Documentation Guidelines for Medical Decision Making

Documentation Guidelines for Medical Decision Making – August 2017 by Margaret M. Maley, BSN, MS With a brief history of their development Thousands of pages of regulation have been generated since the American Medical Association (AMA) first introduced Evaluation and Management (E/M) codes to describe inpatient and outpatient visits in 1992. When originally published, the…


Got a Good Governance Agreement? Use This 12-Point Checklist to Find Out

Healio Orthopedics Today – August 2017 by Karen Zupko A governance agreement is a written directive for how a practice’s board of directors is comprised and how it operates. Governance is the way in which an organization polices itself, and a good agreement includes a number of things that allow your practice to do that…


Is Your Practice Not Getting Paid?

AAOSNow – July 2017 by Michael R. Marks, MD, MBA, and Cheryl Toth, MBA Coding May Not Be the Reason It’s easy to blame a practice’s skyrocketing accounts receivable (A/R) on coding and the insurance companies. But our experience with orthopaedic practices, and the results of AAOS/KarenZupko & Associates (KZA) pre-workshop surveys on coding and…


9 Mistakes You Don’t Want the Patient Care Coordinator to Make

Aesthetic Society News – Summer 2017 by Karen Zupko, President Looking to build the skills of a newly hired Patient Care Coordinator (PCC)? Need an objective approach for showing the PCC how to polish her professionalism? Want to help your PCC go from good to great? This article offers some options. It covers the most…


Medicare Sharpens Focus on the Global Surgical Package

Medicare Sharpens Focus on the Global Surgical Package – June 2017 by Margaret M. Maley, BSN, MS The Centers for Medicare & Medicaid Services (CMS) has expressed concern that services with 10- and 90-day postoperative periods are not valued accurately, and follow-up visits included in the value of the global services are not consistently being…


Learn the Latest in Otorhinolaryngology Coding

AAPC News –  March 2017 by Kim Pollock, RN, MBA, CPC, CMDP CPT® 2017 captures the most up-to-date clinical services for ear, nose, and throat specialists. CPT® 2017 brings several code changes for otorhinolaryngology, a specialty that has seen few, if any, code changes in the past several years. The changes are primarily new codes, with some code…


Stay Current with Spine Procedural Coding

AAPC News –  May 2017 by Kim Pollock, RN, MBA, CPC, CMDP See how spine procedure codes, guidelines, and reporting have changed in 2017. There are many 2017 CPT® code changes pertaining to spine procedures. Here’s a rundown of the most significant changes. Removal of Moderate Sedation Inclusion The moderate sedation symbol (¤) was removed from…


Profiles in Plastic Surgeons’ Practice Transitions

Aesthetic Society News – Spring 2017 by Karen Zupko, President “Sorry, I didn’t call you back last week, Karen. I was climbing mountains in Nicaragua.” That was the message that New Orleans plastic surgeon John Church, MD, left for me after my call requesting an interview. What a perfect message and precursor to the fascinating,…


Pain Management In Orthopaedic Practices

AAOSNow – April 2017 by Karen Zupko Frequently Asked Questions – Pain Management In Orthopaedic Practices Increasingly, pain management specialists—physical  medicine and rehabilitation specialists or anesthesiologists—are joining  orthopaedic groups that have adopted a more global approach to musculoskeletal system care. However, this presents challenges for the billing time,  particularly with respect to coding procedures and transfers…


Can This Partnership Be Saved?

Aesthetic Society News – Winter 2017 by Karen Zupko, President “C an This Marriage Be Saved?” was a McCall’s Magazine column I used to read with great fascination as a teenager. Each month, a psychologist would address questions from real readers whose marriages were on the rocks. The problems were frequently related to miscommunication, money,…


CPT 2017 for Foot and Toes

AAOS Now – January 2017 by Michael R. Marks, MD, MBA Every autumn, the American Medical Association’s (AMA) Current Procedural Terminology (CPT) book is updated with changes for the next year. In 2016, minimal changes were made, possibly due to the implementation of the International Classification of Diseases, 10th edition (ICD-10) and a desire to…


7 Golden Rules for Reducing Hip Arthroscopy Denials

AAOS Now – December 2016 by Michael R. Marks, MD, MBA If a constant stream of denials for hip arthroscopy procedures frustrates you, know that you are not alone. These denials are a common source of angst for physicians. The good news is, if you know how to avoid common coding pitfalls, document correctly, and…


Five Often-Overlooked Areas of Medical Practice Risk

Physicians Practice – November 2016 by Karen Zupko The end of the year is a great time for physicians to review practice operations and policies and assess what’s being done well, what can be improved, and where priorities for next year lie. Reducing overhead and improving collections are no doubt high on that list. But…


