Implementing a Self Service Practice Part I

Grocery stores, banks and other outlets have now implemented a self-service option for their customers.  It’s no wonder that physicians are doing the same.  More and more physicians are offering patient Web portals, which saves time for the staff and also for patients.  It can reduce the administrative errors as well.

These Websites make it possible for patients to communicate with a nurse, the physician, request a refill of medication, access medical records, they can make an appointment, register their insurance information and get lab results online 24 hours a day 7 days a week.

Physicians have found that Web portals has shown to save time and that the office has become more efficient.  Physicians have also found that it can change the way they practice medicine because it’s allowing them to help patients in ways they never expected that they could.

These portals are secure and HIPAA compliant online applications that allow patients to communicate with their physician.  Some portal applications are a stand-alone Website and others are able to connect to their existing Website. 

The patient portal allows patients to directly perform functions that will ultimately save the office time and can be more accurate in these functions.

Most offices provide a clip board with multiple sheets that the patient must fill out for their registration, this would eliminate that step.  A new patient could access the Website and fill out their registration before they are even seen at the office and at their own convenience.  This cuts back on the mistakes made which in turn cuts back on the number of denied claims.

The portals also help the physician to receive payment faster from the insurance carrier.  When a new patient registers on the portal, it’s easier and more efficient to check the person’s insurance eligibility.  If there is a discrepancy, it can be caught before the patient even comes in office for their appointment.

Implementing this plan can save time for the office staff, the physician, the patient and the front office receptionist.  Cutting back on the “paperwork” aspect of the patients visit makes more time for the physician to spend with the patient, the physician is able to see more patients in a day and the office staff has more time to prepare for the day and not have to spend so much time on each patient as the patient is sitting in the waiting room.

Some physicians believe that this is a good investment for their practice.  Anything that helps to cut back on things that are so time-consuming is worth it.  Another advantage is the accuracy of it all.  Cutting back on mistakes always saves time and money.

Is Your Medical Biller Using Modifier 25?

To understand modifier 25, let’s define what it is.  Modifier 25 is Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.

This modifier can only be used with an Evaluation and Management service.  It has to be above and beyond the usual preoperative and postoperative encounter with the procedure.  Using this modifier does not require you to use another diagnosis to bill.  It is most important that the Evaluation and Management level should meet its key components.  Make sure that when using this modifier that it meets medical necessity.  Below is an example of when this modifier would be used.

A patient comes in for a follow up for chronic neck pain, and then the patient then complains of having severe allergies.  A pain management procedure was administered at the same time of service.  This would call for the modifier 25 being used for the Evaluation and Management code to indicate that both services were rendered on the same day.

It is important that a medical insurance biller use this code when appropriate.  Otherwise you will receive many claims that will have unpaid codes that could have been paid for.  Keeping up to date on changes with this modifier is important to ensure efficiency when billing.

An example of not using modifier 25 is when an ear nose and throat physician has seen a patient with Medicare, for a routine office visit and the physician decides that the patient needs a hearing test which can be done in their office by a certified Audiologist.  The physician determines that the patient has hearing loss from the results of the hearing test.  The physician now can bill for an office visit, most likely a 99213 or 99214 and a hearing test, which is a procedure using CPT code 92557.  Now if the modifier 25 was not attached to the Evaluation and Management code, the hearing test 92557 would not receive payment.  So if the E/M code has the modifier 25 billed along with it and then the procedure code for the hearing test 92557 both will be paid.

So many physicians have missed out on payment of minor procedures or testing performed in the office because of the fact that the biller did not attach the modifier 25 to the Evaluation and Management code.  What a costly mistake for the physician.  Some insurance companies may allow you to re-bill a corrected claim to re-submit for payment on claims that did not have the modifier attached.  It would serve the physician well to investigate if this is being done.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

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Is 99214 Being Billed Too Often?

99214 represents a code that is the second highest level of care for an established office patient.  This code ranks second among the most frequently used CPT codes in the world.  Internists use this code for 37% of established office patients and should probably use it more often than they do. 

