Author Archive


10 Books Every New Medical Practice Manager Should Read



Daniel Pink recently published a list of 10 books every new manager should read. I’d like to spin his list into my own 10 books that I recommend for all new healthcare managers.

Dan’s pick #1: ‘Drive’ by Daniel H. Pink

I agree with his description:

In this best-selling business book, Pink explains why, contrary to popular belief, extrinsic incentives like money aren’t the best way to motivate high performance. Instead, employers should focus on cultivating in their workers a sense of autonomy, mastery, and purpose in order to help them succeed.

I have always felt that as a manager, my job is to make sure employees succeed, not look for the ways in which they fail.

Dan’s Pick #2: ‘The One Thing You Need to Know’ by Marcus Buckingham

I’ve not read this book, but I would replace it with my all-time recommendation The One Minute Manager’ by Ken Blanchard. I have given this book to scores of people that I’ve worked with over the years and I recommend it because it introduces you to the seminal concept of

“Praise immediately in public, critique later in private.”

I do agree on capitalizing on individual’s greatest strengths, but especially in small offices, one does not have the ability to craft jobs or tasks that play to one’s individual strengths. You can certainly search for those strengths during the recruiting phase, understanding what qualities often are reflected in those that are good at the front desk, in the exam room, etc.

Dan’s Pick #3: ‘Thinking, Fast and Slow’ by Daniel Kahneman

I had never heard of this book, but now I am anxious to read it. It sounds like it covers things I had to learn along the way, the hard way. Pink says:

Kahneman, a psychologist who won the Nobel Prize in economics, breaks down all of human thought into two systems: the fast and intuitive “System 1” and the slow and deliberate “System 2.” Using this framework, he lays out a number of cognitive biases that affect our everyday behavior, from the halo effect to the planning fallacy.

Dan’s Pick #4: ‘Act Like a Leader, Think Like a Leader’ by Herminia Ibarra

Right away I have to say that I was turned off by the notion that you can be too authentic at work,. Authenticity can be much more of a problem for women than for men. Dan says:

For example, Ibarra, a professor at business school INSEAD, suggests leaders act first and then think, so that they learn from experimentation and direct experience. There’s even an entire chapter devoted to the dangers of being too authentic at work.

Being authentic doesn’t mean wearing your emotions on your sleeve, or making all employees best friends. It does mean being the same person at work that you are at home. See my blog post “Should (Female Leaders Cry at Work?”

Try ‘Lean In: Women, Work and the Will to Lead’ by Sheryl Sandberg. Even if you’re a man. 

Dan’s Pick #5: ‘How to Win Friends and Influence People’ by Dale Carnegie

Couldn’t agree more! This is a classic and there’s a reason it’s a classic – it is a book that not just all healthcare managers should read, it’s a book that all humans should read. In case you can’t find the time or justification to read HTWF&IP, my mother-in-law’s homespun synopsis of the book is “You enter a room and say hello to everybody.” Got it?

Dan’s Pick #6: ‘Mindset’ by Carol Dweck

This is another book that had not crossed my path before, but one that sounds similar to #2, only applied to oneself. I would substitute ‘Blink: The Power of Thinking Without Thinking’ by Malcolm Gladwell for a slightly different take on listening to oneself to bolster confidence and self-learning. Actually, I recommend every one of Malcolm Gladwell’s books for a good read with powerful insights.

Dan’s Pick #7: ‘Meditations’ by Marcus Aurelius and Gregory Hays

To bring things into the 21st century, I suggest ‘Good Boss, Bad Boss: How to Be the Best…and Learn from the Worst’. Author Bob Sutton is a hero of mine, if only because he had the chutzpah to write ‘The No Asshole Rule’, which I live by in my business. One of the foundations of my consulting firm is that I don’t work with mean people. I’ve had to fire a few (clients) along the way, but not many.

Dan’s Pick #8: ‘Things Fall Apart’ by Chinua Achebe

If you didn’t cover this book in graduate school, or didn’t go to graduate school, pick up Crossing the Quality Chasm: A New Health System for the 21st Century’. It’s the book that changed the way we all look at healthcare and it’s good background reading for where we are today.

Dan’s Pick #9: ‘Now, Discover Your Strengths’ by Marcus Buckingham and Donald O. Clifton

Seems similar to Pick #2.

Dan’s Pick #10: ‘Good to Great’ by Jim Collins

Yes, and yes.

READERS: What books would you recommend to a new manager in healthcare?

Posted in: A Career in Practice Management, Human Resources, Leadership, Quality

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Should You Outsource Your Chronic Care Management Program? An Interview With Flow Health

Outsourcing chronic care management could be a boon to your practice and your patientsWe recently caught up with Robert Rowley, MD, Co-Founder and Chief Medical Officer of Flow Health, The Operating System for Value-Based CareSM, to discuss practices outsourcing chronic care management services as well as the services that Flow Health offers to physician practices. Some of our readers may know Bob as the former Chief Medical Officer of Practice Fusion, the cloud-based electronic health record company.

Mary Pat: What is the Medicare Chronic Care Management (CCM) program?