Zoom In On the Rules for Reporting +69990 with Ear Procedures

Healthcare Business Monthly – November 2016 by Kim Pollock, RN, MBA, CPC, CMDP CPT® tells us when not to separately report the use of an operating microscope. We’ll tell you when you should. Many otolaryngologists use an operating microscope when performing ear procedures in the operating room. Coders often wonder if it is acceptable to report…


2017 Spine CPT Code Changes

AAOS Now –  November 2016 by Kim Pollock, RN, MBA, CPC, CMDP Spine surgeons face a multitude of Current Procedural Terminology ® (CPT) code changes, effective Jan. 1, 2017. This article provides a summary of these changes so practices can get a head start on understanding their implications. A complete listing of changes can be…


Don’t Be Intimidated by ICD-10-CM Changes

Don’t Be Intimidated by ICD-10-CM Changes – October 2016 by Margaret M. Maley, BSN, MS A systematic look at the code update in orthopaedics The 2,000 new ICD-10-CM (International Classification of Diseases, 10th edition, Clinical Modification) codes that go into effect Oct. 1, 2016, shouldn’t send you into a panic. The changes, when analyzed and approached…


Spine Practices May Lose Money When They Do Not Bill for Consults

Healio- October 2016 by Kim Pollock, RN, MBA, CPC, CMDP and Teri Romano, RN, MBA, CPC, CMDP Medicare eliminated payment for consultations in 2010, which resulted in significant revenue losses for spine surgeons and all specialists. All office consultations for Medicare patients became a new or established patient, or an emergency department visit if the…


11 Ways to Reduce Employee Embezzlement

Aesthetic Society News – Fall 2016 by Karen Zupko Physicians are easy targets for employee theft. A Medical Group Management Association (MGMA) survey revealed that 83 percent of practices have experienced from $250 – $250,000 in employee theft. Given the cash-based nature of aestheticsurgery, your practice is at even great risk than other specialties. Use these…


Are CMS and Other Payers Requiring –X{EPSU} Modifiers?

Commonly Asked Coding Questions – September 2016 by Sarah Wiskerchen, MBA, CPC  Q: Are the Centers for Medicare & Medicaid Services (CMS) and other payers requiring use of –X{EPSU} modifiers? A: Although the four –X{EPSU} modifiers were initiated by CMS, they have also been part of the Common Procedural Terminology (CPT) manual since 2015. These four…


Setting Up Your New Physician for Success

The American Journal of Orthopedics – September/October 2016 by Cheryl Toth, MBA Practices and hospitals invest significant time and money in recruiting a new physician. From phone interviews to site visits to contract negotiations, it’s a long and involved process. Beyond setting up a new physician’s office and appointment schedule, completing human resources paperwork, and…


Benefits of Patient Financing: 4 Practices Speak Out

KZA News Brief by Cheryl Toth, MBA, Consultant and Speaker Deductibles and coinsurances continue to skyrocket. Many Affordable Care Act (ACA) exchange plans have deductibles of $5,000 or more. The result is that more and more patients are finding it difficult to come up with surgery deposits or pay for elective procedures. Offering payment plans…


Liability Management 101

Liability Management 101 – August 2016 by Michael R. Marks, MD, MBA Why Malpractice Insurance Is Not Enough Today’s orthopaedic practices are at a crossroads. Many face possible mergers or acquisitions and potential relationships with hospital systems and third-party payers. As the healthcare landscape shifts, so too does a practice’s professional liability exposures. Recently, I spoke…


Spine Surgery Quandary: Posterior Lumbar Interbody Fusion

Healthcare Business Monthly – June 2016 by Kim Pollock, RN, MBA, CPC, CMDP When do you bill 63056-59 with 22633, rather than 63047-59? A common question among coders and spine surgeons is whether to bill 63056-59 with 22633, or 63047-59. The answer is complex, but CPT® and Medicare guidelines provide essential guidance. Read Full Article


The Revenue Engine that Could “Think You Can” by Refining the Revenue Cycle with the Right People, Processes, and Tools

Greenbranch – May/June 2013 Kim Pollock, RN, MBA, CPC Many physicians continue to wrestle with an economy-in-recovery and declining reimbursements. In this business climate, practices can’t afford reimbursement process mistakes and inefficiencies; they’re simply too expensive. Just a few denied surgical claims can cost a practice thousands of dollars. That’s the cost of the annual electronic…


New Physician Onboarding Checklist

New Physician Onboarding Checklist by Cheryl Toth, MBA Use this checklist to manage the orientation and onboarding activities for each new physician you hire. Ask for regular status updates – especially about the credentialing process. Items listed in each section are not necessarily in chronological order. Download Checklist


PA and NP Billing: Are You Doing It Correctly?

PA and NP Billing: Are You Doing It Correctly? – May 2016 by Sarah Wiskerchen, MBA, CPC  The effective use of physician assistants (PAs) and nurse practitioner (NPs) in an orthopaedic practice requires an understanding of key billing rules that apply to these nonphysician providers (NPPs). Compare your practice’s internal procedures to the following common questions…


Is Your Bariatric Practice Ready for Retail?

