Your Questions about Patient Payments with Credit Cards Answered

Kareo April 23rd, 2013

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In her February webinar, 3 Innovative Ways to Improve Collections, practice management expert Rochelle Glassman discussed some strategies for getting your patient payments and collections under control. She suggested making it easier for patients to pay by offering online billpay, reminding patients about their balance due when they schedule an appointment and at registration, collecting copays, deductibles and self pay balances at the office, and getting authorization to charge credit cards for balances due or for patient payment plans. The webinar attendees had a lot of questions, which we answered. But we continue to get questions about credit authorizations. So here are some answers to help you make the most of this tactic.

Q: Can we get a copy of the generic credit card authorization form?
A:  Yes. You can download a generic credit authorization form here.

Q: How long does the credit card agreement remain in effect? Does there need to be an expiration date?
A: A payment agreement stays in effect until the balance is paid in full. When an agreement is made, it spells out the length of the agreement and the patient signs that agreement with the understanding of the length of the agreement. Recurring payments can be set up using a payment processing service. If you already accept credit cards, your merchant services department may already have a service in place which you can add to your current plan. Many banks such as Chase and Wells Fargo offer this option to their merchants for a monthly fee. This service is also available through other vendors such as Paypal, Chargify and Authorize.net. You can also use a credit card authorization form and charge the card manually each time.     

Q: What do I say to a patient who refuses to give credit card info for fear of fraud?
A: You can assure them that the practice is maintaining security standards and give them a copy of the practice’s credit card security policy.

Q: Are there any legal requirements with regard to keeping credit information on file?
A:  Yes, the merchant must be PCI DSS (The Payment Card Industry Data Security Standard) compliant. When compliant, you can legally store credit card information, with the exception of the CVV code. You can never, store the CVV code. Your merchant services provider should meet these standards. Details on the requirements can be found at PCI Security Standards Council at www.pcisecuritystandards.org.

Q: If you charge a credit card payment using Kareo, does it post to the patient account automatically?
A:  Yes, on the New Payment screen, indicate the method as “credit card” and hit the Process Credit Card Payment button. You will need to be signed up for Kareo’s Patient Payment Services and have a card swipe connected to your computer. Contact the support team for more info or review the online how to article – http://www.kareo.com/help/practice-management/howto/enter-payments-from-credit-card

Q: In Kareo, how can patients make online payments?
A:  If you sign up for our patient payment services you will be able to direct your patients to an online account where they can make credit card payments online. Also, if you send patient statements through Kareo to your customers those statements it will provide your patients with a link that takes them directly to this online payment portal.

About the Author: Rochelle Glassman

Rochelle Glassman is a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. She is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

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5 Tips for Successful Patient Payment Plans

Kareo March 27th, 2013

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By Rico Lopez, Senior Market Advisor at Kareo

During my consultant days, I gave my clients five tips for successful patient payment plans. Here they are:

  1. Always have a signed agreement. Have the patient sign an agreement with clear expectations that defines all the components laid out below.
  2. Choose a realistic payment amount and reasonable timeline. The patient can always pay more than the scheduled amount or pay earlier. Set the amount so the patient can realistically make the payment and it meets the practice’s minimum payment amount. The minimum payment amount is something the practice should set in advance for their staff to enforce. The timeline has to be acceptable to the practice as well.  The payment plan cannot be $1 a month for the next 100 months to pay a $100 balance. Along with defining the minimum monthly payment amount, the practice should also set a minimum balance to qualify for payment plans. Exceptions to these rules should only be approved by the office manager or the provider. If you find that you are getting too many requests for exceptions, then maybe you should revisit your minimum balance and/or payment amounts.
  3. Define consequences for failure to pay on schedule. There has to be a consequence if the patient doesn’t follow through with the agreement. For example, the total amount becomes due unless patient gets back on schedule or if you offered a discount, they lose the discount. The consequences should be clearly spelled out in the payment plan agreement in writing. This agreement is signed by the practice representative and the patient.
  4. Offer incentives to pay off total balance early. Offering incentives and discounts to pay can help you collect outstanding balances earlier in the payment plan. Always check your payer contracts to be sure you are in compliance with any discounts you offer. Each practice has to decide how much they are comfortable discounting, but determining the costs to collect outstanding balances over time (or in some cases, the risk of never collecting the full amount) is a good basis for determining an appropriate discount amount. Consider this, a balance that you fail to collect that is later referred and recovered by a collection agency may cost you 30-40% of the collected amount. The amount could be more when you factor in your staff time and printing and mail costs over time as well. You could lose as much as 50% of the original amount by the time you get paid. So would you rather dictate your discounts early on or have them decided for you down the line?
  5. Offer the discount at the end of the payment plan. If you do offer a discount, discount the last payment (not on total amount or first payment). If you discounted the whole balance up front and then they failed to comply, it is harder to add back the discounted amount. It is much easier to waive their last payment or give them 50% off the last payment. This also gives them more of an incentive to stay on schedule so they can get the discount at the end.

