Find the Healthy in YOU!

Date: July 20, 2015 | By: Rebekah J. Simon | Link

Being healthy is more than what the scales say. It is not about being skinny or looking good on the outside, but more about what is taking place on the inside. What is your body telling you? Do you have underlying medical problems? You’re tired, you have no drive, your joints hurt, your short of breath…. the list goes on and on. You’re body is trying to tell you that something needs to change, and more than likely that “something” has to do with what you are eating.

The food you eat can be used as medicine or as poison. Food can be an addiction, and it is a hard addiction to fight because our bodies need it to survive. Healthy eating does not come from fad diets or rapid weight loss. It is not about how much weight you can lose in the shortest amount of time, instead it is establishing eating habits that you can stick with for the rest of your life. A diet should incorporate controlled portions from each food group, along with adequate water intake. Water is fuel to our bodies, without it we cannot function properly and are left with a long list of complaints.

There are medications and supplements available to help you get started on your weight loss journey. These products are not indicated for long term use, and optimal results are achieved primarily with lifestyle modifications. There are certain medical problems and vitamin deficiencies that can add to weight gain or the inability to lose weight. Physical activity is also a key ingredient to being healthy. The biggest complaint about exercise is “I don’t have time”. We all have busy lifestyles that keep us on the go, but if we calculated the amount of time we spend on social media, watching TV, and other leisurely activities, we would be surprised by the amount of “free time” we actually have.

Three suggestions on the start to a healthy lifestyle 1. Cut food portions in half 2. Double your current amount of water intake 3. Find time for exercise.

The Front Desk: Your Defense Against Claim Denials

Date: June 16, 2015 | By: Janet Colwell | Original Link

Incomplete or inaccurate patient information can set the stage for a claim denial before a visit. Avoid these mistakes at the front desk.

Whether or not a claim is paid or denied has a lot to do with what happens before a patient walks through the door. Incomplete or inaccurate information gathered on the front end can set the stage for a denial before a visit even gets started.

“It’s critical to have as complete a patient record as possible before a patient presents,” said Ben Colton, senior manager specializing in revenue cycle optimization at ECG Management Consultants in Seattle, Wash. “As the visit gets closer, you should use all lines of defense to verify information right up to the time of the visit.”

Insurance verification has become increasingly important as more patients acquire high-deductible plans, said Lucy Zielinski, vice president of The Camden Group, a Los Angeles-based healthcare business advisory firm. As a result, it’s vital to have staff members at the front desk who know how to interpret different policies and discuss coverage issues with patients.

“The skill set required of [someone at the front desk] today is very different from what was needed 10 or 20 years ago,” said Zielinski. “In addition to customer service skills, you need to know the nuances of insurance policies and how to educate patients about their plans.”

Automated insurance eligibility and verification tools help but cannot replace a knowledgeable staff and a solid pre-visit process, experts said. They offered the following advice for avoiding mistakes on the front end that can require expensive fixes down the road.

• Check and double check. Don’t wait until a patient is in the office to verify insurance and collect demographic information, said Colton. Start the process during scheduling and follow up two days to three days before the visit. Review the details again at the time of the visit in case a patient’s phone number, address, or other information has changed.

• Trace errors back to their source. Frequent communication between the front and back office goes a long way toward preventing repeated errors, said Colton. The best practice is to route any front-end issues that are causing denials back to the person responsible so he can modify his procedures.

• Offer price transparency. Along with eligibility verification, consider integrating a cost estimating tool into your practice management or EHR system. The tools, which are often available through insurers, provide an estimate of the cost of an upcoming service or procedure based on the patient’s benefits and historical claims data. It’s another way of educating the patient about her financial responsibility so there are fewer surprises when it comes time to bill the patient.

• Schedule appropriately. Ask questions about the details of the visit upfront to help you schedule the appropriate type and length for a visit, said Zielinski. For example, some insurers do not allow you to group preventative services, such as a routine physical, and procedures, such as a mole removal, into the same visit for billing purposes. It’s also important to check on the date of a patient’s last mammogram, physical, or other service that’s typically covered annually to make sure it is covered at the time of service.

• Timing is critical. Mistakes made on the front end lead to delays filing claims, and that’s money out of your pocket, said Zielinski. “You have to spend time researching the mistake, updating the claim, resubmitting it, and waiting for payment,” she said. And all of that has to happen within the 90-day filing window required by many payers. “You run the risk of not getting paid at all,” she said, “so that rework ends up being very expensive.”


