How Well Are Insurers Paying You? And What Are You Doing To Improve It?

June 29th, 2010 by Joann Doan

AMA 2010 National Health Insurer Report Card

AMA 2010 National Health Insurer Report Card

The American Medical Association (AMA) released its 2010 National Health Insurer Report Card this month, and as in previous years, it is eye-opening for those who rely on insurance payments for their livelihood. The AMA found that one in five medical claims are processed inaccurately by health insurers, according to their third annual check-up of the nation’s commercial health insurers and the systems they use to manage and pay claims. This was the key finding of the 2010 National Health Insurer Report Card, which for the first time benchmarked the overall claims processing accuracy of the nation’s largest health insurers.

According to the AMA’s findings, the health insurance industry as a whole has about an 80 percent accuracy rate for processing and paying claims. Coventry Health Care Inc. came out on top of the seven commercial health insurers measured by the AMA with a national accuracy rating of 88.41 percent. Anthem Blue Cross Blue Shield rounded out the list with a national accuracy rating of 73.98 percent.

The AMA estimates that $777.6 million in unnecessary administrative cost could be saved if the health insurance industry improves claims processing accuracy by one percent. Currently, the health care system spends as much as $210 billion annually on claims processing. One recent study estimated physicians spend the equivalent of five weeks annually on health insurer red tape. To keep up with the administrative tasks required by health plans, physicians divert as much as 14 percent of their revenue to ensure accurate payments from insurers.

The AMA’s National Health Insurer Report Card provides a useful snapshot of how each of the nation’s seven largest commercial health insurers perform. The systems health insurers use to process and pay claims were measured according to:

•  Accuracy. In addition to measuring overall claims processing accuracy, the report card examined how accurately insurers reported the correct contract fees to physicians. Commercial health insurers made large improvements during the last three years. Contracted fees were correctly reported 78 to 94 percent of the time in 2010, compared with 62 to 87 percent of the time in 2008. UnitedHealth showed the largest improvement in reporting correct contract fees, while Health Care Service Corporation scored the highest. The performance of insurers varied significantly by state, ranging from 58.6 to 96.9 percent.

•  Denials. The inconsistency found among health insurers in 2008 continued to be demonstrated in 2010. There is wide variation in the frequency of denials by insurers, ranging between .7 to 4.5 percent. Lack of eligibility continues to be the most common reason for claim denials, signaling the need for employers and insurers to help educate patients about the limits of their insurance coverage. Physicians can help reduce denials by ensuring all claims are complete and accurate.

•  Timeliness. The report card found that insurers’ response time to a claim varied from five to 13 median days. Except CIGNA, all the insurers measured last year showed slight increases in the number of days needed to respond to a claim.

Since denied, rejected, resubmitted and underpaid claims can cost you as much as $100,000 per month according to the AMA, every effort you can make to reduce denials, rejections and delays will mean money to your bottom line. In the coming months, we will continue to provide you with methods for doing this, both with Kareo medical billing software and without, in this blog. Among the ideas you’ll find in previous posts are:

•  How to Use Real Time Eligibility Verification Effectively
•  6 Ways to Accelerate Collections
•  Catching Unbilled Revenue with Kareo

If you have suggestions or ideas, please feel free to share them in the Comments section, or email them to


Read More | No Comments | Filed in Features, General, Product, Uncategorized

New Release: Customize Your Encounter Screen Layout Plus 25 Other Timesavers

June 28th, 2010 by Dan Rodrigues

Customize Encounter Screen Layout Demo

Watch a demo

We have received a number of excellent suggestions recently from you, our users, on how we can save you time and make Kareo even easier to use. This is the first of several releases that will incorporate your ideas, along with some of our own, all specifically designed to accomplish one of the following goals:

• Save you time
• Make Kareo easier to use
• Simplify the setup process
• Reduce claim rejections
• And more…

Customize Your Encounter Screen for Your Practice
Kareo now allows you to customize the encounter screen layout for your practice and the way you prefer to work. You can add, remove, and change the order of fields and sections of your encounter data entry screen. This helps you streamline the data entry process by entering only the required fields for your practice while skipping over the situational fields that do not apply to your practice workflow. Other improvements in Encounters include:

• Approve or change the status of multiple encounters at once
• Add or change a supervising physician on an approved encounter
• Change in status terminology from “Submitted” to “Review”

20+ More Timesavers and Easy Tools
Other enhancements, the first of many to come in future releases, include a variety of features and workflow improvements:

• You can now settle multiple claim service lines at once

• Removed policy number validation field from Contract screen

• New to-do items make it easier to keep track of rejections, denials, and no response claims requiring insurance follow-up

Document Management
• Enhanced document printing to print specific pages or a range of pages
• Added “Eligibility” as a new document label type
• New scanned documents will default status to “new” for easier identification
• New guidance on good scanning defaults to manage your document storage
• Added file size field to documents list to manage your document storage

• Added the ability to search all Kareo payer lists by payer ID
• Enhanced web enrollment removes fields that are no longer required

• Added validation to prevent saving an insurance plan without an address
• Simpler screen to select a payer connection for an insurance company

Patient Statements
• Send patient statements directly from the Find Claims screen
• Select all or deselect all option now available in the patient statement wizard
• Drill-down from patient to account history from the patient statement wizard

• Added auto-population of the patient address to the guarantor address
• Changed the warning and error messages for required fields on patient record
• Added “Check Eligibility” option from the patient record and Find Patients screen
• Added guarantor name to Find Patients screen
• Added ability to search patients by guarantor name

• Save and print patient receipts in one step when entering patient payments
• Added new validation to warn users of duplicate payments from being entered

• Added a subscription-level column to practices list for quick reference
• Added a column that shows which practices are active or inactive

• Updated taxonomy code list and removed invalid codes that cause rejections
• Split the permission to add or edit rendering and referring providers

At Kareo, we plan to continue working hard to make medical billing easy for you. Customer feedback drives our service and ensures we build the features that matter most to people like you, so your input is critical to us. Please email your ideas for our next release to

Read More | 1 Comment | Filed in Company, Releases

Expanding Our Support Staff Means More Help for You

June 21st, 2010 by Joann Doan

In our Customer Survey in December, we heard loud and clear that our customers wanted us to make more customer support available. So, over the last few months we have begun a number of steps to provide you with the support resources you need, including additional support packages, adding to our self-service training videos and other helpful tools. We have also added some expert staff to help you with implementation and support for your Kareo medical billing software, and we’d like to introduce them.

Edith Santiago, Implementations

Our first addition was Edith Santiago in Implementations, who brings nearly 20 years of experience in information services support to her role. Before joining Kareo, Edith filled a variety of roles in quality assurance, staff training and software support for Officemate Software Solutions, a medical practice management software firm. Edith says what she likes best about working at Kareo is that “every Kareo employee here is hard-working and cares not only about the service and support they provide, but also have the client’s concerns and best interests at heart. “ She adds, “I enjoy learning and hearing our customers’ experiences and being able to share their experience, along with my own experience, with others.” Edith studied Computer Science with a specialization in Systems Analyst at Irvine Valley College and is a member of the Southern California Quality Assurance Association. Born and raised in Hawaii, Edith moved to California to experience three seasons instead of just one.

Jim Millen 3 CroppedJim Millen, MCP, A+, an experienced healthcare software implementation professional with 9 years of experience, came to Kareo from MedAvant Healthcare, where he was a Senior Implementation Specialist. Now a member of the Kareo Support Team, Jim says he likes working “with a good product that’s always improved, not stagnant. It’s important to me to have a good product that I like.” Jim says what he likes most about helping Kareo customers is “being able to give answers right away to an issue. Everybody has to call Support sometime, and I hate when you don’t really get an answer that helps you.” Jim is passionate about technology, half-marathons and paintball. A 12-year veteran of paintball, he participates in international paintball tournaments and has appeared on TV in competitions.

We hope you will enjoy working with Edith and Jim; they’re both terrific people and work hard to help Kareo customers. We realize that providing excellent customer service is key to success in web-based software, and we’re working hard to exceed your expectations. Keeping up with customers’ needs is a challenge for every growing company, and it is one that we take seriously. We will continue to improve our customer support and the Kareo application. We appreciate your feedback on how we’re doing, and your suggestions for how we can improve.