More and more patients are paying a larger amount out of pocket for their medical care. Being prepared with clear guidelines for patient payment plans, a template for an agreement, and strategies to motivate patients to pay their bills can help you collect those patient due amounts.

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When Patients Won’t Pay…

Kareo March 21st, 2013

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By Rochelle Glassman

In my recent webinar, 3 Innovative Strategies to Improve Collections, an attendee asked, “Can a physician refuse to see a patient if they have an outstanding balance and won’t pay or make arrangements to pay?” This is a patient collections question that required a longer answer than I could provide on the webinar. So here are my detailed recommendations.

In all patient challenges, the most important goal is to avoid a claim of patient abandonment and assure that patient care is not neglected. [1]Regardless of the reason for your issues with a patient, whether it’s unpaid bills, failure to follow advice, or mistreatment of staff, the same advice applies:

  1. Document any issues you are having with the patient. Make sure not to terminate a patient until there is evidence in the record of the problem(s). Patients should be provided with notice of such problem(s) and an opportunity to modify their behavior. If the particular patient’s issue is an unpaid balance, meet with the patient privately and discuss the issue. Can a payment plan be established? Can the patient demonstrate financial hardship that you are able to document? Document your meeting with the patient, the issues discussed, and the patient’s response.
  2. If no agreement can be reached regarding payment of amounts due, follow up in writing and let the patient know that unless a payment plan is established by a certain date, the practice will provide notice of termination.
  3. If efforts to establish a payment arrangement are still unsuccessful, you may need to terminate the patient. Always remember that the patient must be provided with sufficient time to find alternative care before termination from the practice. Reasonable notice can vary depending on the patient’s medical condition and the difficulty which a patient may have in finding alternate care. For example, I recommend that an oncologist not terminate a patient for nonpayment of medical bills until the patient has completed the current course of chemotherapy. Alternatively, a patient of an internist who simply comes in when he or she has a cold or other minor issue may require only 30 days notice. There may be state-specific laws regarding minimum notice periods and these must also be observed. It’s not your responsibility to make sure the patient has found a new physician, only to provide sufficient time for the
    patient to do so. However, in certain circumstances, there may certainly be ethical obligations to provide additional assistance to extremely ill patients to secure continued care.
  4. Termination of a patient from the practice should not interfere with your ability to turn over the patient’s bills for collection. However, at all times through the termination process and thereafter, it should be the goal of the practice to attempt to establish a payment arrangement with the patient and to determine if there is a documented financial hardship.
  5. In any notice provided to patients, make sure you clearly note the date on which they will no longer receive care and how they can obtain copies of their medical records. You should also offer assistance in locating a new physician, such as providing contact information for a state medical association or similar organization. The patient should understand that in the event of an emergency or urgent situation (which may depend upon specialty), the practice should take the necessary steps to assure the patient is properly cared for.
  6. Like any other business, physicians should not be required to continue to offer services without payment. However, in medicine it’s not all about the bottom line. Take the time to properly handle each patient and to assure their understanding and continued medical care in order to best protect your medical practice.

