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Profit sharing, productivity bonuses for physicians: 5 Stark Law updates

Posted Jun 18, 2021

Stark Regulatory Changes Effective January 1, 2022

The Centers for Medicare and Medicaid Services (CMS) recently implemented major changes to the Stark Law regulations, most of which are already in place. However, some health care providers may be less aware of the changes to the “special rule for productivity bonuses and profit sharing” within Stark’s group practice definition. 

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Radiology Orthopedics Healthcare News

UnitedHealthcare Reimbursement Policy Update

Posted Mar 26, 2021


As of March 1st, 2021, UnitedHealthcare has made several updates to their reimbursement policy for Advanced Practice Health Care Providers. The previous policy change was made on April 13th, 2020 when the word “Commercial” was added to the policy header. 

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Medical Coding Healthcare News Billing & Reimbursement

CMS Finalizes Major Cut in Radiology Reimbursement

Posted Feb 19, 2021


After some delay due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) has released the final set of guidelines that will govern the Medicare payment system for 2021. The rule for the Medicare Physician Fee Schedule (MPFS) was proposed earlier last year, and since then, slight revisions have been made including an improvement in the conversion factor and a change to the Quality Payment Program (QPP) performance threshold. 

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Radiology Medical Coding Healthcare News Billing & Reimbursement

Vaping-Related Illness and Injury: What Radiologists Should Know

Posted Nov 5, 2020


Radiologists and healthcare providers of all kinds should always prioritize their awareness of illnesses or injuries that have begun to occur more frequently, whether the instances are being described as an “outbreak” or just as a trend that is increasing over time. One such example is the recent occurrences of cases of e-cigarette or vaping product use-associated lung injury, also known as EVALI. The Centers for Disease Control and Prevention (CDC) recently released an in-depth report focused on this outbreak, its evolution, and its potential causes, which can guide radiologists moving forward as they may be faced with cases of EVALI in their own practices. Keep reading to learn more about this illness and how radiologists can best serve patients with EVALI in 2020.

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HIS Coding Update

Posted Sep 9, 2020

E/M Documentation Changes 2021

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What if your employees do not come back?

Posted Jun 2, 2020

The Impact of COVID-19 on the Healthcare Industry

We are undeniably in uncertain times and uncharted territories. The medical world and the world at large has been thrown into upheaval in an attempt to weather and survive the COVID19 pandemic. Arguably, no industry has been affected more so than the medical industry; even-more the musculoskeletal specialities such as orthopedics and radiology have been virtually shut down. Elective surgeries had been canceled to free up space for COVID-19 patients.

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Radiology Revenue Cycle Management Orthopedics Certified Professional Coder Practice Management Billing & Reimbursement

COVID-19 Expanded Insurance Coverage & Updates for Telehealth Services

Posted May 20, 2020

This is the latest information by the insurance companies updated August 3rd, 2020.

We will be reviewing insurance carrier information each business day and update when applicable. These policies change constantly so we have included the websites for reference.

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CMS and ASC Changes to Come in 2020

Posted Apr 22, 2020


As we are sure most healthcare providers come to expect, each new year brings new changes to codes, payment policies, and processes in the healthcare industry. On November 1st, CMS announced upcoming changes to payment policies, which were detailed in its 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule. The final rule included many new details on processes that healthcare providers should be aware of, and at Healthcare Information Services, we want to keep you up to date so your practice can move confidently into the new year. Below, we have provided more details on some of the main points of the final rule. Keep reading to learn more and get informed so you can be as prepared as possible to adapt to these new changes.

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Surprise Billing Negotiations Continue in Congress

Posted Apr 22, 2020


For those who work in the healthcare industry, surprise billing is not a new concept. This practice impacts patients seeking all types of medical attention, and has been a topic of discussion among lawmakers in recent months. Attention from both the federal government and healthcare stakeholders has propelled this issue into one that might soon have a resolution, because both the House Ways & Means Committee and other significant groups in Congress have been working to find a solution. Congress has been at a stalemate for months regarding this issue, but recent proposals have sparked a new wave of negotiations and conversations by lawmakers to come to a resolution before the December 20th deadline. Keep reading to learn more about this issue and where it currently stands in Congress.

