Time to Vote for the January Medical Billing Tip of the Month!

December 31st, 2012 by Joann Doan

It’s that time again! We need you to judge our monthly Medical Billing Tip of the Month contest. Listed below are the three top tips submitted this month (out of the many great ideas we received!). Just read them over and then post on our Facebook page which number is your choice for Medical Billing Tip of the Month. You can also post your choice in the Comments box here on our blog. Either way, be sure to vote before the deadline on Friday, January 4th! The winner will receive a $250 American Express Gift Card and the acclaim of their peers. Here are the candidates:

Tip #1: Sending Claims with Modifier-32

My billing tip of the month is about sending claims with Modifier-32. There will not be any reimbursement if this modifier isn’t used. Using the clinic’s vaccination stock and not being paid for it will cause mental and financial stress. I hope this helps tremendously and promotes an increase in revenue since vaccine prices are increasing and payment for services are fluctuating/decreasing.

Providers who receive vaccines through the Vaccine for Children (VFC) program may use their purchased supply and submit claims using Modifier-32 to receive reimbursement ONLY if there isn’t any VFC supply left or there is a shipping delay.  Sometimes there is an urgent reason why the patient needs the vaccine to prevent delay to enroll in school, daycare, etc and the clinic’s supply must be used.

-          Use the normal modifier beside the E/M code (ex.-25), BUT beside the vaccine code (ex. 90732) use Modifier-32 Mandated Services first.

-          In the “Edit Claim” section of Kareo a second modifier can be added if necessary but most likely one is not needed for vaccines.  Paper claims can have the modifier written or typed in the specified area.

-          If an issue arises resend the claim with the claim number and call the insurance company to verify if the modifier or the NDC is the issue and inform them of the reason the clinic vaccine was used and if it is no fault of your clinic that caused a delay in shipping.

Tip #2: Self-Auditing in Physician Offices

Auditing is important to evaluate the physician processes to make sure their compliance plan is operating correctly and to identify any inappropriate documentation, coding, and/or billing practices. One of the most important reasons for auditing is to identify any potential areas of concern that could put the physician or practice at a risk for audits.

OIG recommends two types of reviews:

1. Standards and procedures review — Are the standards current, complete, or need updated to reflect any government changes in regulations

2. Claims submission audits — Is coding, billing, and documentation in compliance with payer and government contractors. Are services performed reasonable and support medical necessity?

OIG states self-audits can be used to determine:

• bills are accurately coded and accurately reflect the services provided
• documentation is being completed and correct
• services or items provided are reasonable and necessary
• any incentives for unnecessary services exist.

It is recommended to start with a “baseline” audit after the first three months of implementation. This will identify areas that need improvement, education, and a basis for future audits.

The following are areas to build your foundation for future audits. The five steps are:

1. What documentation needs improvement

• Detail and specificity needed
• Medical necessity
• Components of chief complaint, history, examination, or medical decision making
• 95/97 examination guidelines

2. Possible coding/billing problems with EHR system

• CPT, ICD-9, and HCPCS codes
• CCI edits and LCDs
• Modifiers

3. Guidelines

• Interpretation of grey areas
• Consultations
• New verses established patients
• Signatures
• Incident-to
• Medicare guidelines

4. Education

• Providers
• Auditors
• Billers
• Others — front desk, managers, etc.

5. Actions

• Problems identified — How are they resolved?
• How future problems will be identified and reported
• How often will audits will be performed?
• Hire external auditor

Once you have completed the baseline audits, I recommend developing an auditing compliance plan for everyone to follow as a blueprint for documentation, coding, and billing.   Our most important goal as coders is to protect our physicians from any potential fraud or abuse; however, this is a team effort and requires the entire office to follow the necessary steps of a compliance plan to be successful.

Tip #3: How to Easily Upload the Fee Schedule in Kareo

Presently we are using fee schedule import spreadsheet, it would be more save our time rather than update into manually. Below are the step by step instructions on importing the Fee schedule in Kareo:

Go to Settings -> Contracts & Fees -> Fee Schedule -> Import Fee Schedule -> Import fee schedule from a file -> click the browse button and select appropriate fee schedule spreadsheet -> click “Yes import the fees as a percentage of the original amount and then click continue -> Click Save button.

Get into the Kareo settings => Contracts & Fees

Medical Billing Tip December Step 1
Click New tab (for making new fee schedule) and update the fee schedule name and other necessary details in General tab then move on to next tab Fee schedule and click Import fee schedule.

Medical Billing Tip December Step 2

Here we need to select => Import fee schedule from a file => click the browse button and select appropriate fee schedule spreadsheet which we downloaded from the Medicare website or any other Kareo accounts.


The below is an example downloaded spreadsheet and we can import all these codes with the fee value at once.

Medical Billing Tip December Step 4

We need to mark select the option => Yes import the fees as a precentage of the orginal amount and then click continue => Click Save button

Medical Billing Tip December Step 5

Finally we can see the updated fee schedule in the result tab. We just cross verify and click continue and save it.

Medical Billing Tip December Step 6

Which tip is your top choice? Vote now on our Facebook page or in the Comments box on this blog. You have until Friday, January 4th, to vote! We’ll announce the winner in our January newsletter.