Physician Education for ICD-10

Date: May 29, 2015 | By: Melanie Endicott | Original Link

With only five months to go until the implementation of ICD-10, the countdown is on for physicians, and other clinicians to be educated on the nuances of this new code set.

Breadth and Depth of Training

Training in ICD-10 is being offered by many different companies in multiple formats, such as online learning, face-to-face workshops, textbooks, or webinars. With all of these different options, the first step is for the physician to determine the depth of ICD-10 training needed. A few questions to ask:

  • Will the physician be assigning codes in ICD-10?
  • Does the physician have coding staff to assign the codes, but needs to be educated on the documentation requirements for ICD-10?
  • Are there other clinicians in the practice, such as nurses, therapists, etc., that need training on ICD-10 documentation requirements?

Depending on the work flow of the practice, the physician may or may not be responsible for selecting the diagnosis code(s). If the physician is selecting the ICD-10 code, either on a superbill or within an EHR, a detailed course/training covering guidelines and conventions of ICD-10 may be in order. However, if the physician has coding staff that assign the diagnosis codes based on the documentation, the focus of training should be on the nuances of documentation for ICD-10.

The ICD-10 classification system includes many more codes than ICD-9, which at first may be daunting to the clinician. However, when taking a closer look, much of the expansion of the code set is due to the addition of laterality, which is hopefully already being documented. Clinicians who currently have high-quality documentation will likely experience a very smooth transition to ICD-10, with minimal documentation changes necessary.

Another factor to consider is the breadth of training. For instance, a cardiologist may only be interested in learning about diagnosis codes pertaining to the cardiology specialty, whereas a family-practice physician may want a more comprehensive training covering all body systems.

Training Modalities

After determining the depth and breadth of ICD-10 training desired, the next step is to look at the delivery mechanism. There is not a one-size-fits-all ICD-10 physician training program. Comparing and contrasting the different types may assist in selecting the best option.


Attending a workshop or hiring an expert to do the training is probably the quickest method; however, it could be the most costly. Many companies and individuals offer training in ICD-10, and some tailor it to specific needs, such as physician documentation requirements. Having an expert come to the practice to do the training allows for individualized, practice-specific training. One valuable exercise would be to have the expert trainer review the current clinician documentation and identify gaps in documentation that need to be remedied for ICD-10 readiness. This exercise of documentation analysis could even be done by an internal coding staff member that has received extensive ICD-10 coding training.


The flexibility of taking courses online is attractive to many and the cost is typically lower than a face-to-face training. Busy clinicians may prefer to take an online course at their leisure, as time allows. However, finding an online course to meet a practice’s individual documentation needs may be a challenge.


Another form of training that doesn’t require travel is webinars. Oftentimes, these webinars are recorded and may be viewed at any time, allowing for great flexibility for the time-strapped healthcare professional. Webinars are great for learners who like to both see and hear the material being presented.


Probably the least expensive option for training is to purchase a textbook from a reputable ICD-10 training company. Be sure to review the content of the textbook to determine if it is geared toward coders or clinicians. A textbook for coders may be too granular for the average clinician who needs assistance with documentation requirements, not coding guidelines.

Putting Training into Practice

Once the training is complete, the physician must practice what was learned. Many EHR vendors are offering the option to practice coding in ICD-10, which might be ideal for that clinician wanting to preview the codes and get a feel for the necessary documentation. If the physician is working in a practice that has coders assign the codes, then the physician should work together with the coder to ensure that the documentation in the record is specific enough for accurate ICD-10 code assignment. Ideally, physicians and coding staff should work together to ensure that the documentation is ready for Oct. 1, 2015.

Next Steps

A physician practice that has implemented an ICD-10 communication plan, developed a budget, completed staff education, performed readiness testing, analyzed documentation, reviewed quality reporting requirements, and is working on physician education on ICD-10, is on a positive pathway to implementation. Oct. 1, 2015 is quickly approaching and time must be used wisely.

