How Are You Handling Patient No-Show?

How Are You Handling Patient No-Show?Patient no-show is a recurring problem for any medical practice or healthcare facility. As per the recent study, no-show rates in an outpatient setting can range between 22 percent and 35 percent, resulting in a loss of 15 percent of anticipated daily revenue.  In terms of dollars, patient no-show can cost individual physicians as much as $150,000 per year. Such figures make it obvious that missed appointments are the cause of revenue loss as well as a source of frustration.

While not every no-show can be eliminated, there are effective ways to reduce the number of no-shows in your practice. While reducing patient no-show, there are certain things you don’t want to do. If you adopt the wrong practice to reduce patient no-show then it might end up in damaging relationships with your patients.

  1. Create a triage chart:
    The chart should rate your top 20 symptoms by a series of criteria. The criteria should include the symptom, appointment urgency and appointment length. Maintain a list of patients who want to be seen sooner and call them to ‘fill-in’ or ‘compress’ the schedule.
  1. Consider patient’s convenience:
    While booking an appointment, start by asking patients when they would like to come in, rather than assigning them the first available slot.
  1. Don’t overbook appointments:
    Long office wait times were viewed by patients as a sign of disrespect that led to patient no-shows. With as busy as people are these days, asking a patient to wait 20 to 40 minutes or more for an appointment will increase the likelihood of them opting out of future appointments. If patients don’t feel you value their time, they are less likely to value yours. This is how a no-show turns into a lost patient.
  1. Use Automated Reminders:
    Providing a quick and courteous reminder to patients about their upcoming appointment not only serves to jog their memory but is also a thoughtful step that improves patient loyalty. When patients initially schedule appointments, ask them which method or methods of contact they prefer. Many patients rely on reminders from their providers because of the convenience they provide, and automated reminders can save both time and money over the manual system you may be using.
  1. Allow Pre-Paid Appointments:
    Provide a discount or points for patients to show by allowing them to prepay for their appointment. When patients know they’ve already committed the money to an appointment, their incentive to show is enhanced. You can even offer a discount to patients who prepay for their next visit.
  1. Reward Patients Who Keep Appointments:
    When a patient no-shows, you can place a small fee on their bill that remains until they schedule and keep the new appointment. For patients who keep their appointments and arrive on time, you can reward them with a small discount on their bill. You can also enter the names of your on-time arrivals into a drawing for a gift card each month.
  1. Ask reasons for no-show:
    When following up, ask patients why the missed their appointments, then document the reasons. This allows you to spot general trends in no-shows that could possibly be fixed.
  1. Develop Strong Patient Relationships:
    When patients feel valued, when they feel that you take an interest in them individually, they are considerably less likely to become a no-show. You can nurture patient relationship by small things like sending birthday and holiday wishes or simply appreciating them for visiting as per appointment date.  You can also use a patient newsletter to keep patients current on events in your office as well as offer healthcare tips they can use immediately.
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How to Utilize Patient Waiting Time for Better Patient Satisfaction?

How to Utilize Patient Waiting Time for Better Patient SatisfactionPatients perceive long waiting times as a barrier to obtain medical services. Keeping patients waiting can be a cause of stress for both patient and doctor. Even though long patient wait time is not a good thing but activities like Secretary verifying insurance information or Medical Assistant preparing an exam room takes a lot of time.  We can utilize this waiting time for providing clinical, financial education and ultimately increasing overall patient engagement. A small gesture toward patient engagement can go a long way in terms of patient retention and satisfaction.

You can engage your patients in the following ways:

  1. Patient’s comfort must be the prime responsibility:

Think about your patient’s comfort all the time. In a waiting area, something as simple as magazines, a TV, or a few children’s toys are always recommended. Providing bottled water or the availability of reading glass to fill out paperwork can be a good option. Patients notice and often remember these small details long after the appointment is over.

  1. Update Patient and Insurance information:

Waiting time is a great opportunity to update the patient’s address, phone number, email address, and insurance information. Consider providing patients with a print out while they wait so they can take their time reviewing and updating information. You can also provide a computer tablet for easy details verification and updation.