Is Your Bariatric Practice Ready for Retail? Mystery Shopping Results Indicate a Need for Improvement – April 2016 by Karen Zupko and Samantha Lappe After the news of a new, less invasive weight loss option hit the mainstream media last fall, millions of Americans began hearing about the gastric balloon procedure on television and in the news….


Surviving in an ICD-10 World

by Deborah Grider, CPC, COC, CPC-I, CPC-P, CEMC, CPMA, CCS-P, CDIP Certified AHIMA Clinical Documentation Improvement Practitioner AHIMA-Approved ICD-10-CM/PCS Trainer The past few years we have focused closely on getting ready for ICD-10. In most cases, the transition to ICD-10 was successful. We had a few bumps in the road, but overall, things went well….


Dropped Leads, Why They Happen and What to Do About Them

Aesthetic Society News – Winter 2016 by Karen Zupko After mystery shopping over 150 aesthetic plastic surgery practices through their websites and by phone, we’ve come up with a pattern of kerplunked leads. Whether the “lead,” (AKA “prospective patient”) calls or writes your office you’ll’ be surprised how many inquiries are not answered or answered well….


The Only Safe SMS Texting Is No SMS Texting

Greenbranch – Nov/Dec 2015 by Cheryl Toth, MBA, and Michael J. Sacopulos, JD Many physicians and practice staff use short messaging service (SMS) text messaging to communicate with patients. But SMS text messaging is unencrypted, insecure, and does not meet HIPAA requirements. In addition, the short and abbreviated nature of text messages creates opportunities for misinterpretation,…


The Cure for Soaring Patient Receivables: 8 Best Practices for Point of Service Collections and Payment Plans

KarenZupko & Associates Inc. – September 2015 by Cheryl Toth, MBA Patient deductibles and financial responsibilities are skyrocketing. According to a 2014 survey by the Kaiser Family Foundation, 80% of all workers now have annual deductibles, and the average deductible amount has doubled over the last eight years. The study showed that today’s annual deductibles…


Reduce Medical Practice Embezzlement Risk by Implementing Cash Controls

Physicians Practice – September 2013 by Karen Zupko and Cheryl Toth, MBA Several years ago, we visited a practice in which the receptionist drove a Jaguar. We were particularly intrigued about this after we learned that her husband had been in and out of work for several years. As part of our engagement, we observed…


Financial Reports and Data Aesthetic Surgeons Need to See

Aesthetic Society News – Winter 2015 by Cheryl Toth, MBA We frequently find that aesthetic surgeons make expensive business decisions based on hunches or staff suggestions instead of data. And when we ask which reports the surgeon reviews each month, we are often told, “the P&L,” if anything. This is often followed by: “I keep…


ICD-10 Race to the Finish: 8 High Priorities in the 11th Hour

The American Journal of Orthopedics – July 2015 by Cheryl L. Toth, MBA As late as mid-April 2015, a survey of 121 orthopedic practices indicated that 30% had done nothing to start preparing for ICD-10 (International Classification of Diseases, Tenth Revision).1 That’s scary. And even the practices that had begun to prepare had not completed…


“Clean Up” Diagnosis Coding for Staged Revisions

“Clean Up” Diagnosis Coding for Staged Revisions – July 2015 by Margaret M. Maley, BSN, MS Assigning diagnosis codes for joint revision surgery is challenging in both ICD-9-CM and ICD-10-CM. Orthopaedic practices that carefully examine the instructions in both editions may find that they have been reporting staged revisions incorrectly for years. The following side-by-side comparison…


Clean Up Your Revenue Cycle Now: 6 Survival Tips for ICD­10 ­Induced Payment Slowdowns

The American Journal of Orthopedics – May 2014 by Cheryl Toth, MBA You have read the scary headlines and dire predictions about ICD-10 claim submission complications and cash-flow crunches. What are you doing to avoid a near-certain slowdown in your revenue cycle this fall? Assessing and improving specific areas of the revenue cycle cannot only…


21st-Century Patient Collections: Implement a Point-of-Service Collections Program Now

The American Journal of Orthopedics – May 2015 by Cheryl Toth, MBA An 8-surgeon group in the Southeast had a history of high patient receivables, the result of a long-held culture of “We’ll submit to your insurance and bill you after insurance pays.” The billing and collections staff worked in the basement—far away and out…


Going Cosmetic? Part 1

The Association of Dermatology Administrators & Managers Newsletter by Glenn Morley If you’ve decided to make the strategic change toward increasing cosmetic lines of service, you’re joining a bustling movement. Internists, obstetricians, and other specialists continue to enter cosmetic medicine as an antidote to reimbursement decline and the complexities of medical billing and management. The…