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Expanded coverage for Telehealth Services (COVID-19)

Posted Mar 17, 2020

We have received many inquiries on the reporting of telehealth codes due to CMS reducing the restrictions on telehealth services. As of today, these reductions are available for the diagnosis and treatment of any conditions and/or diseases retroactive to March 6, 2020. While there has been communication from some commercial insurance carriers as to their reduction in restrictions also, as of this notification, it is unknown if they will follow CMS. HIS will keep you updated if new developments change the restrictions.

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HIS Coding Updates

Posted Mar 12, 2020

HIS Coding Updates

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Medical Coding

How to Effectively Review Your Revenue Cycle Process | HIS

Posted Mar 3, 2020

Those in the healthcare industry are certainly no strangers to insurance claim payments being delayed or denied. Practices facing this issue are at a great risk for losing out on revenue throughout each year, because it is estimated that around 25% of denied claims are never paid at all. If your organization’s denial rates are particularly high, this issue is one that will need to be addressed and resolved so your practice can continue to serve patients and bring in revenue. One of the most effective ways to determine how to prevent such denials is to evaluate and assess your practice’s revenue cycle. Keep reading to learn more about how to conduct this type of assessment and how Healthcare Information Services can help optimize your revenue cycle for practice success.

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Revenue Cycle Management

September 2019 Coding Updates

Posted Dec 12, 2019

Intermediate and Complex Repairs

The descriptions for intermediate and complex repairs have been clarified
including adding the description for limited and extensive undermining.

Intermediate Repair- Intermediate repair includes the repair of wounds that,
in addition to the above, require layered closure of one or more of the deeper
layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition
to the skin (epidermal and dermal) closure. It includes limited undermining
(defined as a distance less than the maximum width of the defect, measured
perpendicular to the closure line, along at least one entire edge of the defect)
Single-layer closure of heavily contaminated wounds that have required
extensive cleaning or removal of particulate matter also constitutes
intermediate repair.

Complex repair- Complex repair includes the repair of wounds that in
addition to the requirements for intermediate repair, require at least one of the
following; exposure of bone, cartilage, tendon, or named neurovascular
structure; debridement of wound edges (e.g. traumatic lacerations or
avulsions); extensive undermining (defined as the distance greater than or
equal to the maximum width of the defect, measured perpendicular to the
closure line along at least one entire edge of the defect); involvement of free
margins of helical rim, vermillion border, or nostril rim; placement of
retention sutures. Necessary preparation includes creation of a limited
defect for repairs or the debridement of complicated lacerations or avulsions

Scar revision has been removed from the description of complex repair.
Per the AMA, Scar revision in which skin is excised and closure is
performed should be coded as excision of benign lesion. This code will be
considered included in most other surgical procedures.

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3 Benefits of Expanding PA Scope of Practice

Posted Apr 29, 2019

group-of-doctors-and-nurses-looking-at-xrayIf you are involved in the healthcare industry, you are well aware of the prevalence of scope of practice laws, or SOPs. These laws define and specify the tasks (including procedures, actions, and processes) that healthcare providers at different levels can perform. These laws also govern the level of oversight required for specific tasks, and they vary by both state and occupation. Recently, physician assistants (PAs) have begun approaching state lawmakers and governors to seek an expanded scope of practice that would loosen supervisory and regulatory restrictions in terms of the tasks they can perform and the physician oversight needed. This has led to the consideration of New York, North Dakota, and South Carolina to expand their scope of practice laws. Below, we detail the reasons why an expansion of these laws for PAs would be beneficial to the greater medical community and its patient base.

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Updated QPP Tools Now Eligible for Practice Use

Posted Aug 28, 2018

What are QPP Tools?

QPP stands for Quality Payment Program. The Quality Payment Program was designed to improve Medicare by helping physicians focus on the quality of care over service volume. Prior to 2015, physicians were reimbursed on a fee-for-service model. In 2015, QPP was introduced, bringing a two track value-based reimbursement system to replace the existing system.

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Health Information Services Medical Coding Healthcare News

Breaking Down the CMS Medicaid Integrity Strategy

Posted Aug 28, 2018

What is the CMS Medicaid Integrity Strategy?

The Centers for Medicare & Medicaid Services (CMS) developed the Medicaid Integrity Strategy to combat abuse, fraud, and the waste of Medicaid dollars. The Medicaid Integrity Program was the first comprehensive Federal strategy aimed at combating the abuse of the Medicaid program. This program aims to keep Medicaid sustainable for years to come, especially with Medicaid spending increasing dramatically over the past decade.