7 Big Changes for ICD-10 Focus on the most frequently used codes at your practice — such as these seven — to better prepare your primary-care practice for the ICD-10 code set transition. Visit


AHIMA ICD-10-CM/PCS Implementation Toolkit:

AHIMA ICD-10 for Physicians and Clinicians:

AHIMA 2015 ICD-10-CM Coder Training Manual:


Improve Your Practice’s Billing Process in 2015: 3 Tips

December 28, 2014 | By Tom Furr | Original Link

When I get a rare chance to play poker with some of my friends ($0.50 is a big pot in our game) there is one thing I know: No matter how much I wish and hope, after the deal, my cards just don’t change. But the thing I love about poker is that even with bad cards, you can still win if you play them right.

In the midterm election, the people of our country spoke pretty loudly about changing the status quo with government. There has even been talk about trying to use this new leverage to repeal the Affordable Care Act (ACA).

However as time goes on and more Americans rely on the health insurance marketplace and exchanges for their health insurance, it will be harder and harder to take the ACA away.

It is the hand that we have been dealt and so now we have to learn how to play it.

Because of the ACA and other pressures on employers to control healthcare costs, the deductibles that people will be paying this year will continue to rise to record levels.

According to HHS data released in May 2014, almost two-thirds of people on the health insurance marketplace selected the Silver Plan, which has a family deductible around $6,000; and another 20 percent of people selected the Bronze Plan, which has a family deductible around $10,000. So over 80 percent of families on the new exchanges have a deductible of at least $6,000.

Because of this, in 2015 practices can expect to collect a majority of their revenue directly from their patients through the first six months of the year as opposed to from insurance companies. Practices must make sure they are ready for this and can take three important steps now to prepare.

  1. Ensure that your billing is being done properly. According to Medical Billing and Coders up to 30 percent of income at a medical practice is lost due to improper billing. Make sure that claims are submitted quickly too, as payments take time to process.
  2. Ensure your practice technology is up to date. From your scheduling software to your billing applications, there are a lot of features that are available to you through your practice management vendor that you should be taking advantage of. They have done a lot of the work to make sure they are providing value to you, make sure you leverage their work.
  3. Make sure your back office is in order. The financial success of a practice can come down to successful execution of your back office. However with the increase in workload due to the healthcare reforms, your back office is left with less or almost no time to handle the important issues to keep a focus on your bottom line. Make sure your staff takes the time to ensure that all processes are being properly monitored and give it time to find new and innovative ways of doing business.

Remember, you can’t change the cards you’ve been dealt but you can change the way you play them.

Basic Billing Reports Your Medical Practice Should Run

View Original Blog | November 29, 2014 | By P.J. Cloud-Moulds

Over the course of several years, the reports that I run have changed. Some I have stopped monitoring, others have morphed into new reports, and others have combined into one single report. Here are the reports that I suggest your practice run: DAILY The types of information you need to be reviewing on a daily basis are as follows:

  1. Your rolling AR by days

By looking at 0-30, 30-60, 60-90, 90-120, and 120+ days, you will be able to see when your billing department is/is not posting aged A/R, and if they are following up on denials.

  1. Your rolling A/R by clinic/payer/provider

If you have more than one clinic, it’s good to keep an eye on that A/R in each specific facility and by each provider. If suddenly Medicare stops paying on a specific provider, you will be able to easily and quickly identify this, and figure out why they have stopped paying. This happens more often than you think.

  1. Your Medicare payments

It is critical that you identify the exact date that Medicare stops paying you. You need to know this date when you call Medicare to ensure you are paid for any back amounts. Medicare has often delayed payments to providers over the past several years. By knowing this exact date, you are more likely to receive all payments due to you.

  1. Your payments summary

This will allow you to review if your front-office staff are collecting and posting copays and coinsurances, as well as following up with posting insurance payments.

  1. Your billed claims

It is imperative that you know if your claims are being billed out. There are always software systems that have issues and if there is no one checking to see if claims are being billed out, some may never be sent. WEEKLY The types of information you need to be reviewing on a weekly basis are as follows:

  1. Any Medicare allowable summary reports

Is your practice and procedures bound by any Medicare caps or specific allowed amounts? It’s very important that you are aware of these restrictions so that you do not miss out on being paid.

  1. Any missed medical notes

Does your EHR program allow you to run reports that show any provider-missed medical notes and charges? This is critical in the reimbursement process. MONTHLY The types of information you need to be reviewing on a monthly basis are as follows:

  1. Adjustments report

This is where you are going to identify any clinic errors, as explained in my last blog. Also, what types of adjustments are being made and if you agreed to those adjustments.