Meaningful Use for Surgeons – It’s Not as Complicated as You Think

The American Journal of Orthopedics – March 2015 by Cheryl Toth, MBA It’s spring. Have you started your Meaningful Use reporting yet? More important, have you begun reporting at all? “Say the words Meaningful Use to most orthopedists, and they usually roll their eyes or shake their heads,” says Cheyenne Brinson, MBA, CPA, a KarenZupko…


Going Cosmetic? Part 2

The Association of Dermatology Administrators & Managers Newsletter by Glenn Morley For physicians who have decided to incorporate cosmetic services into their established dermatology practice, the early planning stages are like a honeymoon. Managers and physicians engage in lively discussion about creating a medical spa or aesthetic center. New skincare lines are road tested by…


Seven Surefire Ways to Start a Nonphysician Practitioner Off Right

The Journal of Medical Practice Management – January/February 2015 by Cheryl Toth, MBA With the proper planning and preparation, nonphysician practitioners (NPPs) can improve physician productivity and increase patient access to the practice. A thorough training and orientation program is vital to optimizing the effectiveness and retention of an NPP. An organized approach to understanding…


Going Cosmetic: Keep Patients for Life!

The Association of Dermatology Administrators & Managers Newsletter by Glenn Morley You’ve made the strategic shift toward increasing cosmetic lines of service. You’ve developed a solid infrastructure to support your vision. The final and most important philosophy to adopt as you build a cosmetic dermatology practice is this: when you acquire a cosmetic patient, make…


We Just Had Our Two Most Profitable Months Ever!

KZA Success Profile – January 2015 by Cheryl Toth, MBA We love receiving emails like these from aesthetic practices that have successfully integrated what they learned at a KZA workshop. Melissa Peterson, Patient Care Coordinator for John Wakelin, MD at Columbus Aesthetic & Plastic Surgery recently sent an enthusiastic note telling us that Dr. Wakelin…


The Patient Relations and Service Recovery Guide: A Colorful Approach to Handling Upset and Angry Patients

The American Journal of Orthopedics – January 2015 by Jennifer A. O’Brien, MSOD Tearful breakdowns and loud outbursts—they happen with orthopedic patients even in the best of practices. And if you are an orthopedic surgeon who has rarely or never experienced a patient in emotional distress, just talk with your staff—they have no doubt experienced…


Mapping Your Way to ICD-10 Implementation Success

AAOS Now – December 2014 by Sarah Wiskerchen, MBA, CPC As orthopaedic surgeons and their practice teams ready themselves for the implementation of ICD-10, a team-based transition action plan is essential. One step in making the transition is known as “mapping.” Mapping describes the process of comparing the codes currently used in ICD-9 to those…


Employee Verification

MedEsthetics – November/December 2014 by Karen Zupko Because employees of medical practices and medspas have easy access to patient information, employers must conscientiously verify information provided by applicants. One way to decrease the risk of hiring staff members who may jeopardize patient or practice safety is to perform reference and background checks. Some of the…


6 Action Steps for Getting Documentation Ready for ICD-10

Doctors Direct Insurance Newsletter – Winter 2014 by Cheryl Toth, MBA We are less than a year away from the biggest change to healthcare administration in decades. Yet, many practices are woefully behind when it comes to their ICD-10 conversion planning. And some physicians still mistakenly believe that this is a job for their billing staff….


To Outsource or Not to Outsource Your Physical Therapy Service Line Management?

The American Journal of Orthopedics – November 2014 by Jennifer A. O’Brien, MSOD You currently offer a physical therapy (PT) service line but feel like it could be doing better, or you are thinking of adding PT services and are not sure where to begin. Either way, the thought of your patients and bottom line…


When “7” Is Not a Lucky Number

When “7” Is Not a Lucky Number – November 2014 by Margaret M. Maley, BSN, MS Using the 7th character extension in ICD-10-CM for orthopaedic injuries The 7th character extension represents a major distinction between the International Classification of Diseases, Ninth Edition (ICD-9) and the International Classification of Diseases, Tenth Edition (ICD-10). A clear understanding of…


Look Back To Lead Forward

Medical Office Manager – October 2014 by Cheryl Toth, MBA Every autumn, it’s easy to get bogged down with next year’s budget crunching, fret about the unveiling of Medicare’s new conversion factor, or worry about the amount of this year’s physician bonuses. Because in the harried life of a practice manager, it’s easy to focus…


Follow an eight-step formula for correct spine coding

Spine Surgery Today, September/October 2014 Teri Romano, RN, MBA, CPC, and Kim Pollock, RN, MBA, CPC Reporting the “just right” CPT codes isn’t easy for spine surgeons and coders. In fact, it is complicated. If you under code, in effect, you “pick your own pocket” by losing revenue and/or relative value unit. Overcoding leads to…


Do Your E/M Service Levels Match Medical Necessity?