Bob: In 2015, Medicare began a new program called Chronic Care Management (CCM) and established a new billing code for it – 99490. This is an initial step away from in-office, traditional care, and starts to promote (i.e., pay for) regular contact with patients in between office visits. A Medicare patient must first enroll in the service, since there is a charge for it – payable by Medicare just like any other service. Then, once a month, a CCM nurse will reach out to the patient, usually by phone, and review the patient’s treatment plan with them. Once 20 minutes each month has been spent addressing the patient’s case, a bill is generated. This service is unlike Case Management, or Home Health, which are intended for the 5% or so of Medicare enrollees who are very ill and need intensive support. Instead, the CCM service is intended for all Medicare enrollees with 2 or more chronic conditions – estimated to be about 80% of all Medicare members.

Mary Pat: Why have few physicians implemented CCM in their practices?

Bob: After a year of implementation, Medicare is discouraged at the low uptake of this new code by clinicians. According to CMS, CCM services have only been billed for 100,000 patients, out of 35 million enrollees – 0.029% of the potential. Why is that? There are a number of barriers:

  • The code is new, and physicians are just starting to become aware of it.
  • The service is burdensome, especially for smaller practices. It may involve hiring extra staff to do the CCM nurse calling. It involves extra billing – an extra bill for every enrolled Medicare member every month. The reimbursement from Medicare (about $40-44 per patient each month) may not cover the overhead of CCM nursing staff and billing.
  • Medicare wants a connected health platform, so that everyone taking care of the patient can see what is going on, and a consolidated care plan can be developed, understood by all. This is hard to achieve in a disaggregated, siloed environment

Mary Pat: What are the benefits of CCM to a small practice?

Bob: Medicare’s CCM service is like a non-physician health coach that reaches out from the practice to the patient and makes sure the care plan is understood, and “checks up” on the patient. If a patient does not want the service, after initially signing up for it, he or she can disenroll from the service at any time. In our experience, very few patients disenroll; most appreciate the extra outreach. The practice gets improved patient engagement and satisfaction, with fewer patients “falling through the cracks.”

Mary Pat: Tell me about Flow Health.

Bob: Flow Health is a universal patient-centered data platform that can draw from all separate sources of information and put it all in one place, unifying the data into a standard form. It can organize a patient’s data, and make it immediately and universally useful. Flow Health also has a suite of apps that sit on this data platform, and allow direct access to this data – a patient-facing app (called Guide), a provider-facing app, and a point-of-care app (Patient Check-In). Flow Health interfaces in the background with connected EHRs in physician offices, so that the data appears “native” to each EHR, and is updated whenever an event occurs in any connected care team member’s systems.

Mary Pat: How does Flow Health address CCM for practices?

Bob: Flow Health offers a full-service outsourced CCM service to medical practices. Flow Health hires the CCM nurses, who present themselves to patients as members of the medical practice, and have all the collected information about the patient and the care plans at their fingertips. Then, when the interaction has reached 20 minutes cumulatively over the month, a bill is sent on behalf of the practice for the CCM service. This allows smaller practices to participate in CCM without having to encumber the overhead required (staff, billing, connected platform).

Flow Health charges a portion of the bill as a fee to cover the cost of administering the service (CCM nurses, billing and platform), and the practice enjoys new revenue from Medicare without the down-side of out-of-pocket expenses to set up and run the new service.

Mary Pat: How much of the monthly Medicare reimbursement does the practice get?

The practice nets about $10-$15 per patient per month or approximately 25% of the Medicare allowable.

Mary Pat: What is the process for outsourcing CCM to FlowHealth?

A practice interested in participating in CCM and wanting the Flow Health outsourced solution simply contacts Flow Health, and an implementation process begins. Integration with the practice’s EHR is set up, which will vary depending on the EHR the practice uses. The Check-In app, deployed on iPads that Flow Health provides for office-lobby use, captures patient consent and on-boards patients into the system so that they can effectively use the patient-facing Guide app subsequently. The mechanism for billing Medicare for the service is set up.

Mary Pat: How does the Check-In app work?

Bob: Using the Check-In app facilitates enrollment in CCM for candidate patients. The authorization forms are embedded in the app, and appear when the patient is a Medicare enrollee with 2 or more chronic conditions. The Check-In app also collects numerous other data (pre-populated as much as possible), including the history of present illness, past medical history, and all the other things generally included on a paper check-in clipboard. It can be used for all of the practice’s patients, not just CCM patients, since its information is linked with the practice’s EHR

Mary Pat: Who supervises the CCM nurses?

Flow Health sets up teams of CCM nurses comprised of a mixture of Medical Assistants trained in CCM and supervising RNs. The notes from the CCM encounters are posted on the Flow Health platform, which the physician office staff can see using the provider-facing app. If there are suggestions and improvements that the clinician feels are important, these can be communicated using the provider app, or by phone. Every attempt is made to assign the same CCM nurse to the same patients, so that longitudinal relationships and trust can be built

For more information about Flow Health’s CCM program, Contact Flow Health.

Full Disclosure: I receive no compensation from Flow Health for this published interview, or for any business that Flow Health may garner due to this interview.

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How to Ride the Social Media Wave in Your Practice

Don't Get Knocked Down By Social Media!During the course of setting up a new practice, we always discuss the role of social media in the practice’s marketing strategy. We do not recommend a cookie cutter approach to marketing and social media, as every practice is unique in its needs and the marketing investment will depend on the practice specialty, the practice’s target demographic and the practice model (see my recent slide deck on 12 practice models).