In my last blog post, I provided my 8 Best Practices for Patient Collections, which I also discussed in the webinar. For more great information about improving collections and shortening your revenue cycle, check out the recorded webinar.

About the Author:

Rochelle Glassman Our guest speaker is Rochelle Glassman, a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. Rochelle is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

 


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8 Best Practices for Patient Collections

Kareo March 14th, 2013

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By Rochelle Glassman

In my recent webinar, 3 Innovative Strategies to Improve Collections, I discussed collecting patient due amounts at the time of service as part of your medical billing strategy. I touched on patient collections and many attendees had questions about collections best practices for past due accounts. Here is my detailed guide for best practices on turning patients over to collections.

Whatever collections efforts you make, one rule always applies: Get busy as soon as possible and stay on the account until you’re paid. Send bills promptly and re-bill monthly. There’s no need to wait for the end of the month. Send past due notices promptly once an account is overdue.

  1. Don’t harass. Don’t harass people who owe you money, but let them know that you follow these matters closely. Don’t leave more than one phone message per day for the debtor (person responsible for payment), and never leave messages that threaten the debtor or contain statements that put the debtor in a bad light.
  2. Be direct, listen, and don’t get personal. Keep your calls short and be specific. Your goal should be to prevent the debtor from taking the call personally—that is, from associating the failure to pay as meaning a failure in life. Always stay calm but maintain a sense of urgency about getting paid.
  3. Get creative. If the customer has genuine financial problems, ask what amount they can realistically afford to pay. Consider extending the time for payment if the customer agrees in writing to a new payment schedule. Call the day before the next scheduled payment is due to be sure the customer plans to respect the agreement.
  4. Write demand letters. Along with phone calls, send a series of letters that escalate in intensity. Save copies of all correspondence with the customer and keep notes of all telephone conversations. You may need these if you hand the matter over to a collections agency or take the customer to court.
  5. Use a collections agency to send letters. You can pay a collection agency a fixed fee to write a series of letters on your behalf. This is different than turning over the debt to an agency. For example, Dun & Bradstreet Small Business Solutions (http://smallbusiness.dnb.com) will write a series of three letters for under $30. They will also make telephone collection calls on your behalf. Other companies such as Transworld Systems (www.transworldsystems.com) and
    I.C. System (www.icsystem.com) offer similar services.
  6. Offer a one-time deep discount. If an account is fairly large and remains unpaid for an extended period (say six months) and you’re doubtful about ever collecting on the debt, consider offering in writing a time-limited, deep discount to resolve the matter. You can finalize this with a mutual release and settlement, a legal document that terminates the debt.
  7. Have the Patient/Guarantor sign. Have a clause on the patient/new patient forms that states that any charges not covered by insurance are the responsibility of the patient/guarantor, including any collections fees incurred if turned over to collections.
    Example: In the event that your insurance is not valid or your coverage was terminated at the time the services are rendered, you will be solely responsible for the full amount of your office visit and/or any procedures rendered. In addition, if your insurance plan determines a service or procedure to be “not covered”, you will be responsible for the complete charge of such services. I agree to be responsible for the payment of all unpaid services rendered on my behalf or my dependents, including any fees for collection service needed.
  8. Turn the account over to a collection agency. Turning a debt over to collections is your last resort. A collection agency will usually pay you 50% of what it recovers. Of course, in some cases, half is better than nothing. Dun and Bradstreet Small Business Solutions, and the similar business services Transworld Systems and I.C. System, all offer debt collection services. The Commercial Collection Agency Association (www.ccascollect.com) provides more information on debt collection agencies.

In my last blog post, I answered the Top 5 Questions from attendees at the webinar. You can also check out the recorded webinar to get all of the great information provided there.

About the Author:

Rochelle Glassman Our guest speaker is Rochelle Glassman, a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. Rochelle is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

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Top 5 Questions from Innovative Collections Webinar

Kareo February 28th, 2013

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In the free webinar 3 Innovative Strategies to Improve Collections Rochelle Glassman discussed collecting patient due amounts at the time of service as part of your medical billing strategy. She reviewed how to find out what they owe and what to collect. She suggested collecting deposits for high dollar services or getting authorization to charge a credit card for balances due after the time of service. While this was just one of her strategies, participants had a lot of questions. We’ve selected the top 5 related to this section of the webinar and provided Rochelle’s answers.