KZA Practice Brief for Orthopedics – September 2014 by Cheryl Toth, MBA In May of this year, the Office of the Inspector General (OIG) published a report describing, among other things, its methodology for evaluating E/M code documentation during audits for the Centers for Medicare and Medicaid Services (CMS). In addition to the OIG’s typical…


Patient Portal in Your Orthopedic Surgery Practice: You Can So Do This

The American Journal of Orthopedics – September 2014 by Jennifer A. O’Brien, MSOD On initial consideration, the patient portal portion of Meaningful Use (MU) might seem: Daunting More appropriate for primary care practices than for orthopaedic surgery practices Just another government requirement with no real practical application Too much work for not enough reward Unnecessary…


6 Ways to Reduce the Risk of Text Messaging With Patients

Doctors Direct Insurance Newsletter – Fall 2014 by Cheryl Toth, MBA Who doesn’t love text messaging? It’s fast, easy, and efficient. People of all ages and generations have embraced it. And with Millennial generation physicians now hitting their practice stride, many practices are saying yes to patients who ask to communicate in this way. But…


Follow an Eight-Step Formula for Correct Spine Coding

Follow an Eight-Step Formula for Correct Spine Coding – September/October 2014 by Teri Romano, RN, MBA, CPC, CMDP and Kim Pollock, RN, MBA, CPC, CMDP As part of the new Spine Coding Source column, Spine Surgery Today will begin discussing relevant spine coding issues for surgeons. We hope this new feature will enhance your practice and…


Ten Key Things Surgeons Need to Know About “Meaningful Use”

ACOS News – August 2014 Cheyenne Brinson, MBA, CPA Say the words “meaningful use” to most surgeons, and the response is usually a sigh, groan, mumble, or headshake. As a consultant who has been helping surgical practices implement meaningful use since its inception, I most often have to debunk myths surrounding the EHR Incentive Program….


Five Ways to Ensure Secure Text Messaging In Your Medical Practice

Physicians Practice – August 2014 by Cheryl Toth, MBA Texting is to this decade what e-mail was to the last. It’s the “killer app” that people of all ages and demographics love. In fact, it’s so endeared and easy to use that we regularly see physicians and staff sending text messages to patients, without recognizing…


ICD-10 Focus on Common Knee and Shoulder Codes

ICD-10 Focus on Common Knee and Shoulder Codes – August 2014 by Margaret M. Maley, BSN, MS Much has been written about the explosion of diagnosis codes under the International Classification of Diseases, 10th Edition Clinical Modifications (ICD-10). The amplified granularity of the system and the addition of laterality coding will certainly have an impact on orthopaedics….


Tighten Cash Handling & Audit Controls: 9 Best Practices That Reduce Embezzlement Risk

Aesthetic Society News – Summer 2014 by Karen Zupko A few years ago, we worked with an aesthetic practice whose patients frequently paid in cash. To document the amount collected, the staff made copies of the cash, fanning out the bills to show the dollar amount listed on each, but displaying the serial number of…


Six Strategies for Reducing Information Overload at Your Medical Practice

Physicians Practice – July 2014 by Cheryl Toth, MBA Feeling frazzled and overwhelmed with the amount of material coming across your desk each day? Having difficulty keeping up with journals, transmittals, e-newsletters, reports, documents, podcasts, Tweets, pins, and business-management bestsellers? If so, you may be suffering from “information overload,” a growing problem that impacts productivity…


Banking: Shop and Compare

Journal of Medical Practice Management – May/June 2014 by Jennifer A. O’Brien, MSOD, and Sherry DeJarnette, CPA There are many reasons to take a critical look at the practice’s banking relationship(s)—technology advancements, security measures, improvements in available services, recent banking enhancements designed specifically for medical practices, the impact of the financial crisis on bank ratings and stability,…


Matrix Management: What To Expect from the Orthopaedic Surgery Practice Manager

AAOS Now – June 2014 by Jennifer A. O’Brien, MSOD Matrix management means that an employee may have multiple reporting relationships. A unilateral decision by one of the managers could affect the productivity and work flow within the other units or other overall business goals such as eliminating the expense of unnecessary overtime or achieving…


Three Scary Predictions About ICD-10’s Influence on the Revenue Cycle: What to Do Now to Mitigate Financial Risk

American Academy of Otolaryngology-Head and Neck Surgery – June 2014 by Cheryl Toth, MBA Practices have many competing, high priorities these days: dealing with Electronic Health Records (EHR) implementation, qualifying for Meaningful Use, conducting diligence on the hospital’s employment offer, and, of course, transitioning to ICD-10. Right now, everyone in the office is (rightfully so)…


Measuring Up: What An Orthopaedic Group Should Expect In A Practice Manager/CEO

AAOS Now – May 2014 by Jennifer A. O’Brien, MSOD On any given issue within a group practice—whether operational or organizational—it may be difficult for an individual physician partner to see the issue from any perspective other than his or her own. Older physicians sometimes don’t understand the younger physicians’ points of view and vice versa….