Many of our client practices ask for social media education, but until recently, I did not have a resource to provide. Then I met Janet Kennedy. She has 25+ years of marketing experience and is a member of the Mayo Clinic Social Media Health Network. She is also the host of Get Social Health Podcast, an amazing lineup of healthcare social media luminaries, including Physicians!

Janet has filled the great need for social media education for the physician practice by creating The Get Social Health Academy – a resource that fits the bill – affordable, available on demand and very pertinent to today’s medical practice.

Social Media Education for Healthcare


Mary Pat: What exactly is included under the title “social media” and is all social media considered marketing?

Janet: The simplest definition of social media is “websites and applications that enable users to create and share content or to participate in social networking.” In essence – any online platform that allows users to generate content, share it and connect with others. In the broadest sense you could say that any activity in social media has the potential to be marketing because it is building awareness and brand recognition. If by marketing you mean “selling”, then no, social media is not always marketing.

Mary Pat: What was your first experience seeing social media used in healthcare?

Janet: As with most users, I probably didn’t notice when I had my first experience with healthcare social media because if it was done well, it would have appeared seamless with my other online experiences. Once I began to look for instances of healthcare related social media I found it in many consumer facing channels – Facebook, Google searches, etc.

Mary Pat: Previously only very large medical groups and hospitals used and had staff and money dedicated to social media. How do you see this changing?

Janet: It’s a combination of inevitability and acceptance. Many smaller healthcare practices are realizing that they have to commit to a basic engagement in social media in order to rank in search queries and better serve their current patients. While larger healthcare groups may be expanding their involvement in social media by adding more social media platforms, I am seeing a lot more smaller practices taking a look at social media and determining what they need to get started even if it’s by dipping their toe in the water

Mary Pat: Are there any types of practices that don’t need to use social media as a part of their marketing effort?

Janet: First, I don’t think there is a way to totally avoid social media whether you want to or not. So at the very least, claim your online profiles to ensure that your practice is represented correctly and you can receive notifications when your practice is mentioned in social media. That said, you might think that a healthcare practice that deals with sensitive health issues, like mental health or substance abuse, would not be able to utilize social media. If you view patient education as an important role for healthcare, social media offers the opportunity to reach a wide audience and share needed information. The concern for these type of practices is patient privacy and the fear that a patient might reach out in social media. As long as your practice has a social media policy, have trained your staff and posted the policy so your patients understand, you should be able to engage safely in social media.

Mary Pat: Are some social media platforms more applicable/amenable to healthcare than others?

Janet: From a business standpoint, there are platforms that are more popular than others. 71% of online adults have a Facebook profile versus 26% for Instagram, for instance. Therefore you need to know who your patient is and where they are likely to be found in social media to make efficient use of your time, resources and budget. With a commitment to the use of social media to educate, a blog is the best place to start for any healthcare practice.

Mary Pat: I know many practices are wary of using social media because of HIPAA and Privacy rules. What is the most basic concept that practices needs to understand about HIPAA/Privacy when using social media?

Janet: It is really very simple. Disclosures made on social media concerning a patient’s PHI (protected health information) without that patient’s authorization is considered a HIPAA violation.

Mary Pat: What are some other barriers that keep practices from utilizing social media?

Janet: Most healthcare practitioners tell me it boils down to three issues (not necessarily in this order) regarding not committing to social media:

  • Time (where do I find it?)
  • HIPAA (what if a patient tries to talk to me on social media?)
  • Resources (how much will it cost me in terms of staff and expense?)

Mary Pat: All businesses need to understand the return on investment for any resource or money expended. How can practices determine how much they should be spending for social media, either in-house or externally, and how can they measure the effectiveness and return from social media efforts?

Janet: Calculating a financial benefit to any investment is important in business and I’ll be one of the first to say you should track, analyze and improve your marketing based on metrics. However I would like to encourage healthcare practitioners to also consider the value of “ROE” or return on engagement when evaluating social media success. If your social media strategy is founded on content marketing and educating your patients, then there is a true value to having content liked and shared in social media networks.

It may seem like you have to invest a lot of time when you launch into social media. Developing a strategy, finding and creating content, planning and tracking your success; when you are new to social media it can take time. Once you are into a regular schedule the process becomes much more efficient. If you need help, I would recommend hiring an experienced social media manager, ad agency or investing in online learning to speed up your learning process.

If you have a good sense of what you want to accomplish in social media and have some experience, your investment is primarily time plus a few online tools to aid in management, curation and tracking. Costs for content creation, management and writing can start at a few hundred dollars per month and up.

Mary Pat: You’ve developed a “Social Media for the Small Healthcare Practice” curriculum as part of your Get Social Health Academy. Tell us about the course content and who the course would benefit.

Janet: The Get Social Health Academy was created to help the healthcare practitioner, especially in a small practice, to get up to speed on social media and how to use it in healthcare. The courses cover a wide variety of topics from an introduction to social media for healthcare to HIPAA compliance and breaches, content development and social media strategy.

The courses were developed to inform and educate team members who may have little formal marketing background. They are focused on practical learning and tactical actions and would be effective in any size or type of practice.