  1. Hire a patient advocate:

The patient advocate can assist patients by answering questions and other concerns that the physician can’t address during the actual appointment. The cost of hiring a patient advocate can be redeemed through time saved on back-end accurate data collection and appreciation from the patient for providing the unbiased third-party opinion.

  1. In-depth information about financial assistance:

Communicate financial policy for your practice to your patients to avoid any payment confusion or discrepancies in the future. This could include brochures about tax-deductible health savings accounts (HSA) or local charities that can help patients in need. The policy should be comprehensive and address issues pertaining to your practice specialty and patients. You can also ask patients whether they have any billing-related questions while they wait—and remind them of any outstanding balances that are due. Clearly define patient responsibilities for all non-covered services.

  1. Educate the patients about the dangers of non-compliance:

Consider providing a resource on what can happen if a patient with diabetes doesn’t take his or her insulin. Another example is a patient with depression who suddenly stops taking his or her anti-depressant medication. This engages patients while they wait and provides subtle and non-intrusive education that can drive positive behavior change. Rather than hiring new resources, you can train existing staff.

  1. Introduce patients to the portal:

Patient waiting is an ideal time for providing patients with a username, password, and brief introduction to the portal. You can provide portal education by including access to a laptop or tablet in the waiting area so patients can sign up with the help of an office assistant. But you have to make sure that the portal contains useful information. If the patient can’t access the meaningful data then there is no point convincing them to sign up for the portal.

  1. Encourage them to fill a brief satisfaction form:

Asking patients to provide brief satisfaction form or dropping card in a suggestion box can be a great way of utilizing patients’ time.

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Using Modifier 59 (Distinct Procedural Service) Effectively

Using Modifier 59 (Distinct Procedural Service) EffectivelyWhen used appropriately, coding modifiers help practices code appropriately and collect revenue to which they’re entitled. The key here is -when used appropriately. A modifier should never be used just to get higher reimbursement or to get paid for a procedure that will otherwise be bundled with another code.

Modifier 59 describes a distinct procedural service and is used to identify procedures and services that are not normally reported together. For example, Modifier 59 should be used when coding for a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion (noncontiguous lesions in different anatomic regions of the same organ), or a separate injury. Modifier 59 should not be used on Evaluation and Management Codes, and should only be used when no other modifier is accurate.

Difficulties in using modifier 59:

  • The 59 modifier is one of the most misused modifiers. The most common reason it should be used is to indicate that two or more procedures were performed at the same visit but to different sites on the body.
  • Unfortunately, many times it is used to prevent a service from being bundled or added in with another service on the same claim. It should never be used strictly to prevent a service from being bundled or to bypass the insurance carrier’s edit system.
  • 59 should also only be used if there is no other, more appropriate modifier to describe the relationship between two procedure codes. If there is another modifier that more accurately describes the services being billed, it should be used instead of the 59 modifier.
  • When using the 59 modifier to indicate a distinct and separate service, documentation should be in the patient’s medical file that substantiates that the services were performed separately. The insurance carrier may request to review the record to deem if the 59 modifier is being appropriately used before reimbursing the full amount for the modified CPT code.
  • It’s important to note that the use of the 59 modifier does not require that there be a different or separate diagnosis code for each of the services billed. As such, simply using different diagnosis codes for each of the services performed does not support the use of the 59 modifier.


As mentioned above, Modifier 59 may be used appropriately for procedures performed on different anatomic sites during the same encounter when the procedures are performed on different organs or on different, noncontiguous lesions in the same organ.