The definition of 99214 is as follows:

The documentation for this encounter requires two out of three of the following:

1.  Detailed History

2.  Detailed Exam

3.  Moderate Complexity Medical Decision-Making

Or 25 minutes spent face-to-face with the patient if coding based on time.  The appropriate documentation must be included.

A study has been done showing that from 2001 to 2010, physician’s increased using code 99214 which is a higher-level and more lucrative billing code for evaluation and management (E/M) services in the course of treating Medicare patients.  During that time, the volume of Medicare payments for E/M services rose 48%, whereas spending for all Medicare Part B goods and services increased 43%.  In 2010, E/M services accounted for 30% of all Medicare B expenditures.

Dramatic changes occurred with 99213 and 99214 visits.  In 2001, the midrange 99213 visit represented 54% of the pie, and the 99214 visit, 21%.  In 2010, the share for 99213 had slipped to 46%, whereas that for 99214 stood at 36%- a 15% increase over 2001.

The jump from 99213 to 99214 yielded a big increase in compensation.  In 2010, Medicare paid on average $97.35 for a 99214 visit, which is 50% more than the $64.80 for a 99213.

One suggested but unproven explanation for higher E/M coding says that Medicare patients are sicker than they were in 2001, prompting physicians to be with the patient longer in order to evaluate and diagnose them and to manage their conditions.

A physician in Florida states that an aging population means more complex care and there is a significant increase in obesity, which is driving a rise in adult-onset diabetes.  Patients are also on many more mediations than recent years.

Over the years physicians have undercoded with 99213 due to lack of documentation and chose to play it safe and settled for a lower reimbursement in the process.  Even if they did thoroughly document the visit in their notes, they often would code 99213 to avoid being accused of overcoding, or their patient chart notes were not complete, not thorough and lacked information.  Any practice management consultant would say, such physicians “left money on the table”.

Undercoding has been a problem for primary care physicians who depend on E/M services for the bulk of their income.  So the push has been to turn undercoders not into overcoders but accurate coders.   Just some food for thought….

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

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Etiquette For Your Medical Practice

Giving Medical Advice

Current patients and even new patients to the office often call the office for medical advice over the phone.  The receptionist does not have the medical authority to answer these types of questions.  The receptionist should never give suggestions or advice for medical care to a patient.  The best way to handle this situation is to let the caller know that you are not qualified to give out medical advice.  They can then ask the patient to make an appointment so that the physician can recommend treatment.  Or the patient can be transferred to the nurse, nurse practitioner or physician who can give them further medical advice. When given to the proper person who can give medical advice, this should always be out of earshot of other patients so as to keep that patient’s confidentiality private.  Usually a medical practice has a private office that an appropriate staff member can give results to patients without the possibility of other people hearing them.

Patient Confidentiality

Making sure patient confidentiality is enforced is the one of the most important things when communicating with them.  This falls under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  This law forbids medical staff from releasing any information about their patient unless specified by the patient themselves.  If a family member of a patient calls the medical office for any type of medical history or want results of tests that have been performed on the patient, this is not allowable under the HIPAA regulations.  The staff member should inform them that they are not allowed by law to give out medical or personal information from the patient’s chart.  When requesting records whether it be another medical office, law office or even the patient themselves, a signed medical records release form should be signed and dated by the patient giving the appropriate person the right to view their records.

Switchboard Operation

Some medical offices operate a switchboard in their offices.  When doing this there are a few things to keep in mind.  Keeping track of what patients are on hold will keep the lines of communication open.  Most medical practices have multiple lines that can accommodate several lines at one time.  Make sure that the receptionist asks the caller for their name and phone number, then place them on hold and refer the line to the appropriate person.  The tone of voice of the staff member should always be polite and professional. If the person is not available then they should take a message along with the patients name, phone number, alternate phone number, reason for calling, date and time that the call was received and then give the message right away to the appropriate person.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

Click here to read testimonies regarding MariAnn Medical Billing Service

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Ways to Thank Patients

Ways to Thank Patients

Most medical offices are so busy and are trying to keep up with patients or the everyday problems within their practice, there’s no time for thanking the patients that have been loyal to physicians for many years.  Some people may think that it’s a business and we don’t need to thank anyone, others feel that if it weren’t for the patients they would have no practice.  With that said, what’s wrong with saying thank you?  Below are some reasons to thank your patients who may be new to your practice or patients that have been loyal to you throughout the years.  Focus on customer service!

