healthcare providers who are interested in improving patient collections and reducing A/R.

Register now to learn how to improve patient collections

About the Speaker

Register NowMary Pat Whaley, FACMPE, CPC, is the Co-Founder and President of Manage My Practice. With over 25 years managing physician practices of all sizes and specialties in the private and public sectors, Mary Pat is one of the preeminent physician advocates and practice management consultants in the United States today. In addition to her Board Certification in Medical Practice Management, she is also a Certified Professional Coder and a Fellow in the American College of Medical Practice Executives. She is widely quoted in national practice management magazines including Medical Economics, Physicians Practice, the Journal of Medical Practice Management, Physicians Digest, and Outpatient Surgery Magazine.

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July Kareo Newsletter Highlights Changing Trends in Healthcare

Lea Chatham July 10th, 2014

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The July edition of the Kareo Getting Paid Newsletter highlights changes in patient accounts receivable and trends in physician satisfaction. The newsletter also provides a chance to discover upcoming events, news, and resources from Kareo. Plus, you’ll learn about how to register for our upcoming free educational webinar, Patient Collections 101: Let’s Start at the Beginning, presented by Mary Pat Whaley. Read all this and more now!

Kareo July Getting Paid Newsletter

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3 Ways Bad Patient Collections Practices Hurt Your Bottom Line

Lea Chatham July 9th, 2014

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Register now to learn how to improve patient collectionsWe know that not all patients prioritize paying medical bills.

According to the Medical Group Management Association, in 2010 more than 60% of patient balances were never collected! Tweet this Kareo story

This is not necessarily because patients refuse to pay, but often because practices don’t understand what patients owe or don’t ask patients for payment when they are most willing to pay—at the time of service.

Not communicating to patients about their financial responsibility and not asking for payment at time of service can be detrimental to more than just your revenue. There are other reasons that you want to make sure you have a solid financial policy that you enforce consistently and fairly.

Word Gets Out
If you think patients don’t share which physician practices collect and which ones do not, think again. Word gets around in your community about practices that do not collect at time of service and do not pursue patient collections. Most practices only collect co-pays at time of service and some practices do not even ask patients for their co-pays. If you do not collect co-pays consistently for all patients, you can be sure other patients will demand to defer payment of their co-pays too—one good reason to apply the same collection policies to all patients.

Breaching Payer Contracts
You may have heard that a balance can be written off to bad debt after sending three statements. If you are routinely writing off patient balances, your payer may consider that they are overpaying you since you do not find it necessary to collect the full amount that the patient owes. This can ultimately reduce your reimbursements. When you do not collect from patients, you send the clear message “What insurance pays us is enough and we do not need to collect from patients!” Many patients already believe that physicians make enough from what insurance pays alone—do you want to reinforce that myth?

Unnecessary Expenses
Every time you send a patient a statement it costs you money. Tweet this Kareo story

It costs you money to have an employee open the payment envelope, find the correct patient in the billing system, post the payment, prepare a deposit or remote scan the check, and reconcile the checks with the posted amount. If collecting a $25 co-pay means sending one or more statements, you are reducing how much money you are truly collecting. You are spending a lot to collect a little. The cost savings when collecting at time of service (front-end collections) vs. sending statements after insurance pays (back-end collections) can be as much as 20%.

When you add up the consequences of not collecting at time of service, you begin to realize you are spending too much money, losing too much money, and potentially opening yourself to a challenge of your collection practices by patients and payers. Help your practice by establishing a fair financial policy, committing to collecting at time of service, and putting a plan in place to treat all patients—and your practice—fairly.

To learn more about how to implement an effective patient collections strategy, join me for my upcoming free webinar, Patient Collections 101: Let’s Start at the Very Beginning, on Wednesday, July 16. Register Now!