  1. How long does the credit card agreement remain in effect? Does there need to be an expiration date?
    A: A payment agreement stays in effect until the balance is paid in full. When an agreement is made, it spells out the length of the agreement and the patient signs that agreement with the understanding of the length of the agreement. Recurring payments can be set up using a payment processing service. If you already accept credit cards, your merchant services department may already have a service in place which you can add to your current plan. Many banks such as Chase and Wells Fargo offer this option to their merchants for a monthly fee. This service is also available through other vendors such as Paypal, Chargify and Authorize.net.
  2. Is it legal to charge no-show, administrative, late, and processing fees?
    A: This is not a legal question but a payer contracting question. The answer depends on what your payer contract dictates related to charging the health plan members administrative fees. It is highly recommended that you review your contracts. With that being said, it is recommended that all of the practice’s administrative fees be described in the practice’s financial policy that all new and existing patients should read and execute every year or every time there is a financial policy change. It’s good to have policies reviewed by your accountant, attorney, or a qualified healthcare consultant.
  3. What is the timeframe for returning overpayments to patients?
    A: I tell people within 30 days. Most payer contracts define this for you so you can check your contracts, but I think within 30 days is a best practice.
  4. Are there any legal requirements with regard to keeping credit information on file?
    A:  Yes, the merchant must be PCI DSS (The Payment Card Industry Data Security Standard) compliant. When compliant, you can legally store credit card information, with the exception of the CVV code. You can never, store the CVV
    code. Your merchant services provider should meet these standards. Details on the requirements can be found at PCI Security Standards Councilwww.pcisecuritystandards.org.
  5. Can you give patients’ discounts on their copay and deductibles? I thought that most payers didn’t let you do this.
    A: Initially, most payer contracts prevent you from offering discounts. However, I use Medicare as my guideline and they say that you should do what you can to collect payment from patients. I believe that after the practice has tried to collect any outstanding balance by sending out at least 3 patient statements over 90-120 days and if the patient hasn’t paid or made arrangements for a payment plan, that you can offer a discount to encourage the patient to pay something. This is better than not getting paid at all. If the patient has a legitimate financial hardship you can reduce the fee and/or write it off. I recommend that you use the standard Medicare financial policy to identify those patients that have a legitimate financial hardship. These financial statements provided by the patient should be reviewed and analyzed by a manager or practice owner who has the authorization to discount or write off fees based on the practice’s financial policies. It is recommended that the practice remains consistent with their financial policies and keep within the Medicare guidelines. The patient’s financial statement(s) should become part of the patient’s permanent financial record for 7 to 10 years in the event the practice is ever audited.

Check out the recorded webinar to get all of the great information provided there. And take a look at our next event, Medical Practice Marketing for Profitability.

About the Author: Rochelle Glassman

Our guest speaker is Rochelle Glassman, a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. Rochelle is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

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What Does a Medical Billing Best Practice Look Like?

Kareo February 14th, 2013

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Complimentary Webinar: 3 Innovative Strategies for Increasing Collections

Kareo February 13th, 2013

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Wednesday, February 20, 2013
1:00 PM EDT/10:00 AM PDT
Speaker: Rochelle Glassman

Getting paid. It’s one of the biggest challenges that all medical practices face. But it can be especially tough for small practices to collect payments from patients. Once they walk out the door, your chances of getting all the money you’re owed starts to decrease. In this webinar, Rochelle Glassman will talk about some innovative ways to increase your collections from high-deductible and self-pay patients. She’ll also provide simple ways to shorten your revenue cycle. By the end of this event you will learn how:

  • A deposit from self-pay and high deductible patients can help you get paid
  • To cut 10 days out of your insurance payment cycle
  • You can motivate your staff to collect more money from patients
  • And more

You don’t want to miss this.