The Guru for Social Media in Physician Practices - Janet KennedyVery generously, Janet is discounting Academy classes to all Manage My Practice readers. For more information click here. You can also contact Janet via email at or by phone at 919-802-1423.

Full Disclosure: I like Janet’s courses so much that I’ve agreed to promote them through my website, and for this I receive compensation. There are very few companies that I’ve partnered with in this way because I stand behind anything I personally promote and very few products meet my standards for pricing, quality and customer service.

If you would like to know when we post new practice management information, click here to be notified.

Posted in: Practice Marketing, Social Media

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12 Medical Practice Models for 2016

12 Practice Models for 2016In 2012, we wrote “Yes, You Can and Should Start a New Practice in 2013” and more than 13,000 people have viewed it since then. Despite what you may read on the internet, private medical practice is not dead, and physicians are starting new medical practices using new practice models every single day.

What kind of practice is right for you? Here are 12 common and not-so-common medical practice models for independent physicians and other practitioners.

Read more about our new practice start-up services hereFor more information, contact us here or call (919) 370.0504.





Posted in: Starting a New Practice

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2016 CPT Code Changes

New Year CPT Codes for 2016

The 300 new, deleted, revised, and converted CPT codes for 2016 are here and you will need to make sure they are loaded in your billing and EMR system(s) on or before January 1, 2016. This is also a great time to upload the 2016 Medicare allowables for your locality and for any payer contracts that apply a multiplier to the current Medicare fee schedule for their own allowables (for instance, XYZ payer pays 125% of 2016 Medicare).

Only a few areas do not have any changes this year – there are no deleted or changed modifiers and there are no changes to the anesthesia chapter of CPT. As for everything else, grab your 2016 CPT code book or digital version and follow along. Note that this is not an all-inclusive list; review your CPT book for complete description of all codes.

Don’t forget to scroll down to the bottom of this post to see the new category three (temporary) codes that may apply to your specialty.


Evaluation and Management Codes (E/M)

  • Add-on codes for Prolonged Services +99354 and +99355 now apply to prolonged face-to-face outpatient psychotherapy as well as to prolonged face-to-face E/M codes. Use a primary E/M or psychotherapy code, one 99354 (30-74 minutes in addition to the time spent on the initial/primary service) per day and as many units of 99355 as needed to match the time spent. NOTE: check the table in your CPT book to report the correct codes by time. OUTPATIENT ONLY.
  • Two new add-on Prolonged Services codes have been created. +99415 and +99416 are to be used to report prolonged face-to-face clinical staff service with physician, NP OR PA supervision. Same rules as above. Prolonged codes start at >45 minutes. NOTE: Document what you did and how long you did it. If you are reporting additional procedures, document the time and note that they are excluded from the prolonged service so no one thinks you’re double-dipping. OUTPATIENT ONLY.
  • Any code with a “+” prefix must be reported with a primary code. These add-on codes can never appear on a claim by itself.

Integumentary System

  • New: 10035, placement of soft tissue locations devices such as clips, markers, etc., first lesion
  • New add-on: +10036, placement of soft tissue locations devices such as clips, markers, etc., additional lesions (Not be used for breast, use existing breast codes (19081-19086), w/biopsy (19281-19288)

Musculoskeletal System

  • Deleted: 21805 – open treatment w/o fixation for rib fracture (Closed treatment or uncomplicated to use E/M code, Open treatment with fixation, use 21811- 21813)

Respiratory System

  • Revised: 31632 and 31633 bronchoscopy codes now include moderate sedation
  • Deleted: 31620
  • New: Bronchoscopy codes with EBUS 31652 (one or two node stations or structures), 31653, (three or more node stations or structures), +31654 (peripheral lesions – look in the CPT book for primary codes this add-on code can be used with)

Cardiovascular System

  • New: Category III code 0262T has been replaced with 33477, Transcatheter pulmonary valve implantation, includes procedure, angioplasty and imaging guidance, supervision and interpretation when performed
  • Revised: 37184, 37185, and 37186 were revised to include description “non-intracranial vessels”. Fluoroscopy is included.
  • New: 37211 is for intracranial vessels
  • Deleted: +37250 and +37251
  • Newadd-on: +37252 (intravascular ultrasound, initial noncoronary vessel) and +37253 (intravascular ultrasound, each additional noncoronary vessel. Look in the CPT book for primary codes this add-on code can be used with.)
  • Deleted: 39400
  • New: 39401 (Mediastinoscopy with biopsy of mediastinal mass, when performed) and 39402 (Mediastinoscopy with lymph node biopsy, when performed)