Read More | No Comments | Filed in Company

Submit Your Best Billing Tip for Our Monthly Contest and Win

June 17th, 2010 by Joann Doan

We’ll give you much more than a penny for your thoughts.

How about $250 for your best medical billing tip?

That’s right—you can win $250 by entering our contest for the “Billing Tip of the Month.” Every month, Kareo will select one tip that offers the most upside for practices trying to improve their collections and bottom line, and the winner will receive an American Express gift card for $250.

Then, we’ll publish your tip on our website and in our upcoming e-newsletter and give you credit with a byline that includes your name and company. So you not only win a prize, if you’re a billing service you’ll also get free publicity for your company in front of thousands of providers.

To enter, just send an email to and describe your billing tip in 500 words or less. Include any experience and results you’ve had with using this tip, and that will enhance your chances of winning. Feel free to include screenshots of the features you use in Kareo medical billing software, if that applies to the tip you’re submitting. The tip can include processes, forms, better ways to utilize Kareo features…the field’s wide open. The tip does NOT have to involve Kareo necessarily; we just want to tell our customers how to improve their billing and bring more to the bottom line.

The deadline to submit your tip is the 25th of each month, so to win for July 2010, submit your tip by June 25, 2010.

We look forward to reading your tips and awarding the prize.

Good luck!

Read More | 2 Comments | Filed in Company, Events, Uncategorized

How to Use Real-Time Eligibility Verification Effectively

June 15th, 2010 by Joann Doan

Many of our customers tell us that one of the features in Kareo they like best is the real-time insurance eligibility verification. We’re glad to hear that, and wanted to share some tips for making the most of this feature.

In many practices, the standard process is to check insurance eligibility when the patient arrives for the appointment. This is a good time to check eligibility, but not the best time.

The best practice, according to The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid (Walker, Larch and Woodcock, MGMA, 2004) is to check a patient’s insurance eligibility when they first call for the appointment—while you have them on the phone. That way they can answer any questions regarding policy number, provider, primary insured, etc. And you can ask key questions at that point about co-pays, preauthorization requirements and other issues. The authors suggest that this is easily done: You can tell them, “While I’m looking for an appointment time for you, would you be kind enough to get your insurance card out of your wallet?”

Moving this step as early in the process as possible eliminates the awkwardness that can occur when patients arrive for an appointment and you find there are problems with their eligibility. This way, you won’t have to explain why the doctor can’t see them, or have a suddenly cancelled appointment.

One more important point: It’s best to save the information on the verification in the patient’s account, in case there are any disputes later with the insurance company over when or if the eligibility verification occurred. Kareo saves this automatically for you in the account.

Here’s a quick pre-visit checklist to follow:

1. During the initial phone call, ask the inquirer to get their insurance card ready while you look for an appointment time.

2. Verify the insurance eligibility and ask any questions over the phone before scheduling the appointment.

3. Save the verification information in case of a later dispute (date/time of verification, etc.)

4. As soon as possible after the phone call, send the new patient packet including patient history, HIPAA forms, etc.

5. During the appointment reminder phone call, remind the patient to bring the completed forms and their insurance card.

6. Upon the patient’s arrival, collect the completed forms and copy the insurance card, checking to see that there’s been no change in insurance since the appointment was made.

During this process, remind the patient that you are gathering this information to make sure the process with their insurance company is smooth; you are helping to make sure they receive their full benefits. Of course, your practice will see a benefit as well–you can significantly reduce overhead with practice automation features such as real-time eligibility verification. Electronic verification can eliminate up to 50% of denials on the spot and save your staff from hours on the phone. In fact, the AMA estimates that you save approximately $3,700 per year, $2.95 per verification, by automating your eligibility verification process.

Gathering this information early in the process will slightly increase the length of appointment phone calls, but will reduce time at check-in, and as mentioned, avoid problems at that point. And with medical billing software that includes a real-time insurance verification feature (as Kareo does), you can conduct the insurance verification in seconds.

If you would like to consider a Kareo plan that includes real-time eligibility verification, visit our plan comparison. If you already use the real-time verification, we hope you’ll consider using this tip to make the most of it and improve your practice profitability.

Read More | No Comments | Filed in Uncategorized

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Welcome to Building Kareo, a weblog by the team at Kareo about our products, our partners & competitors, medical billing, healthcare information technology, and much more.


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