  1. If the patient were having a nerve conduction study with CPT codes 95900 and 95903 being billed. If the two procedures are done on separate nerves, then the 59 modifier should be used to indicate that. If the codes were performed on the same nerve, then the 59 modifier should not be used. The biller should never be the one to add the 59 modifier to a claim, even if she knows that billing the services without the modifier will result in bundling or a denial. The 59 modifier should only be added by the provider or by a coder who has access to the patient’s chart.
  2. Proper use of Modifier 59 may be when a surgeon performs a laparoscopic partial nephrectomy (CPT 52343) on two separate, noncontiguous lesions in the same kidney. In contrast, CPT 50542 is defined as laparoscopic ablation of a renal mass lesion(s); therefore the use of a 59 or XS modifier is not appropriate when ablating more than one lesion. As intraoperative guidance and monitoring when performed is part of the description of CPT 50542, it should not be separately reported or billed. However, if ultrasound guidance is used to biopsy a separate lesion, consider using CPT 76942, ‘Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, and localization device), imaging supervision and interpretation’ with Modifier 59, or the XP modifier if unrelated to the laparoscopic kidney tumor ablation.
  3. The kidney and the ureter are separate structures, so Modifier 59 (or the XS modifier) may be appropriately used when ureteroscopy and laser lithotripsy are performed on separate, noncontiguous stones in the ureter and kidney on the same side at the same session. Some argue that stones are lesions and therefore multiple, noncontiguous stones in the ureter, or multiple noncontiguous stones in the kidney, may fit the definition of proper use of Modifier 59 or XS, whereas others argue that they are not lesions. In these cases, local payer rules should be followed.
  4. Instillation of an antineoplastic agent (CPT 51740) such as mitomycin is bundled to most cystoscopic procedures, including bladder tumor treatments. If the antineoplastic agent is instilled intra-operatively, two codes should not be billed. However, if both procedures are performed on the same date but at different encounters, they should be separately billable. If a patient undergoes a transurethral resection of a medium-sized bladder tumor (CPT 52235) in an ambulatory setting, is discharged, then goes to the office for the instillation of the antineoplastic agent, it is appropriate to bill CPT 51740 with an XE modifier.

If you are the biller and you believe that the 59 modifier would be appropriate but was not indicated, you should go back to the provider to see if it was omitted by mistake. Don’t just add the modifier to the claim without substantial evidence that it is needed. However, it is important to check with your own local carrier for their rules with regard to which modifiers they accept and under which circumstances. Misusing 59, or any other modifier can cause a payer to deny your claim altogether. Avoid claim issues by making sure to always use it properly. As always, bills should only be submitted for legitimately billable services.


 How Best to Use Modifier 59


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New Medicare Enrollment Application (For Physicians and Non-Physician Practitioners)

New Medicare Enrollment Application (For Physicians and Non-Physician Practitioners)CMS received approval for a new Medicare Enrollment Application for physicians and non-physician practitioners (CMS-855I dated 12/2018). Many changes are minor; the major ones reduce provider burden:

  • Eliminated reporting for advanced diagnostic imaging, Clinical Laboratory Improvement Amendments number, and the Food and Drug Administration radiology certification number
  • Expanded instructions for individual and group affiliations to simplify reporting
  • Made it optional to list a contact person
  • Added electronic storage information for those who no longer keep paper records
  • Created a more logical data flow

You may begin using the new application immediately. Through April 30, Medicare Administrative Contractors will accept applications dated 7/2011, but after that, you have to use the new version.

Who is affected?

All physicians and other qualified healthcare professionals (as defined in section 1848(k)(3)(B) of the Social Security Act) must use the CMS-855I (or PECOS) to enroll in the Medicare program and receive a Medicare billing number.

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10 Tips to Reduce Claim Rejections

10 Tips to Reduce Claim RejectionsA rejected claim contains one or more errors found before the claim was processed. Errors will prevent the insurance company from paying and the rejected claim is returned to the biller to be corrected. A rejected claim may be the result of a clerical error or a mismatched procedure and an ICD code. A rejected claim can be resubmitted once the errors have been corrected. If you follow some tips then you can reduce your claim rejections.

Common causes of claim rejections:

  • Incorrect patient demographics
  • Incorrect coding
  • Patient eligibility
  • Out of date information
  • Duplicate claim
  • Incorrect place of service

How to reduce claim rejections:

  1. Talk to the front desk:

The front desk usually collects the patient and insurance information that gets entered into the computer system. Billing needs to communicate and work closely with them to be able to obtain correct information. Getting updated information from the patient at each visit will help to get your claim paid.

  1. Verify patient coverage:

Make sure you have correct insurance information to bill the claim by verifying the eligibility of coverage at each visit. While verifying patient coverage, your first call is probably to the payer, who can verify plan benefits with regard to in-network coverage and out-of-network coverage.

  1. Double check your work:

If you are working fast to complete the assigned work then making typos is very common. Forgetting a digit in an insurance ID or transposing a number can cause claim rejection. Being diligent about double checking your work will automatically reduce the risk of denial.