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Healthcare News

5 Social Media Tips You Need to Use for Your Orthopedic Practice

Posted Jun 20, 2018


Is Your Orthopedic Practice Getting Social?

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3 Common Business Challenges for Orthopedic Practices

Posted Jun 20, 2018


Solving Common Business Challenges for Orthopedic Practices

Running an orthopedic practice, or any medical practice for that matter, requires a delicate balance of business and clinical expertise. Orthopedists want to focus on providing the highest quality medical services possible, but at the end of the day, they also have a business to run. This can cause several issues within the orthopedic practice. Today, we will go over some of the most common business challenges for orthopedic practices and how to go about managing these problems. 

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5 SEO Tips to Help Your Medical Practice

Posted Mar 28, 2018

SEO Medical Practice.jpg

Useful Medical Practice SEO Tips

The business world experiences insurmountable changes even to the smallest detail on an everyday basis. It’s safe to say that we’re at the height of the digital age and your medical practice must follow suit in order to maximize revenue and onboard new clients in order to increase your online presence both on a local and more widespread scale. With the market rapidly evolving, you must keep up with the latest trends to improve the overall success of a business. One of the most crucial elements of digital marketing lies within the domain of search engine optimization, or more commonly known as SEO. Here are ­­five SEO tips for you to implement into the regular operations of your medical practice’s digital agenda.

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Digital Marketing

February Coding Update

Posted Mar 5, 2018

February Coding Update:

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Certified Professional Coder

The Importance of Accuracy and Compliance in Billing and Coding

Posted Dec 15, 2017


Always Ensure Accurate and Compliant Billing and Coding

When managing a medical practice, you undoubtedly have several things to worry about at any given time. Medical billing and coding is difficult to keep up with, especially with evolving laws, regulations, and medical codes. These changes make it difficult to be compliant even for the most astute practices. Unfortunately, failure to have accurate and compliant medical billing and coding can result in several negative ramifications for your practice. Here are the top three reasons it is vital to be accurate and compliant in billing and coding all of the time, and some of our tips for achieving greater accuracy and compliance.

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Medical Coding Billing & Reimbursement

5 Key Concepts for Payor Reform in Spine Surgery

Posted Aug 30, 2017

Payor Reform Opportunities for Spine Surgery

A recent article published in Clinical Spine Surgery observed payor reform opportunities for spine surgery. The article, written by Jason Scalise, MD, and David Jacofsky, MD, focuses on bundled payments, and the demands for spine surgery to implement bundled payment strategies. Spine procedures are projected to increase dramatically due to age demographics and other population factors. Substantial focus is being put on this division of musculoskeletal care to find a way to drive consistency and value. The trends and increasing pressures by government and commercial payors to drive accountability to the level of the surgeon should not be thought of as a passing phase by spine surgeons. Below are five key concepts for payor reform in spine surgery from the article.

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Healthcare News

7 Revenue Cycle Concerns for Orthopedic Practices and How to Fix Them

Posted Aug 9, 2017

Managing a revenue cycle in the medical field is no easy task. Below are some concerns for orthopedic practices and recommendations for monitoring the health of your revenue cycle.

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Revenue Cycle Management

Radiology Tops Medicare Patient Services

Posted Aug 9, 2017


Radiologists Serve More CMS Beneficiaries Each Year

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CMS Plans to Cut Mammography Reimbursements

Posted Jun 19, 2017



CMS Proposed Cuts to Mammography Reimbursements

Due to be released in early July, the CMS will likely propose a 50 percent cut to the technical component of mammography reimbursement in the 2018 Medicare Physician Fee Schedule (MPFS) proposed rule. According to industry experts, cutting down mammography reimbursements could potentially drive down access to a mammography. As a result, imaging organizations are raising questions about outdated reimbursement formulas in an effort to prevent the cuts from happening.

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Healthcare News

CMS Uncovers 2018 Medicare Advantage Plan Rates

Posted May 8, 2017

2018 Medicare Advantage Plan Rates


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Healthcare News

MedPAC Discusses Refining MIPS and A-APMs

Posted Apr 13, 2017

medi part b.jpg

On March 3rd, the Medicare Payment Advisory Commission (MedPAC) discussed proposed reforms to the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payments Models (A-APMs). The purpose of this meeting was to review the issues and challenges facing the Medicare program and then making policy recommendations to Congress. Commissioners suggested different ways to help physicians’ transition from MIPS to A-APMs, and discussed their recommendations for the future.