Who Should Attend
Private practice owners, office managers, billing managers, billers, billing service owners and others concerned about improving medical practice revenue.

Register now to learn innovative ways to increase collections

About Your Speaker:
Rochelle Glassman

Our guest speaker is Rochelle Glassman, a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. Rochelle is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

Register now to learn innovative ways to increase collections

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Don’t Miss Great Medical Billing Tips in Getting Paid Newsletter

Kareo February 12th, 2013

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The February edition of the Getting Paid newsletter is out. Don’t miss the great articles and medical billing information in this month’s issue. Rochelle Glassman, a renowned practice management consultant, discusses strategies for collecting copays and deposits from patients who are self-pay or have high deductibles. Laurie Morgan, MBA, reviews a few common questions about E&M coding and provides a great tool to see if your providers are under-coding. And, Stelle Smith, offers tips on how to make the conversion from one practice management system to another. In addition, there is information about our upcoming free webinar, 3 Innovative Ways to Improve Collections, and a chance to win $150. So, if you haven’t already read it, check it out now!

Kareo February Getting Paid Newsletter

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Beware of the Insured Patient!

Kareo February 11th, 2013

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By: Rochelle Glassman, President & CEO, United Physician Services

With today’s high deductible plans, it is wise to view every patient who has commercial insurance (HMO, PPO and POS, etc.) as a self-paying customer. Why? Now that January 1 has come and gone, many patients’ deductibles have been reset leaving the first bulk of healthcare services paid by the patient. If the average office visit costs $199 and a patient as a $5,000 deductible, it is safe to assume that the charges for the first 25 visits will be paid out-of-pocket. Most patients do not meet their deductible unless they have high-dollar procedures, surgery, or a hospital admission.

Patients who are on Medicare and do not have supplemental (secondary) insurance also are responsible for 20% of the cost services provided. Have you thought about this and is your practice prepared for this reality?

If we aren’t careful, high percentages of insured patients can create a false sense of normalcy for our revenue cycle. We fall into the trap of believing the party responsible for paying the practice is the insurance company. Well, with high deductibles, we’d be making the wrong assumption. To avoid falling into this trap, here are a few precautions you and your staff can put in place today!

  1. Prior to the patient visit. Confirm with the patient on the phone or through a patient portal that their insurance plan remains the same. Update any change of information in your practice management system.
  2. Verify “every” patients’ insurance and benefit package prior to the patient visit. If you have a software system in place that checks eligibility for you, please use it. If not, it is worthwhile to use the payers’ websites to check, especially for new patients.
  3. Patient notification. If the new deductibles begin in January, alert the patient of what remains of their deductible prior to the appointment, and explain that payment will be due at time of service. The payment will be counted toward the deductible and will need to be paid by them, not the insurance company. Notifying the patient in advance does not open the patient to surprises at the time of the visit. This should limit the number of patients who do not pay at the time of service with the excuse that they did not know that they had not met their deductible.
  4. Collect the deductible before the patient leaves your office. Pre-collecting the deductible or a portion of the deductible before the patient visit or at the check-out counter is a great way to avoid the costly and risky process of trying to bill the patient after they have left our office. If the patient cannot afford the entire payment ask for a minimum of 50% and then request that the patient allow you to make a deposit on their credit or debit card for the balance to be applied to their account either at the time the EOB is posted or after an agreed to date no longer than 30 days.

Taking a deposit on an account via credit card is becoming more common in healthcare as it is no longer cost effective to send out patient statements for small dollar amounts. Many practices automatically write off balances under $10.00, this could add up to be a significant dollar amount over 1 year. If for example you write off $10.00 for 250 patients that would be $2,500.00.

For patients having expensive procedures or tests (over $500.00) who cannot afford to pay the in full at the time of service or within 30 days, it is important to have them agree to a payment plan before the service is provided. Again, the patient should approve monthly payments to be applied to their credit card until the balance is paid.

Like car insurance, healthcare insurance today is often geared to pay for medical emergencies. Those patients requiring only primary care services rarely meet their annual deductibles.