Happy voting!

Read More | 31 Comments | Filed in Billing Tip of The Month

Fixes, Enhancements, and 2013 Plans for Kareo

December 18th, 2012 by Kareo

On Friday, December 14, your Kareo account was upgraded to the latest version. This month’s release is focused mainly on improving data entry validations and cleaning up a laundry list of fixes across the application.  We have also been working on some exciting 2013 projects we want to share with you.

Improved Kareo Field Validations
Correct and complete data can help you avoid miscommunication with patients, delays in claims processing, and disruption to your cash flow.  In this release, your Kareo account now includes a few validations that will better your chances of getting the right information the first time. See the 5 new validations.

Looking Into 2013
Throughout the upcoming year, we will make it a priority to share with you the improvements we have on the drawing board – including a forward look to next month’s release and updates on major projects that will take shape throughout
the year.  Look for revisions to fee schedules and contracts in January and ongoing work on the introduction of the web-native platform. Intrigued? Read more.

New Features

There are about 10 items we corrected during this release cycle.  Check out the full release notes for more information. Read more.

At Kareo, we continue working hard to make running your medical practice(s) as easy for you as possible. Customer feedback drives our service and ensures we build the features that matter most to you, so your input is critical to us. Please submit your suggestions, challenges and ideas for our next release here – Give Feedback.

Read More | No Comments | Filed in Features, Product, Releases

Improve Medical Billing with Kareo’s New A/R Reports, Part 2

December 12th, 2012 by Kareo

by Rico Lopez, Senior Market Advisor at Kareo

If you are a biller or anyone working medical billing claims, it’s all about the details. You need to create a work list of identified problem payers and claims and sort that list based on practice objectives (by aging, outstanding balance, provider, etc.). You need to drill down to the individual claim so you can see all the activity including rejections and denials associated to the individual claim. You also want to be able to make corrections to the claim, rebill, and then quickly go right back to the report and address the next item.

The Kareo Detail A/R by Responsible Party Report allows you to do exactly what you need to do so you can get your job done. Once the problem payer and aging category has been identified, then it is just a matter of customizing the Filters, selecting the relevant Columns to display and sorting the list of claims based on the priorities.

Working with Filters

  • Aging Method: Similar to the other versions of the A/R Aging Report, this report also allows the user to determine the Aging Method (Date of Service, First Billed Date, Last Billed Date or Encounter Post Date) as well as the reference date. If you are specifically working claims that are close to the filing limit, you should utilize the Date of Service Aging Method so the Aging column sorting will allow you to focus on the oldest items first. Otherwise, you will want to use
    Last Billed Date.
    The reason you want to use Last Billed Date most of the time is that you want to generate a list of the items that are outstanding based on the last time the claim was handled (corrected and resubmitted). If you run it by First Billed Date, some items may have already been worked and rebilled recently. These items would more than likely appear on your work list and you would not find out until you drill down to the individual claim. If you are worried about working the items with the oldest dates of service first, you will still have the ability to “sort” the list of claims based on Service Date.
  • A/R Aging Bucket Filter: This filter allows you to limit the list of items only to the required aging bucket.
  • Provider, Location, Payer Scenario and Batch #: These three filters may or may not be necessary and will depend on the items targeted. For example, the issues flagged may only be isolated to one Provider. In this case, you can filter to only show the claims for that provider. But what if it is one provider at only one location? Then you can also filter for the target service location. Finally, if you need to, you can limit the list based on a specific Payer Scenario
    and/or Batch number.

Customizing the Columns
This level actually provides the most extensive option for displaying data. Since each recovery initiative will have a specific objective or priority, you can easily add or remove columns based on the specific needs.

A/R Reports

Column Sorting
This is one of the most powerful additions to the new A/R Aging Report. This new layout allows you to “re-sort” the list of the generated items based on their recovery initiative priority.

You can prioritize the list by:

  • Aging to target the oldest ones first.
  • Total Charges or Total Outstanding to focus on the high dollar items first.
  • Procedure Code to look at patterns that revolve around a procedure or group of procedures.
  • Service Date to address items that are closer to the filing limit first.
  • Patient so you can quickly knock out a group of claims for the same patient since those claims will likely have the same issues.
  • Rendering Provider to group the items by the provider and work them accordingly and address any issues with the provider to avoid the same problems in the future.
  • Location to group the claims for services rendered in the same location together and identify any issues for that location.
  • Batch so you can see any pattern tied to a specific batch, then you can sort the list by claim batch and work the items together (if significant enough, you may want to Filter the list to the specific batch only).

Remember, sorting the list of items is as simple as clicking on the column header. Clicking on it once will sort it ascending and a second click will reverse the order.

Find out more about the new A/R Aging Report and other Kareo features that can help improve your medical billing in the Help Center. And check out our post on Getting the Most from the New A/R aging Report in the Getting Paid blog.

Read More | No Comments | Filed in Features, Product, Releases

Learn How Kareo Can Streamline Your Medical Billing

December 12th, 2012 by Kareo

See how Kareo’s easy-to-use medical billing solution can help streamline your medical practice! Join us for our next free demo webinar on Tuesday, December 18 at 1:00 pm EST to learn how Kareo will make medical billing easy and improve your profitability.