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Healthcare News

How to Survive a Merger or Acquisition in Radiology

Posted Apr 13, 2017

Radiology practices continue to grow, but for several years, mergers and acquisitions between practices have been a topic of discussion in radiology. Although there has not been a significant increase in blended practices, it’s a possibility that still concerns many. If your practice is facing the decision of a merger or acquisition, here’s when it might be beneficial to conjoin.

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Top 10 Reasons Why Healthcare Claims are Denied

Posted Nov 30, 2016

Common Reasons for Denied Claims


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ICD-10 Grace Period Ending in October

Posted Oct 18, 2016

CMS Will End the ICD-10 Grace Period on October 1, 2016

Are you ready? The Centers for Medicare & Medicaid Services (CMS) have announced that the grace period for healthcare providers is to expire October 1st, 2016.

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Tips for Orthopedic Revenue Cycle Management

Posted Oct 18, 2016

Revenue Cycle Management Tips for Orthopedic

As specialists in orthopedic revenue cycle management, we understand the importance of a strong and efficient revenue cycle for the health and stability of an orthopedic practice. A robust revenue cycle encourages strong cash flow, maximizes reimbursements, keeps your practice compliant, and increases efficiency and profitability.

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Practice Management & Consulting 101

Posted Oct 18, 2016

Practice Management and Consulting 101

Does your practice need help ? Could it be more successful and profitable with the help of some expert practice management and consulting? Trusting someone to manage your practice and provide you with professional advice honed from 40 years of experience is not easy. Here are some best practices to ensure your practice’s needs are being met.

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Radiology RCM 101

Posted Oct 18, 2016

Radiology Revenue Cycle Management 101

When running a radiology practice, your number one priority is on the patients, ensuring they receive the absolute best diagnostic care. While this is of the utmost importance, it is also vital to remember you are also running a business. With a strong revenue cycle management partner, your radiology practice can  remain stable  and profitable for years to come – allowing you to best serve your patients. Take a look at the best practices for managing your radiology practice’s revenue cycle.

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HIS to Attend BSOF Annual Conference

Posted Sep 13, 2016

Bones Society of Florida Conference in Manalapan Florida

September 16th through 18th marks the annual Bones Society Of Florida (BSOF) Conference at East Palm Beach Resort and Spa. Guests can find HIS at booth 45 within the conference all weekend long. Stop by our booth to learn more about the services HIS provides and discuss how we can help your specific orthopedic practice. As an added bonus, our table will also be giving away a gorgeous Vincent Camuto handbag.

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The difference with HIS

Posted Jul 20, 2016

Recently, I was asked the question “We are wondering what sets your company apart from other billing/revenue cycle companies such as Athena.  We have been comparing EMRs and some have the billing side as well. We would like to know if we are comparing Apples to Apples.” I love when we are asked that question, in short it means “How does HIS compare…?”

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Monthly Coding Update

Posted Jun 6, 2016
Keep up-to-date on the latest industry updates, courtesy of the experts at Healthcare Information Services. Here are this month’s coding updates:

New Cigna Coverage Policy

Effective May 16th, 2016 Cigna enacted a new policy for strapping. This policy will now cover strapping tape as a medical necessity, citing its importance in the initial management of an immobilized joint and restriction of movement. Strapping tape will be covered for the following:

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3 Ways to Start Increasing Healthcare Revenue Today

Posted Apr 19, 2016

You know there are times when you need to make something fit but it just won't. Like a time when all of your information had to fit on a single page but just didn't? When this happens it's not time for a complete overhaul. Instead, some subtle tweaks are needed...

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Revenue Cycle Management Billing & Reimbursement

The Essential Cheat Sheet On Radiology Billing

Posted Apr 11, 2016

radiology-billingWhen it comes to profitability in healthcare, billing is only one part of the big picture. There are steps any radiology practice must take in order to ensure financial success. Effective revenue cycle management is key to profitability and financial health.