  1. DSO (Days sales outstanding)

You will want to know how many days it takes for you to be paid, from the date the patient was seen to the date the payment was received and posted.

  1. Clinic key metrics
  • Patient visits
  • New Patients
  • Charges
  • Inflow
  • Adjustments
  • Percent collections
  • Number of statements mailed
  • Timed units
  • Charge per visit
  • Pay per visit
  1. Collections and 15-day letters

QUARTERLY The type of information you need to be reviewing on a quarterly basis is as follows:

  1. Total A/R review

How do you know your billing staff are following up on unpaid claims if you are not reviewing their work? By reviewing your AR, you have the final decision on what adjustments need to be made. Has your billing staff tried following up on an $18.34 secondary payment more than once? If so, you’ve already lost money on that claim. Consider this cleaning house on those types of claims. ANNUALLY The type of information you need to be reviewing on a annual basis is as follows:

  1. Year-end review of all of the reports mentioned above

If you had goals set for the year, its time to look at your office performance versus your set of goals. Did you outperform over last year, or the year prior? By looking at years prior, you can review if your goals were on track. Keep in mind that looking at your performance data is truly key in your overall success; even if you are just starting out. While it can seem a little overwhelming, don’t give up and remain consistent with the monitoring process. It can truly make a difference in your overall bottom line.

When Your Admin and Billing Departments Work Together

Original Blog | November 01, 2014
By P.J. Cloud-Moulds

When a new financial policy is made at your practice, I bet you rarely hear “Let the billing department decide!” But you should seriously consider it. Those who do billing or work at billing companies are cheering right now and I think the rest of us are scratching our heads and asking “But, why?”

As a physician you see patients and treat them. It’s why you went to medical school. You’re really good at that part; but maybe not so good at the back end of practice operations. Oftentimes, policies are made in practices for behavioral reasons, but once the results of these well-intentioned policies trickle into the billing department, things can often go awry very quickly. The best intentions sometimes create more work.

Try this instead:

  1. Call a meeting with your billing department or outsourced billing company representative.
  2. Identify areas that hold your claims up and prevent them from being sent out clean.
  3. Ask for feedback on how your practice can change a procedure in a way that will assist the billing department in their processes.
  4. Update your policies and procedures to reflect the needed changes.
  5. Train your staff.

Those five small steps can make all of the difference in the world — and change how quickly you are paid. Think about it, shouldn’t the people doing the billing work, that know there are mistakes that can be prevented, be allowed to help rewrite office procedures? Here are some examples of what could be changed right now to make the greatest impact:

  • When entering collected patient copays into your system, be sure that the front-office staff balances payments on a daily basis. This will prevent data-entry errors (i.e., $1,500.00 instead of $15.00). Double-check to make sure all payments were collected at time of service, and that all payments were entered at time of service. All of this work will prevent phone calls to the billing department when patients receive their statements. Believe me, the volume of calls will be reduced significantly.
  • Do a statement review. Run your monthly billing statements, and before they are mailed, review the balances to see why the patient is getting a bill. No statement generation is the best goal to have, but realistically we know that’s close to impossible. Did the insurance company process the claim differently than the benefit information that was provided to you? Did the front office neglect to post a payment, but has a receipt you can now post? Does your software have any flaws or bugs that might post payments into the wrong area, creating a patient balance? Find out why the statement is being generated. By doing this, the call volume will decrease significantly.
  • Do you have a staffer checking claims denials? When a billing department asks the front office to provide additional information or call the patient and obtain the subscriber’s date of birth, those types of requests should be top priority. The longer the front office waits to send that information over, the longer the billing office has to wait to send claims out. Aging out a claim due to missing or incorrect information is a poor way to run a billing department. You can also run into timely filing deadlines and then you’ll never be paid.
  • Does your front-office staff know what insurance plans you take? If you see a patient on an insurance plan you are not contracted with, even the best medical biller can only get you out-of-network payments. Be sure your front-office has a list of accepted insurances.

There has always been an “us” versus “them” divide between the front office and the billing department. That stigma needs to be tossed out today. Two groups of people with the same exact goal (getting the practice paid) should be working so close together, their hands should be intertwined. Take a moment and meet with your billing department, you won’t regret it.