Avoid Billing Service Nightmares: Issues to consider before partnering with independent and hospital-based billing services

AAOS Now – April 2014 by Jennifer A. O’Brien, MSOD In addition to the compliance and security issues highlighted in part 1 of this series (“Avoid Billing Service Nightmares,” AAOS Now, February 2014), an evaluation of operations, experience, and costs is essential to selecting the right partner for the provision of billing services. This is…


Are Online Coding Discussions Putting Your Practice At Risk?

Medical Office Manager – April 2014 by Cheryl Toth, MBA Here’s an email we recently saw while monitoring a specialty coding listserv: We have a surgeon that says I am not an aggressive coder because I communicate to him when NCCI indicates that certain procedures are bundled, and now I am second-guessing myself. Can you…


Make Your Last Impression as Good as Your First: Fine-Tune the Fee Quote

Aesthetic Society News – Spring 2014 by Karen Zupko You’ve spent thousands on attractive branding and Web design. You’ve hired a capable team that excels at personalizing the patient experience. Your office decor rivals the Four Seasons. So why on earth would you give your patients a fee quote that looks like that? So much…


Five Technologies That Increase Patient Collections

ACOS News – April 2014 by Cheryl Toth, MBA Health insurance deductibles are skyrocketing, and patient financial responsibilities are reaching new heights. Employers continue to move toward higher deductible plans to keep their expenses in check, and many health insurance exchange plans have deductibles of $3,000 or more. And the millions of patients being added…


Four Things to Know About ICD-10 and Prior Authorization

Physicians Practice – March 26, 2014 by Cheryl Toth, MBA When most practices think about the shift from ICD-9 to ICD-10, they think of changes to physician documentation, diagnosis code selection, and software upgrades. But ICD-10 is going to have a big impact on the pre-authorization process too. Here’s why, and what to do about…


How Do YouSpell ICD-10 Success? Teamwork Pays Off For a Nebraska Practice

AAOS Now – March 2014 by Cheryl Toth, MBA New West Sports Medicine & Orthopaedic Surgery, Kearney, Neb., is a seven-surgeon practice with seven physician assistants (PAs) and four athletic trainers (ATs). It’s also ready to face the challenges presented by the transition to the International Classification of Diseases, 10th edition (ICD-10) in October. The…


Coding Boards or Confessionals? Use Online Coding Discussion Tools With Caution

The American Journal of Orthopedics – March 2014 by Cheryl Toth, MBA Author’s Note: The content of the e-mail examples presented in this article is from actual online discussions. Practice and participant names and contact information have been changed. Thanks to Arlene’s question, posted to an orthopedic listserv group, Surgical Specialists has just sent an…


Avoid Billing Service Nightmares: Use Business Rigor to Reduce Your Risk: Part I

AAOS Now – February 2014 by Cheryl L. Toth, MBA Recently, an orthopaedic surgeon remarked that he was thinking about outsourcing his billing so he could avoid learning ICD-10 and make ICD-10 “the billing service’s problem.” But hastily outsourcing billing and collections without carefully evaluating the company can lead to problems. Choosing the wrong billing…


Ready, Set, 10 Months to Go: How to Get Organized and Be Fearless About ICD-10

The American Journal of Orthopedics – December 2013 by Cheryl Toth, MBA “The billing office is handling that,” an orthopedic surgeon at a recent reimbursement workshop said. Like many physicians, he was unaware that asking the billing office to handle ICD-10, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems…


Ferocious Fracture Documentation for ICD–10

Ferocious Fracture Documentation for ICD–10 – November 2013 by Margaret M. Maley, BSN, MS With less than 1 year to go before implementation of the International Classification of Diseases, 10th revision (ICD–10), the American Health Information Management Association (AHIMA) suggests that practitioners focus on their documentation to identify gaps that need filling before the “go live”…


No ICD-10 Immunity for Aesthetic Surgeons: Why & How to Prepare Now

Aesthetic Society News – Fall 2013 by Karen Zupko “ICD-10 is not a priority for us. Our patients are almost all aesthetic.” This is what the manager of an aesthetic practice told me during a recent client visit. Like Scarlett O’Hara, she mistakenly thought the practice could put ICD-10 planning off until next year. She…


Baby, You Can Drive That Vendor Demo

AAPC News – October 2013 by Cheryl Toth, MBA Use these five tips to get more out of EHR and PMS demos. You’ve probably noticed that most electronic health record (EHR) and practice management system (PMS) vendors don’t seem to know anything about your specialty or your practice when they give you a demo. Typical…


Don’t Get Burned by the Billing Company: Avoid These Revenue, Reputation, & Regulatory Risks

Plastic Surgery News Connection – October 2013 by Cheryl Toth, MBA “It’s a total nightmare!” The physician’s voice was a mixture of fear and anger. He had hired his cousin’s next-door neighbor’s billing company, which had reportedly worked miracles for other practices. But with this physician’s claim volume, the one-woman company quickly fell behind. In…