  1. Stay up-to-date on insurance carrier information:

Monitor your claim denials on regular basis. Something as simple as new insurance company requirements that your biller did not know about can lead to multiple claim rejections.

  1. File claims within 24 hours:

Avoid timely filling issues and file claims immediately. You may have to put a claim on hold to obtain correct information or ask the doctor about code, but don’t forget about it. A good medical biller has a way to handle those claims systematically. It’s also important that you work the claims rejections right away, as the time is essential in both cases.

  1. Preauthorization and other numbers:

Make sure that any authorization number, CLIA number or NDC number for medications, vaccines, and injectable are submitted with the claim. These are easy to find through many helpful websites, as these numbers are required by the FDA.

  1. Submit to correct insurance:

It should come as no surprise the selecting the wrong company to send your claim will result in a speedy rejection. This is another reason it’s so important for the front desk staff to verify insurance with the patient at each and every visit. If the patient has multiple insurance carriers make sure to select the correct one as primary.

  1. Insurance participation:

A provider who is not participating with insurance may also cause your claim to be rejected. If your providers are not credentialed with insurance carrier it’s important to have a system in place to provide your patient an estimate and make them pay in cash.

  1. Train staff:

Train your billing staff to handle rejections quickly. As mentioned, time is essence on both sides of fences, not just when submitting. Far too many claims never get paid simply because rejections aren’t handled appropriately and that can be a huge drain on your practice earning.

  1. Outsource billing:

There is a lot of work involved to ensure you are submitting a clean claim. Many practices struggle with rejected and denied claims and have turned to outsource billing companies for help. The firm like MBC ( has experienced billers and coders who are qualified to deal with the complexities of medical billing. Outsourcing medical billing can be a great choice for your practice as it takes the burden of medical billing off of your staff so you can focus on patient care.

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Have Your Patients Got New MBI (Medicare Beneficiary Identifier)?

Have Your Patients Got New MBI (Medicare Beneficiary Identifier)?The Centers for Medicare & Medicaid Services (CMS) is mailing the new Medicare cards with the MBI in phases by geographic location. There are 3 ways you and your office staff can get MBIs:

Ask your Medicare patients:

Ask your Medicare patients for their new Medicare card when they come for care. If they haven’t received a new card at the completion of their geographic mailing wave, give them the “Still Waiting for Your New Card?” handout or refer them to 1-800-Medicare (1-800-633-4227).

Use the MAC’s secure MBI look-up tool:

You can look up MBIs for your Medicare patients when they don’t or can’t give them. Sign up for the Portal to use the tool. You can use this tool even after the end of the transition period – it doesn’t end on December 31, 2019.

Check the remittance advice:

Starting in October 2018 through the end of the transition period, CMS will also return the MBI on every remittance advice when you submit claims with valid and active Health Insurance Claim Numbers (HICNs).

You can start using the MBIs even if the other health care providers and hospitals that also treat your patients haven’t. When the transition period ends on December 31, 2019, you must use the MBI for most transactions.

Ask your patient for their card. If they have not received a new card, ask them to look for a plain white envelope from the Department of Health and Human Services or sign in to to get their new number or print an official card; or call 1-800-Medicare (1-800-633-4227). Use your Medicare Administrative Contractor’s lookup tool. Sign up for the Portal to use the tool.

Why new MBI?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers from all Medicare cards by April 2019. A new randomly generated Medicare Beneficiary Identifier, or MBI, is replacing the SSN-based HICN.

Using new MBI:

The new MBI is noticeably different than the HICN. Just like with the HICN, the MBI hyphens on the card are for illustration purposes: don’t include the hyphens or spaces on transactions. The MBI uses numbers 0-9 and all uppercase letters except for S, L, O, I, B, and Z. CMS exclude these letters to avoid confusion when differentiating some letters and numbers (e.g., between “0” and “O”).


Use the MBI the same way you use the HICN today. Put the MBI in the same field where you’ve always put the HICN. This also applies to reporting informational only and no-pay claims. Don’t use hyphens or spaces with the MBI to avoid rejection of your claim. The MBI will replace the HICN on Medicare transactions including Billing, Eligibility Status, and Claim Status.