Digestive System

  • New: 43210 transoral approach using endoscope, not open, partial or complete


  • Deleted: 47560 and 47561 (see 47579, 47531, or 47532 for percutaneous cholangiography)
  • Deleted: 47630 (see 47544)
  • Deleted: 47500, 47505, 47510, 47511, 47525, 47530, 74305, 74320, 74327
  • New: 47531 Injection procedure for cholangiography, includes RSI – radiologic supervision and interpretation, existing access and 47532 Injection procedure for cholangiography, includes RSI – radiologic supervision and interpretation, new access.
  • New: 47533 Placement of biliary drainage catheter, includes cholangiography, includes RSI – radiologic supervision and interpretation, external and 47534 Placement of biliary drainage catheter, includes RSI – radiologic supervision and interpretation, internal-external.
  • New: 47535 Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, includes cholangiography, includes RSI – radiologic supervision and interpretation
  • New: 47536 Exchange of biliary drainage catheter, all types, includes cholangiography, includes RSI – radiologic supervision and interpretation
  • New: 47537 Removal of biliary drainage catheter, includes cholangiography, includes RSI – radiologic supervision and interpretation
  • New: 47538 Placement of stent into bile duct, includes cholangiography, includes balloon dilation and catheter exchange(s) and removal(s), includes RSI – radiologic supervision and interpretation, each stent, existing access
  • New: 47539 Placement of stent into bile duct, includes cholangiography, includes balloon dilation and catheter exchange(s) and removal(s), includes RSI – radiologic supervision and interpretation, each stent, new access, without placement of separate biliary drainage catheter (Handy table for reference in CPT book before this code!)
  • New: 47540 Placement of stent into bile duct, includes cholangiography, includes balloon dilation and catheter exchange(s) and removal(s), includes RSI – radiologic supervision and interpretation, each stent, new access, with placement of separate biliary drainage catheter
  • New: 47541 Rendezvous Procedure, new access, includes RSI – radiologic supervision and interpretation
  • New add-on: +47542 Balloon dilation of biliary duct, each duct (look for primary codes this can be used with and use modifier -59 if a second unit/duct is treated)
  • New add-on:+47543 Endoluminal biopsy of biliary tree, single or multiple, includes RSI – radiologic supervision and interpretation , report this code once per session
  • New add-on:+47544 Removal of calculi or debris from biliary ducts or gallbladder, includes RSI – radiologic supervision and interpretation (look for primary codes this can be used with)

Digestive System: Sclerotherapy

  • New: 49815 – one unit per lesion treated, report subsequent lesion(s) with modifier -59

Urinary System: Kidney

  • Revised: 50387 deleted transnephric ureteral stent and added “nephroureteral catheter”, see 50688 for removal and replacement of externally accessible ureteral stent (removal of stent without a replacement falls under E/M)

Kidney: New Heading Called Injection, Change or Removal

  • Deleted: 50392, 50393, 50394, 50398
  • New: 50430 (new access) and 50431 (existing access) both include RSI – radiologic supervision and interpretation
  • New: 50432 and 50433 (new access) both include RSI – radiologic supervision and interpretation, report one unit of 50432 for each renal collecting system or ureter accessed
  • New: 50434 (pre-existing nephrostomy tract) and 50435 (exchange catheter), both include RSI – radiologic supervision and interpretation, report one unit of 50435 for each renal collecting system or ureter accessed
  • New add-on: +50606 non-endoscopic endoluminal biopsy, once per ureter per day, includes RSI – radiologic supervision and interpretation (look in the CPT book for primary codes this add-on code can be used with)
  • New: 50693 (placement of ureteral stent, existing access) 50694 (new access  separate nephrostomy catheter) and 50695 (new access with separate nephrostomy catheter), all include RSI – radiologic supervision and interpretation
  • New add-on: +50705 (ureteral embolization or occlusion) includes RSI – radiologic supervision and interpretation, once per ureter treated per day (look in the CPT book for primary codes this add-on code can be used with)
  • New add-on: +50706 (balloon dilation) includes RSI – radiologic supervision and interpretation (look in the CPT book for primary codes this add-on code can be used with)

Male Genital

  • New: 54437 Penis Repair (repair of urethra may be reported separately)
  • New: 54438 Penis Replantation, complete amputation (for partially amputated see 54437,  for urethra repair see 54310 and 54315)

Nervous System

  • New: 61645 Mechanical thrombectomy, intracranial
  • New: 61650 Endovascular intracranial prolonged administration of pharmacologic agents not for thrombolysis, arterial, initial vascular territory
  • New add-on: +61651 Endovascular intracranial prolonged administration of pharmacologic agents, arterial, not for thrombolysis, each additional vascular territory
  • Deleted: 64412, use 64999
  • New: 64461 Paravertebral Block (PVB), thoracic, single injection, includes imaging guidance when performed
  • New add-on: +64462 Second and any additional injection sites, can only be reported once per day, includes imaging guidance when performed
  • New: 64463 Continuous infusion by catheter, includes imaging guidance when performed


  • New: 65785 Implantation of intrastomal corneal ring segments, revised to state “one session” (Category III code 0099T was replaced by this code)
  • Revision: 67101 Trabeculoplasty by laser surgery, revised to state “including drainage when performed” and revised to replace “with or without” with “including when performed”
  • Revision: 67105 Trabeculoplasty, photocoagulation, repair of retinal detachment, revised to state “including drainage when performed” and revised to replace “with or without” with “including when performed”
  • Deleted: 67112 Retinal detachment, use 67107, 67108, 67110 or 67113 as appropriate
  • Revised: 67107 Repair of retinal detachment, scleral buckling, revised to replace “with or without” with “including when performed”
  • Revised: 67108 Repair of retinal detachment with vitrectomy, revised to replace “with or without” with “including when performed”
  • Revised: 67113 Repair of complex retinal detachment, revised to replace “with or without” with “including when performed”
  • Revision: 67227 Destruction of extensive or progressive retinopathy, revised to remove “one or more sessions”
  • Revision: 67228 Treatment of extensive or progressive retinopathy, photocoagulation, revised to remove “one or more sessions”

Auditory System

  • New: 69209 Removal of impacted cerumen using irrigation/lavage, unilateral
  • New: 69210 Removal of impacted cerumen requiring instrumentation, unilateral, NOTE: For removal of non-impacted cerumen, use E/M code, append modifier -50 for bilateral (both ears), do not report 69209 and 69210 for the same ear!