Cyber Exposure by Proxy: Businesses Should Evaluate Data Security Risks Posed by Vendors

Bloomberg BNA, Health IT Law & Industry Report – September 9, 2013 by Michael J. Sacopulos A new metric is emerging for some corporations when selecting or retaining vendors. We are all familiar with the traditional metrics of price and competency. In this age of identity theft, data breaches and foreign hacking, the IT security…


Procedure Coding Made Simple: Five Principles Will Help You Capture Appropriate Charges for Spine Surgeries

Procedure Coding Made Simple: Five Principles Will Help You Capture Appropriate Charges for Spine Surgeries – September 2013 by Kim Pollock, RN, MBA, CPC, CMDP “It seems like coding spine cases is as complicated as doing the surgery,” said a spine surgeon at his first coding training session with me. Spine procedure coding can make even the…


Redefined Business Associate Agreements Create Concern

AAPC News – August 2013 by Cheryl Toth, MBA Guard against liability when someone else mishandles your practice’s patient records. True story: A journalist reported finding patient medical records at a trash transfer station. An investigation revealed that a Massachusetts physician group’s billing company improperly disposed of the private health information (PHI). Although there was…


Are Your Business Associate Agreements HIPAA (Omnibus) Compliant?

Plastic Surgery News Connection – 2013 by Karen Zupko If you’ve been “too busy” to update your Business Associate Agreements (BAAs) with every vendor who accesses your Protected Health Information (PHI), it’s time to pay attention. The HIPAA Omnibus Rule took effect September 23. Your practice is on the hook for ensuring that all these…


Coding and Reimbursement Strategies: Using an Unlisted Code for Endoscopic Skull Base Surgery

Coding and Reimbursement Strategies: Using an Unlisted Code for Endoscopic Skull Base Surgery – April 2013 by Kim Pollock, RN, MBA, CPC, CMDP and Mary LeGrand, RN, MA, CCS-P, CPC The American Medical Association’s Current Procedural Terminology® (CPT) codes for reporting medical services and procedures performed by physicians must be used to bill services to third party…


5 Tips for Optimizing the Use of Nonphysician Providers

Physicians Practice – March 7, 2013 by Cheryl Toth, MBA Many practices are hiring nurse practitioners and physician assistants, collectively referred to as nonphysician providers (NPPs). But most aren’t quite sure how to optimize the skills and value of these clinicians, which will be increasingly needed with the coverage expansion under the Affordable Care Act….


All Work (RVUs) and No Pay?: Eight Questions to Ask the Hospital about Its Work RVU Compensation Formula

Greenbranch – January-February 2013 by Sarah Wiskerchen, MBA, CPC As more surgeons and specialists are offered hospital employment, work RVU-based compensation agreements are becoming more sophisticated and complex. In order to have a meaningful conversation with health system administrators and ensure that a compensation agreement addresses all issues pertinent to the physician’s practice and specialty,…


Employee Embezzlement: It Can Happen To You

Doctors Direct Insurance – Winter 2012 Cheyenne Brinson, MBA, CPA & Karen Zupko, Consultant and Speaker, KarenZupko and Associates Physicians unfortunately are easy targets for employee theft. A recent MGMA survey revealed that 83% of practices have experienced theft by an employee in amounts ranging from $250 – $250,000. Headlines across the country share this…


Coding For Same Day Anterior-Posterior Spine Procedures: Four Myths Clarified

Coding For Same Day Anterior-Posterior Spine Procedures: Four Myths Clarified – November / December 2012 by Kim Pollock, RN, MBA, CPC, CMDP Coding and billing for anterior-posterior spine procedures can almost be as complex as performing the procedure, particularly if you aren’t familiar with the nuances of the American Medical Association’s Current Procedural Terminology® (CPT) codes. Many…


Upcoding: Is Your EHR Putting You at Risk?

Physicians Practice – September 26, 2012 by Karen Zupko Electronic health records are being blamed, in part, for the skyrocketing payments associated with level four and level five evaluation and management codes in private practices and hospital emergency departments. Over the last decade, the additional costs for E&M coding increases are estimated to be in…


Reclaiming Skincare in Dermatology

Executive Decisions in Dermatology – September/October 2012 by Glenn Morley Many practices struggle with ways to introduce and integrate skincare products into their patient’s treatment plans as well as infuse staff with excitement about practice product options. Most patients want effective skincare products, and almost every cosmetic practice sells an excellent line of products. So…


How to Reduce No-Show Patients at Your Medical Practice

Physicians Practice – April 11, 2012 by Karen Zupko and Arielle Nelson, MFA When a physician hears “What is your hourly rate?” she most likely assumes the question is directed to an accountant or an attorney. Unfortunately, physicians rarely think they possess an hourly rate like other professionals. While it’s true that payment systems do…