How can you learn about more innovative ways like this to improve collections? Join me on February 20 to hearabout other strategies to increase revenue and shorter your revenue cycle. Register here.

rochelle glassman discussees innovative strategies for increasing collections

About the Author
Rochelle Glassman is a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. Rochelle is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

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The Top 12 Medical Billing Tips of 2012

Kareo January 7th, 2013

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As we head into 2013, let’s not forget about some of the great tools, tips, and tricks, we learned from a few the industry experts who shared their knowledge about medical billing with us through blog posts and webinars in 2012. Here are some of our top picks from each month in 2012!

January: Surviving the Deductible Reset in 2012
At the beginning of each calendar year, medical groups feel the impact of deductibles on their bottom line unless they implement “best practices” for self-pay collections. Read More

February: The Importance of Documentation for Medicare and Medicaid Claim
Dr. Julie Taitsman, Chief Medical Officer for the Office of Inspector General, gave a presentation recently as a part of the OIG’s award-winning HealthCare Fraud Prevention and Enforcement Action Team (HEAT) on the importance of documentation for Medicare and Medicaid claims. Read More

March: The PQRS Incentive Program: How to Qualify, Get Started and Get Paid
The Physician Quality Reporting System (PQRS) is a federally mandated, voluntary program implemented by CMS. PQRS provides incentive payments to providers who satisfactorily meet specific quality measures. Read More

April: Understanding RVUs: Ensure Accurate Reimbursement for the E/M Services You Provide
When was the last time you took a closer look at the Relative Value Units (RVUs) associated with the evaluation and management (E/M) services you provide? Read More

May: Hidden Ways Medical Billing Shortcomings Hurt Your Practice
When a practice’s medical billing staff or service fails to accurately claim all the revenue the practice has earned – for example, by under-coding to ‘save time’ or neglecting to use important modifiers – this naturally represents an immediate loss of revenue. Read More

June: 7 Simple Ways to Improve Your Medical Billing Appeals Process
Spending the time and resources to appeal denied claims is crucial for any physician practice. Not only can appeals potentially help physicians recoup money, but they can also divert auditors from honing in on problematic claims. Read More

July: Hidden in Plain Sight: Five Medical Coding Gems from Your CPT Book
A spy in a novel I was reading said the best place to hide was in plain sight. I’ve never traveled incognito, so I don’t know if that’s true. But, I do know that the answers to many of my medical coding questions are an arms’ length away from me, hidden in plain sight in my CPT book. Here are five of my discoveries. Read More

August: Take a Closer Look at Your Superbill to Ensure Accurate Billing
Superbills aren’t necessarily supposed include every code a physician might report. The superbill is typically a one-page reference of the most common codes used in a particular practice. Still, practices should take the time to review their superbills and any relevant coding/billing policies to look for deficiencies that could affect their bottom line. Read More

September: Seven Ways to Improve Your Patient Collections
It’s not front-page news: patients have higher deductibles and out of pocket costs, shifting the burden in medical practices from insurance to patient due collections. Read More

October: Is Your Medical Practice Disaster Plan Ready?
Are you ready for a disaster? The best time to create a medical practice disaster plan is long before the disaster hits. If you don’t have a plan, consider putting these five best practices in place before it’s too late. Read More

November: Increase Your Revenue Tip: Prescription Refills
Prescribing is a big deal for practices. Many report the greatest percentage of in-bound phone calls to their practices are prescription related. Either the patient is asking for prescription refills or pharmacy personnel are seeking approval to fill a script. Have you ever considered how much this process is costing your practice? Have you ever asked, “How can we be compensated for this time?” Read More

December: 9 Essentials for an Effective Year End (and year to come)
Closing out the year is about more than just running reports and handing data to your accountant. It’s the time when you can evaluate the year, analyze whether you have achieved your practice goals, set new goals for the coming year, and look at new opportunities.  Read More

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Welcome to Getting Paid, a weblog by Kareo offering ideas, news and opinions about medical billing and practice management with the goal of making medical billing easier and yes, getting you paid. Visit the Product Blog for more information on our products.

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