1.  Does your office staff send out friendly reminders or thank you cards to patients?

2.  Do you have a monthly newsletter sent to patients?

3.  Have you ever conducted a secret-shopper experience in your medical practice?

4.  Can your receptionist welcome patients new and old with a warm smile and genuine attitude?

5.  How long are patients being put on hold for?

6.  What is the tone of the office staff?

7.  Are the nurses or back office assistants helpful to patients?

8.  Does everyone in the office thank each patient for their visit?

9.  Is the office staff courteous on the phone when speaking to them?

Advertise and market the office.  Take an ad out in a local paper and offer specials to patients.  Physicians could offer specials to patients that are paying cash.  Reward patients with a monetary incentive off their 3rd or 4th visit.

Keep tract of inactive patients.  You should always maintain a recurring relationship with all your patients.  If they don’t receive any sort of communication from you throughout the year, how are you ever going to have any sort of valuable relationship?  Make sure that you especially target the patients that have been inactive.  Have a staff member call them and ask them how they are doing.  You could even send them a card to thank them for being a loyal patient and let them know that they are missed and you are willing to help them with their needs.

Patient’s always want to know they are important and the physician they are seeing cares for them personally.  Taking the time to reflect on patients and putting their needs in the forefront is key to a having a successful record of return patients to a physician’s office.  It’s not only a moral way of handling your practice but it’s a way to show that you and your staff really care about the well-being of your patients and their health.  In turn that makes a good reflection on the medical community and you as a physician.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

Click here to read testimonies regarding MariAnn Medical Billing Service

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How to Handle a Problem Patient

Most patients are easy to work with.  They call ahead for an appointment, they arrive at their scheduled time, they pay their bill on time, but there is always that one patient that defies all of the above.  On occasion, however, things can go very wrong and patients become angry, stubborn, manipulative and even abusive.  Some people are ready for confrontation while others avoid it at all costs by hiding, giving in to strong demands, or finding someone else to handle the problem.

If you communicate in ways that show you care and have empathy for the patient this could diffuse a situation or at least calm the situation down.  You could simply say that you wish you could help them but the physician’s policy is very clear in this manner.  You can also agree with the patient on principal.  Rather than go back and forth and try to prove your point, you can acknowledge that the patient has a valid point of view and you can present to the patient what you are willing or able to do.  You may say things like “I can understand how you might see it that way…”  By saying those simple words shows that you care for the patient and also validates your understanding of the complaint.

When patients continue to ask and demand what they want it is best to stay firm, talk with the patient in a calm voice, make sure that they know what you are willing and able to do.  If you keep coming up with new reasons or excuses why you can’t do something this will only prolong the situation and make it seem as though the policy can be changed in some manner. 

Keeping your tone of voice low, soothing but yet firm should help to calm a situation and help the patient to regain their composure.

Keep direct eye contact with the patient and a straight posture.  This adds to your credibility.  If the patient is standing, stand up, if the patient is sitting down, sit down.  If a patient is in the waiting room with other patients or in an area where others can hear the confrontation, move the conversation into a private office if possible, so that other patient’s or staff are not disrupted.  Ask the office manager to join you in the conversation, or it might get to the point where the physician may need to step in.  The bottom line is you want to keep the office in a peaceful state and have the ability to handle patient complaints in a professional dignified manner so not to disrupt the entire office staff and patients that are waiting to be seen.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

Click here to read testimonies regarding MariAnn Medical Billing Service

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