Diagnostic Radiology

  • Deleted: 70373 (see unlisted code 76499 for contrast laryngography)
  • Revised: 72080 Spine, thoracolumbar junction, minimum of two views
  • Deleted: 72069 and 72090
  • New: Scoliosis Evaluation Codes 72081 (one view), 72082 (two or three views), 72083 (four or five views) and 72084 (minimum six views)
  • Deleted: 73500, 73510, 73520, 73530 and 73540
  • New: Hip With Pelvis (when performed) Unilateral 73501 (one view), 73502 (two or three views), 73503 (minimum four views)
  • New: Hip With Pelvis (when performed) Bilateral 73521 (two views), 73522 (three or four views), 73523 (minimum five views)
  • Deleted: 73550
  • New: 73551 Femur (one view) and 73552 (two or more views)
  • The word “film” has been replaced by “image” in 74240, 74241, 74245, 74246, 74247, 74250 and 74340
  • New: MRI of Fetus 74712 (single gestation) and +74713 (each additional gestation) only if fetus is imaged

Radiology: Brachytherapy

  • New: 77767 and 77768 (multiple lesions or channels)
  • Deleted: 77785 and 77786
  • New: 77770 (one channel), 77771 (two to twelve channels), 77772 (more than twelve channels)
  • Deleted: 77776 and 77777 (see 77799 for intermediate service)
  • Revised: 77778  to include “supervision, loading and handling of the radiation source”

Radiology: Nuclear Medicine

  • Revised: 78624 to include “imaging study” and “(solid food, liquid food or both)”
  • New: 78265 (small bowel transit) and 78266 (small bowel and colon transit)

Pathology and Laboratory

  • New: 80081 addition of HIV testing the standard OB panel (must have all elements of the panel performed to use 80085 or 80081, otherwise must code each test separately
  • NOTE: Refer to the CPT book for many additional changes

Medicine: Vaccines

  • Deleted: 13 outdated codes deleted
  • Revised: 40+ codes reworded to improve clarity
  • New: 90625 Cholera Vaccine
  • New: 90697 DTap-IPV-Hib-HepB
  • New: 90620 Meningococcal, 2 dose schedule
  • New: 90621 Meningococcal, 3 dose schedule


  • Deleted: 92543
  • New: 92537 (bilateral, bithermal, 4 irrigations) and 92538 (bilateral, monothermal, two irrigations)

Cardiovascular and Pulmonary

  • New: 93050 Arterial pressure waveform analysis (Category III code 0311T deleted)
  • Revised: 94640 “for therapeutic purposes” and includes “sputum induction”

Neurology and Neuromuscular

  • Deleted: 95973
  • Revised: 95972 revised to remove the time element


  • New primary and add-on codes: RCM Codes 96931 (image acquisition, interpretation and report, first lesion), 96932 (image acquisition only, first lesion), and 96933 (interpretation and report only, first lesion), +96934 (image acquisition, interpretation and report, each additional lesion), +96935 (image acquisition only, each additional lesion), and +96936 (interpretation and report only, each additional lesion) NOTE: Technical is image acquisition, Professional is interpretation and report. Both components are included in 96931 and 96934.

Medicine: Other

  • Revised: Ocular Screening 99174 to include “remote analysis and report”
  • New: Ocular Screening 99177 onsite analysis

Category III Codes

  • Sunset Codes: 0103T, 1223T, 0123T, 0223T, 0224T, 0225T, 0233T, 0240T, 0241T, 0243T, 0244T (codes not replaced by a Category I code)
  • Replaced Codes: 0099T see 65785, 0182T see 0394T and 0395T, 0262T see 33477, 0311T see 93050
  • New: 0381T (Epilepsy seizure recording up to 14 days with review and report), 0382T (14-day with review and report only), 0383T (Epilepsy seizure recording for 15 to 30 days with review and report), 0384T (15 to 30 days with review and report only), 0385T (Epilepsy seizure recording for more than 30 days with review and report), and 0386T (>30 days with review and report only)
  • New: Permanent Leadless Pacemaker 0387T (insertion/replacement), 0388T (removal), 0389T (programming), 0390T (evaluation) and 0391T (interrogation)
  • New: Esophageal Sphincter Augmentation Device 0392T (placement), and 0393T (removal)
  • New: Electronic Brachytherapy 0394T (skin surface) and 0395T (interstitial or intracavitary)
  • New add-on: +0396T Implant stability testing during knee replacement
  • New add-on: +0397T Optical endomicroscopy during ERCP
  • New: 0398T MRI-guided ultrasound for intracranial lesion ablation
  • New: +0399T Myocardial strain imaging
  • New: 0400T (Digital skin lesion analysis, one to five lesions) and 0401T (digital skin lesion analysis, six or more lesions)
  • New: 0402T Collagen cross-linking of cornea
  • New: 0403T Behavior change in high-risk patients for diabetes prevention, group setting, 60 minutes per day
  • New: 0404T Uterine fibroid ablation with ultrasound guidance, radiofrequency,reported once regardless of number of fibroids treated
  • New: 0405T Thirty minutes or more per month non-face-to-face liver assist care oversight
  • New: 0406T Nasal endoscopy, placement of drug-eluding implant and 0407T endoscopy with biopsy, polypectomy or debridement

CPT Copyright American Medical Association. All rights reserved.