The effective date of the MBI, like the old HICN, is the date each beneficiary was or is eligible for Medicare. Until December 31, 2019, you can use either the HICN or the MBI in the same field where you’ve always put the HICN. After that, the remittance advice will tell you if CMS rejected claims because the MBI wasn’t used. It will include Claim Adjustment Reason Code (CARC) 16, “Claim/service lacks information or has submission/billing error(s).” along with Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier”.

The MBI does not change Medicare benefits. Medicare beneficiaries may start using their new Medicare cards and MBIs as soon as they get them. Use MBIs as soon as your patients share them. The new cards are effective the date beneficiaries are eligible for Medicare. Medicare Advantage and Prescription Drug plans continue to assign and use their own identifiers on their health insurance cards. For patients in these plans, continue to ask for and use the plans’ health insurance cards.

Source: New Medicare Beneficiary Identifier (MBI) Get It, Use It

                Still Waiting for Your New Card?

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Improved Acute Myocardial Infarction (AMI) Guidelines

Improved Acute Myocardial Infarction (AMI) GuidelinesICD-10-CM implementation brought several significant changes to the OCG (Official Guidelines for Coding and Reporting) with regard to Chapter 9 (Diseases of the Circulatory System) I.C.9.e Acute myocardial infarction (AMI). Preparing yourself for coding updates based on MI type is not sufficient. You also must learn how to apply these new codes using OGC for Coding and Reporting.

Here’s how the guidelines update for 2018:

  1. Codes from between I21.0 – (ST elevation (STEMI) myocardial infarction of anterior wall) – I21.2 – (ST elevation (STEMI) myocardial infarction of other sites), as well as I21.3 (ST elevation (STEMI) myocardial infarction of unspecified site), are for Type 1 STEMI heart attacks. Code I21.4 (Non -ST elevation (NSTEMI) myocardial infarction) captures a Type 1 NSTEMI heart attack and nontransmural heart attack. [I.C.9.e.1]
  2. If a patient has a Type 1 NSTEMI and it evolves into a STEMI, code it as a STEMI. If a Type 1 STEMI converts to an NSTEMI due to thrombolytic therapy, code it as a STEMI. [I.C.9.e.1]
  3. Code I21.3 for a heart attack documented as a Type 1 STEMI or a transmural heart attack of unspecified site. [I.C.9.e.2]
  4. Codes between I21.1 – (ST elevation (STEMI) myocardial infarction of inferior wall) and I21.4 are only for type 1 heart attack. [I.C.9.e.5]
  5. Code I21.A1 (Myocardial infarction type 2) along with a second code for the underlying cause of the demand ischemia or ischemic imbalance for a type 2 heart attack. Sequence the two codes according to the focus of care. Use I21.A1 whether the Type 2 heart attack is described as STEMI or NSTEMI. Do not use I24.8 (Other forms of acute ischemic heart disease) to capture demand ischemia in these scenarios. [I.C.9.e.5]
  6. Use I21.A9 (Other myocardial infarction types) for type 3, 4a, 4b, 4c, and 5 heart attacks. Follow tabular instruction contained in “code also” and “code first” notes for associated complications, and for postprocedural myocardial infarctions during or following cardiac surgery. [I.C.9.e.5]
  7. Codes in the I22. – Category (Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction) should not be used for myocardial infarctions other than type 1 or unspecified. For subsequent type 2 heart attacks, assign only I21.A1. For subsequent type 4 or type 5 heart attacks, assign only I21.A9. [I.C.9.e.4]

If you have been coding inpatient records since the implementation of ICD-10-CM, you may have noticed that the OCG for Subsequent acute myocardial infarctions has been evolving. For codes, effective October 1, 2018, additions were made to this guideline referring to Type 2 myocardial infarctions for the first time.

The codes for Type 2 myocardial infarctions, Subcategory I21. The Other type of myocardial infarction, were new codes as of October 1, 2018. Prior to this, there were no unique codes for Type 2 myocardial infarctions. With new codes, new or revised guidelines or clarifications often follow.

It becomes very essential to thoroughly review the 2018 OGs. It’s the only way to be sure you’re using the new codes correctly. Spending a little time on the OGs now will save your practice from costly denials and hours of rework in the future.

Source: 2018 ICD-10 CM and GEMs

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