About the Author

Register NowMary Pat Whaley, FACMPE, CPC, is the Co-Founder and President of Manage My Practice. With over 25 years managing physician practices of all sizes and specialties in the private and public sectors, Mary Pat is one of the preeminent physician advocates and practice management consultants in the United States today. In addition to her Board Certification in Medical Practice Management, she is also a Certified Professional Coder and a Fellow in the American College of Medical Practice Executives. She is widely quoted in national practice management magazines including Medical Economics, Physicians Practice, the Journal of Medical Practice Management, Physicians Digest, and Outpatient Surgery Magazine.

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New Survey Shows Latest EHR Trends

Lea Chatham July 9th, 2014

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2014 Technology SurveyThe Physicians Practice 2014 Technology Survey, sponsored by Kareo, shows EHR implementation continues to be the most pressing technology issue for physician practices. Nearly 17% of practices say that EHR adoption and implementation is the most pressing problem while another 16% say it is lack of interoperability, and 13% say it is the cost to implement and use new technology.

Over 50% of practices surveyed already had a fully implemented EHR, but nearly 20% don’t have an EHR at all and another 10% are in the process of installing an EHR. Of the practices that don’t have an EHR at all, about 25% say they are going to purchase one in the next 12 months. But the other two-thirds have many reason for holding out:

  • 25% say they are too expensive
  • Nearly 16% says they can’t find an EHR to meet their needs
  • 11% have heard too many horror stories
  • And, 13% are struggling to get buy-in from all providers

Whatever the reason may be, practices can’t really afford to put off an EHR much longer. “There are so many reasons to implement an EHR today, and they aren’t all clinical” says Tom Giannulli, MD, CMIO at Kareo. “Reimbursement is changing and moving towards value-based models, which really requires an EHR. The ICD-10 transition will be more challenging without an EHR, and in general, having an EHR can improve billing and reimbursement.”

“Since we started using an electronic superbill in the EHR that can be sent to the practice management system, we’ve seen fewer errors and cleaner claims,” says Theresa Jenkins, Office Manager at Appalachia Medical Clinic. “Using an integrated practice management and EHR solution has improved our billing, and we now have much more consistent cash flow.”

On the clinical side, Dr. Giannulli adds, “There are also many clinical benefits too. Having an EHR can reduce prescriptions errors and the need to reorder lab tests. It can also improve patient compliance by giving physicians the tools to educate patients and give them summaries of their care and treatment plan.”

According to the Tech Survey, just under half of those using EHRs say they have seen a return on investment and about the same number say they have seen work flow improvements. In addition, almost 60% say they are satisfied or very satisfied with the vendor they chose. But for many it has taken several tries at implementing an EHR to get there. Over 30% of the practices with an EHR are on their second, third or even fourth or fifth EHR.

So many tries to get it right doesn’t have to be the case for practices that are looking to install an EHR for the first time. With affordable, cloud-based solutions cost is less of a factor now. In addition, there are clear best practices today for EHR selection and implementation. The Small Practice Guide for EHR Implementation can help your practice make a successful implement the first time.

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Free Webinar: Grow Your Medical Billing Service

Lea Chatham July 3rd, 2014

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Register Now3 Ways to Grow Your Medical Billing Service
Thursday, July 10, 2014
10:00 AM PT, 1:00 PM ET

There has never been a better time to grow your billing service. According to the 2014 Black Book Survey, many practices see outsourcing their revenue cycle management as one of the keys that can help them stay independent. In fact, 42% of small physician practices with employed billing staff hope to move billing out-of-house to an outsourcer in next twelve months.

In this webinar, billing service and marketing experts will help you understand what you need to do to take advantage of this growth in outsourcing. You’ll learn how to:

  • Improve your marketing and online reputation
  • Close more deals
  • Use resources from Kareo to strengthen your business offerings

There are many tools that you can add to your arsenal to grow your business and revenue. Kareo can help.

Who should attend?
Billing service managers and staff who are interested in finding ways to grow the business and meet the increasing demand from physician practices.

Register now to learn how to grow your medical billing service

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