Posted in: Collections, Billing & Coding, Compliance

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2016 Medicare Deductibles and Premiums

Medicare Part B Deductible Increases

Yesterday the Centers for Medicare & Medicaid Services (CMS) announced the 2016 premiums and deductibles for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

Part B Premiums/Deductibles

As the Social Security Administration previously announced, there will be no Social Security cost of living increase for 2016. As a result, by law, most people with Medicare Part B will be “held harmless” from any increase in premiums in 2016 and will pay the same monthly premium as last year, which is $104.90.

Beneficiaries not subject to the “hold harmless” provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama last week. Medicare Part B beneficiaries not subject to the “hold-harmless” provision are those not collecting Social Security benefits, those who will enroll in Part B for the first time in 2016, dual eligible beneficiaries who have their premiums paid by Medicaid, and beneficiaries who pay an additional income-related premium. These groups account for about 30 percent of the 52 million Americans expected to be enrolled in Medicare Part B in 2016.

“Our goal is to keep Medicare Part B premiums affordable. Thanks to the leadership of Congress and President Obama, the premiums for 52 million Americans enrolled in Medicare Part B will be either flat or substantially less than they otherwise would have been,” said CMS Acting Administrator Andy Slavitt. “Affordability for Medicare enrollees is a key goal of our work building a health care system that delivers better care and spends health care dollars more wisely.”

Because of slow growth in medical costs and inflation, Medicare Part B premiums were unchanged for the 2013, 2014, and 2015 calendar years. The “hold harmless” provision would have required the approximately 30 percent of beneficiaries not held harmless in 2016 to pay an estimated base monthly Part B premium of $159.30 in part to make up for lost contingency reserves, according to the 2015 Trustees Report. However, the Bipartisan Budget Act of 2015 mitigated the Part B premium increase for these beneficiaries and states, which have programs that pay some or all of the premiums and cost-sharing for certain people who have Medicare and limited incomes. The CMS Office of the Actuary estimates that states will save $1.8 billion as a result of this premium mitigation.

CMS also announced that the annual deductible for all Part B beneficiaries will be $166.00 in 2016.

Premiums for Medicare Advantage and Medicare Prescription Drug plans already finalized are unaffected by this announcement.

To get more information about state-by-state savings, visit the CMS website here.

Since 2007, beneficiaries with higher incomes have paid higher Part B monthly premiums. These income-related monthly adjustment amount (IRMAA) affect fewer than 5 percent of people with Medicare. Under the Part B section of the Bipartisan Budget Act of 2015, high income beneficiaries will pay an additional amount. The IRMAA, additional amounts, and total Part B premiums for high income beneficiaries for 2016 are shown in the following table:

Medicare Premiums Vary Based on Income and Type of Tax Return

Premiums for beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:
2016 Medicare Monthly Premiums

Part A Premiums/Deductibles 

Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not pay a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A annual deductible that beneficiaries pay when admitted to the hospital will be $1,288.00 in 2016, a small increase from $1,260.00 in 2015. The Part A deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. The daily coinsurance amounts will be $322 for the 61stthrough 90th day of hospitalization in a benefit period and $644 for lifetime reserve days. For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 in a benefit period will be $161.00 in 2016 ($157.50 in 2015).

Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to receive coverage under Part A. Individuals with 30-39 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $226.00 in 2016, a $2.00 increase from 2015. Those with less than 30 quarters of coverage pay the full premium, which will be $411.00 a month, a $4.00 increase from 2015.

Part A Deductibles and Coinsurance for 2016

Slight Increases for Medicare 2016 Part A

For more information on the 2016 Medicare Parts A and B premiums and deductibles (CMS-8059-N, CMS-8060-N, and CMS-8061-N), click here.

Posted in: Collections, Billing & Coding, Finance, Medicare & Reimbursement, Medicare This Week

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Is This Physician Crazy? She Walked Away From a “Big Five” Payer Contract!

Feel All Alone Contracting With Payers?I recently helped a physician start a new practice and we began applying for enrollment with the Big Five insurance companies. The physician was stunned to find:

  • Insurance companies regularly “lost” her applications and we had to submit the same information numerous times. Some companies require an online application which provides no ability to track. They will not accept paper applications which can be tracked by the delivery service.
  • She was offered contracts with no fee schedule attached. When we asked for the fee schedule, we were told it was available in the physician portal. When we went to the physician portal, we were told that only enrolled physicians have access to the portal.
  • Contracts she received made reference to the physician adhering to the rules of the Provider Manual. When we asked for a copy of the Provider Manual, we were told it was available in the physician portal. You guessed it – only enrolled physicians have access to the portal.
  • Some insurance companies routinely took 90-120 days or more to complete the application process, then another 60-90 days to enter the contract into the system so physician claims would be paid. This means that a physician may not be able to get paid by one or more payers for 6-7 months after opening a practice.