Learn how you can streamline your medical billing in a free Kareo demo webinar

You’ll hear how to:

  • Reduce your cost of ownership – no upfront fees or costly upgrades
  • Save money – affordable monthly fee subscription that INCLUDES clearinghouse fees
  • Increase collections from payers and patients
  • and much more…

See why more than 15,000 providers are already leveraging Kareo to run their medical businesses. Monthly plans start at just $69 per provider per month making Kareo one of the most affordable, easy-to-use medical billing options on the market today!

Register now for this Kareo demo webinar to learn how Kareo medical billing software can help you streamline your medical billing

Join us! It just may be the most productive 30 minutes of your week.

Please note that this webinar is designed for those who are not currently using Kareo but are interested in learning more about our software. After registering, you will receive a confirmation email containing information about joining the webinar. Space is limited, so reserve your webinar seat now.

Register now for this Kareo demo webinar to learn how Kareo medical billing software can help you streamline your medical billing

Read More | No Comments | Filed in Events, Features, Product

December Issue of the Kareo Getting Paid Newsletter Includes Big Changes in 2013 & More

December 11th, 2012 by Joann Doan

The December issue of the Kareo Getting Paid newsletter, out this week, features great articles on the 2013 Medical Billing & Reimbursement Alert, understanding and making the most of your A/R Reporting and much more. Take a minute to review these useful articles and also be sure to subscribe to the newsletter so you receive it in your inbox automatically. The articles featured include:

Getting Paid Blog & NewsletterIn This Issue / December 2012

E. WoodcockThe 2013 Medical Billing & Reimbursement Alert:
Big Changes Ahead
By: Elizabeth Woodcock, MBA, FACMPE, CPC

There are going to be a lot of factors that may affect your medical billing and reimbursement in 2013. Expect it to be a year full of changes. The following are some of the biggest issues that we are going to see in the next twelve months. Read More

Rico LopezThe 9 Essentials for an Effective Year End (and year to come)
By: Rico Lopez, Senior Market Advisor at Kareo

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

Understanding (and Making the Most of) Your A/R Reporting
By: Thom Schildmeyer, Co-Founder and President, Aesyntix Health, Inc.

At Aesyntix Billing Solutions, we provide monthly “report cards” that include certain measurements and ratios, as well as financial reports and month-end summaries to our clients. I’d like to share some insights into the ways you can utilize information from your A/R reporting to identify important trends that indicate the financial health of your practice. Read More

Educational Webinar:
Getting Paid in 2013: What You Need to Know

Thursday, December 13, 2012
10:00 AM – 11:00 AM PST

Elizabeth Woodcock, MBA, FACMPE, CPC.

Register Now

Are you worried how healthcare reform will affect your practice- especially as the recession continues? This is no time to go into retreat mode. In this high-energy educational webinar, national speaker and author Elizabeth Woodcock highlights the key changes in payment for physicians in 2013.

1 PAHCOM / AMBA CEU Credit for attending live.

Billing Tip

Sending NDC information with claims

By Tasha Johnson
Absolute Family Health

Top News & Ideas from Industry

Bush Tax Cut Expiration: What It Means for Physicians
With President Barack Obama’s re-election, there is now no doubt that the Bush Tax Cuts will expire as of January 1, 2013.

Physicians Practice, 11/26/12

First-Ever Group Aims to Speed Medical Devices to Market
The US Food and Drug Administration (FDA) today unveiled a new, nonprofit, public-private partnership that aims to speed safe medical devices to market…

Medscape Medical News, 12/3/12

Two-thirds of Providers Hire Consultants to Prepare for ICD-10
The Department of Health and Human Services’ August decision finalizing a one-year delay for ICD-10 has given providers additional time to make the necessary preparations for the switch, and, according to a KLAS report released Monday, most of them plan to use a third-party firm to help get them there.

Healthcare Finance News, 12/4/12

CMS Tweaks Final Stage 2 Meaningful Use Rule
The Centers for Medicare and Medicaid Services has issued an interim final rule making changes to the Stage 2 electronic health records meaningful use program, which already had been finalized.

Health Data Management, 12/5/12

CMS Seeks Doc input in push for patient Experience Data
In its latest move to get performance data up and available on the fledgling Physician Compare consumer website, the CMS is seeking feedback from providers about the use of patient experience measures.

Modern Physician, 12/6/12 

Kareo in the News

Based on Employee Survey, Kareo Ranks 12th in the Orange County Register Top Workplaces
Kareo has been selected as one of The Orange County Register’s Top Workplaces based on employee feedback in a survey of hundreds of leading companies in Orange County.

More than Meets the Eye
Chiropractic Economic’s Tech Talk shares insights from Terry Douglas of Kareo about using scheduling software as a revenue generating tool.

We hope you enjoy this issue of the newsletter. Be sure to subscribe now to the Kareo Getting Paid newsletter in order to insure you receive future issues.

Read More | No Comments | Filed in Billing Tip of The Month, Company, Newsletter

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