Raising the Bar: Integrating Skincare Products into Practice

Practical Dermatology – February 2012 by Glenn Morley Many practices struggle with ways to introduce and integrate skincare products into their patients’ treatment plans. Most patients want effective skincare products, and almost every cosmetic practice sells an excellent line of products. So why is integration still so difficult for some? The answer is two-fold: 1.)…


CPT 2012 Code Update for Otolaryngology: An Overview of Evaluation and Management Code Changes

CPT 2012 Code Update for Otolaryngology: An Overview of Evaluation and Management Code Changes – February 2012 by Kim Pollock, RN, MBA, CPC, CMDP and Mary LeGrand, RN, MA, CCS-P, CPC There are several Current Procedural Terminology® (CPT) code changes for 2012 applicable to otolaryngologists. This article provides a high-level overview of Evaluation and Management (ElM) code…


IT Security—What All Orthopedic Surgeons Must Know

American Journal of Orthopaedics – 2012;41(1):44-46. Cheyenne Brinson, MBA, CPA Orthopedic surgeons rely on technology on a daily basis, from using a practice management system for billing and scheduling to (for some) electronic health records (EHR). Walk in to any education session for orthopedic surgeons and more than half the people in the room have…


Discounting Can Be Dangerous

Organization of Facial Plastic Surgery Assistants – Winter 2011 by Karen Zupko Discounting is dangerous to your reputation and brand – not to mention costly. Bought business is not good business. Research from top business schools, psychologists, consultants and Groupon victims prove that discounting can be a very expensive mistake. Professor Paul Wang at the…


Hiring Right Makes Your Practice More Profitable and Pleasant

Aesthetic Society News – Winter 2011 by Karen Zupko When Lucy showed up for the interview, you thought your prayers were answered. Here was the patient coordinator/office manager candidate you had always envisioned. Actually Lucy’s resume and cover letter caught your attention; they were among the best you’d seen. Well-groomed, articulate with a soothing slightly…


Make Interviewing Easier

American Society for Surgery of the Hand – June 2011 by Karen Zupko Since Katie Couric famously asked candidate Sarah Palin about what the vice presidential candidate reads, questions about reading habits have become popular during interviews. When pressed about which newspapers she reads, Palin tried to skirt the issue with her response: “Um, all…


Practice Tips: Why Patients Don’t Schedule Surgery – Try These Reasons On For Size and Take Action

Facial Plastic Times – May/June 2011 by Karen Zupko Potential patients don’t schedule surgery for dozens of reasons. You’ll find five of the “big ones” here. Many plastic surgeons neglect to track the all-important Patient Acceptance Rate (PAR)–most particularly by procedure. PAR information is valuable because it allows you to examine your consultation processes and…


Business Advisor: Capturing the Online Aesthetic Patient

Practical Dermatology – April 2011 by Glenn Morley and Brent Foster Managing the perceptions of an online prospect is not difficult, and the return on your investment can be significant. Many opportunities have emerged over the past decade as the cosmetic medical sector has grown. One of the largest opportunity segments in today’s market is…


Creating Effective Patient Payment Plans

American Society for Surgery of the Hand – April 2011 Cheyenne Brinson, MBA, CPA High deductibles, co-insurance, self pay, oh my! Gone are the days that insurance paid for everything. More and more patients are responsible for a much greater portion of their health care costs leaving you the hand surgeon tasked with collecting from…


Therapy Billing for Beginners

AAOS Now (Volume 4, Number 12) – November 2010 by Sarah Wiskerchen, MBA, CPC How to bill for physical, occupational therapy Orthopaedic surgeons are increasingly incorporating physical and occupational therapy services into their practices. In-house billers, who may be inexperienced with the new services, terminology, and associated CPT codes, may be apprehensive about the move. Clarifying the services,…


Business Advisor: Mentoring Matters

Practical Dermatology – September 2010 by Glenn Morley Coaching and mentoring are critical components at the heart of great performance and stellar practice management success. Stories abound of artistic and athletic prodigies, such as Tracey Austin and Yo-Yo Ma, who were identified and groomed for world-class performance. A similar identification and grooming process takes place…


From Entrepreneur to Employee: Part 1 Ambiguity in Attitudes about Hospital Employment

The American Journal of Orthopedics – June 2010 by Cheryl Toth, MBA and Karen A. Zupko, BSJ Results from a recent survey have shed new light on the trend of hospitals’ employing orthopedists. In short, nothing about these orthopedists’ experiences with, or opinions about, hospital employment is crystal clear. In fact, the survey data indicates…


The Employment Agreement: What Every Doctor (Junior and Senior) Needs to Know, Parts 1, 2, and 3

Journal of Practice Management – May/June 2000; July/August 2000; September/October 2000 by James G. Stuart J.D. This is the first of a series of three articles dealing in considerable detail with the process involved in developing physician employment agreements. It is assumed that the contemplated relationship in between two or more physicians (single or multi-specialty)….