The physician ultimately decided to walk away from the most egregious of the payers.

After having numerous potential new patients call the practice to find out if she was contracted with this payer, she had to tell them that she would not be contracting with this payer.

Here’s the letter she wrote to the Insurance Company Representative:

Good Afternoon:

Thank you for your follow-up note.  I am uncertain why, but the information you provided, once again, is in direct conflict with the data provided by our local physician’s organization as well as the objective data of looking at pricing vs reimbursement for the ___ vaccination.

I have included for your review comments made by an 18-year veteran of contract negotiations, Ron Howrigon.  It appears being evasive and obtuse in how you negotiate with physicians is an intentional cultural value.

The tenets of our practice require honesty, good-faith and integrity from all of our partners in healthcare.  This article and our experience with you suggests a different and unacceptable organizational value displayed by your company.

At this time, given the disorganized credentialing process, the poor interactions with your company and the vexatious conversation with you, we will not be partnering with you.  We have notified all of our patients insured by your company that we will not be accepting your plans in our practice.  This is a values and ethics-based decision.  We regret you and your company have chosen to conduct yourselves with such hostility and disregard for physicians and the important work we do on behalf of our patients.


Physician in a New Practice

Posted in: Collections, Billing & Coding, Starting a New Practice

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Why You Should Not Reward Your Billing Staff for Collections

I Don't Recommend You Incentivize Billing Staff for Collections!

Do not incentivize and reward your billing staff for reduced days in accounts receivable, increased collections or decreased non-contractual (bad debt) write-offs!

I bet you thought I was going to say that billers are paid to do a job and they should not be incentivized for doing the job you hired them to do.

Not true – I am not against incentivizing employees to do a job at all; most people enjoy a challenge and feel great when they reach a goal.

However, when a subset of employees in your practice is incentivized for increasing revenue, you can be sure it will create resentment and low morale for the rest of your employees. Do you think word won’t get around that you’re rewarding the billers? If so, you’re completely wrong. There are no secrets in a medical office. People know what others make, and regardless of what your Employee Handbook might say, it is not grounds for termination for employees to share what they make with others.

What I do encourage you to do is to incentivize your ENTIRE staff to reduce days in accounts receivable, increased collections and decrease non-contractual (bad debt) write-offs. Ultimately, your entire staff is responsible in one way or another for collections.

Consider how each person in your practice must contribute to the overall effort to make sure collections are at goal:

Front Desk: entering/verifying demographics and picking the right insurance plan for each patient; collecting the correct amount at time of service, whether it is an exact amount or an estimate of the patient’s responsibility.

Phones/Scheduling: making new patients aware of financial policies and what will be expected at time of service (“Please remember to bring the credit card you’d like us to keep on file for you”); making sure that Medicare patients know the difference between an Annual Wellness Visit and a Complete Physical.*

All clinical staff including Physicians/PAs/NPs: making sure that the patient signs an Advance Beneficiary Notice (ABN) for any services that insurance will not pay for, regardless of whether the patient is Medicare or non-Medicare**, before the service is rendered.

Manager: addressing patient complaints that escalate to you quickly and efficiently, not giving a patient any reason not to pay; making sure you have an easy-to-read-and-understand Financial Policy*** explaining your collection at time of service policy.

Everyone: embracing a culture of Customer Service, making sure that patients are satisfied with their experience; sending a consistent message to patients that you are interested in bringing them value for their dollars and reinforcing your desire to have an ongoing relationship with them.

Complete the Contact Form here to request any of the free resources discussed in this post and listed below.

  • *Cheat Sheet for Medicare visits
  • **Non-Medicare Advance Beneficiary Notice (ABN)
  • ***Financial Policy

Image by Samuel Zeller

Posted in: Amazing Customer Service, Collections, Billing & Coding, Day-to-Day Operations, Finance, Human Resources

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Who’s Listening to Our EHR Issues?

Who You Gonna Call When Your EHR Sucks...the Life Out of You?






We hear more and more every day about EHR problems and physician dissatisfaction with performance and usability, and the way the federal government makes them use it. So, who should physicians complain to?

Of course you should complain to the vendor about usability, and complain in groups when possible. I’ve started several user groups in the past and have had success in communicating with vendors to improve their products. The key is keeping the User Group independent from the vendor, which takes committed volunteers.

In addition, you may want to complain to the Office of the National Coordinator (ONC) and hope that other physicians will do the same and there will be traction gained by many voices. The ONC has just launched an online complaint form for this purpose, but note, Coordinator Karen B. DeSalvo, MD only wants to hear about problems with certified EHRs.

Don’t know if your EHR is certified? Check here.

The American Medical Association (AMA) is also working on behalf of physicians with a campaign called “Break The Red Tape” which calls upon physicians to write about (or video) their EHR story. Even if you don’t plan to share your EHR story, be sure to click on the link and hear from real people.

Physicians (and their staffs) are overwhelmed with all the mandates. As a consultant, I no longer work with Meaningful Use, PQRS/VBM or PCMH. I refer practices to other consultants for these needs because I would rather work on what I think is meaningful in medical practice today – practice business models and strategies that bring more satisfaction to the physician and the patient.

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Posted in: Electronic Medical Records, Headlines, Learn This: Technology Answers

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