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4 Myths about Billing & Revenue Cycle Outsourcing

Posted Mar 21, 2016

Revenue Cycle Management (RCM) is a necessary piece of the healthcare puzzle and it remains an integral part of the success of any healthcare business. When a clinic outsources the management of their revenue cycle, they entrust an outside company to handle coding, claim submission, collections, et al. Some practices choose outsourcing RCM due to cost-benefit analyses, spacing and time issues, or convenience. Other practices retain in-house management of the revenue cycle, traditionally when they have experienced, trained coders on staff and a time-tested process already in place.

All practices are not alike and have their own nuances to their revenue cycle. Look within, and evaluate your current situation to determine whether outsourcing is right for you. Whether or not you have considered partnering with a revenue cycle management firm or not, I am sure you have heard both success and horror stories. Below, I’ve debunked four common myths about revenue cycle outsourcing.    

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healthcare Health Information Services Revenue Cycle Management

Most Common ICD-10 Error Codes

Posted Mar 16, 2016

According to a recent study by the Healthcare Information Management Systems Society, only 63% of ICD-10 coding is accurate. There were some common trends in this study as far as common mistakes people tend to make when coding. Incorrect coding costs both time and money, so take a look at these common coding errors made in ICD-10 to learn more about improving your practice’s efficiency.

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3 Healthcare Coding Updates You Can't Afford to Miss

Posted Mar 15, 2016

Healthcare coding is constantly in a state of change. Since ICD-10’s implementation, we’ve done our best to keep you informed and updated on all decisions, changes, and clarifications. Following proper coding practices increases the likelihood of prompt payment and keeps processing as efficient as possible. Below I’ve included a breakdown of changes and updates regarding comparison view x-rays, foot care, and surgical spine treatment. 

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ICD-10 Medical Coding Orthopedics

ICD-10 Impact on Radiology Billing

Posted Mar 11, 2016

Now that ICD-10 is officially in full effect, radiology practices have had to fully integrate with the implementation of ICD-10. To make the conversion both swift and successful (and to avoid losing money), practices will need to implement new strategies and education. Setting up, performing, testing, and training on the new system will take some time - hopefully you've got the hang of most of it since the October 2015 switch. But what kind of impact is ICD-10 going to have on radiology billing? Good question.

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Radiology ICD-10 Practice Management Billing & Reimbursement

Radiology Coding Changes in 2016

Posted Feb 9, 2016

One of the biggest challenges any radiology practice faces is accurate coding. The right coding procedures can make the difference between a smooth revenue cycle and quick reimbursements, and a drawn-out process that costs the clinic money and leads to delays in reimbursements. The adoption of ICD-10 codes led to changes in radiology coding. At Healthcare Information Services, our number-one priority is to assist your hospital or clinic in dealing with coding changes to maintain a healthy bottom line.

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Radiology Medical Coding

Report: CMS underpays Medicare Advantage plans for treating chronic conditions

Posted Feb 1, 2016

This content was originally posted on Jan. 22, 2016 by Katherine Moody on FierceHealthPayer. Click here to see the original source.

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Healthcare News Billing & Reimbursement

The Basics of Multiple Procedure Payment Reduction (MPPR)

Posted Jan 5, 2016

Physician billing can be complicated, especially if you work with Medicare. But even commercial companies impose a Multiple Procedure Payment Reduction, or MPPR, in some instances. And although our team of experts at Healthcare Information Services know the ins and outs of how MPPR works, we want to make sure  you understand this insurance procedure, and why it occurs.

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Health-Insurance Billing & Reimbursement

The Impact of ICD-10 After its First Quarter in Effect

Posted Dec 22, 2015

October 1st, 2015 marked the official transition of the long anticipated ICD-10 coding guidelines going into effect. While there was no “transition period”, medical practitioners were told well in advance that they would have to completely make the change to ICD-10 by the first of October 2015. Hospitals and medical practices all over the United States have been preparing for the huge medical coding change to go into effect. This has included hiring teams to come in and train the staff, hiring a team to take over the management of your revenue cycle, or spending a significant amount of time dedicated to learning the new guideline on their own.  Now that ICD-10 has been in full swing for a full quarter, let’s see the effects it is having on practices and hospitals in the United States.

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3 Tips for a Better Radiology Billing Process

Posted Dec 21, 2015

Radiology is a high-volume specialty, and as you can image accurate coding is critical. If you think about the massive number of medical records and documents your radiology staff have to read and interpret, you understand why they want billing processes and reports that are quick and to the point. An experienced radiology coder understands the critical pieces of documentation needed to assign procedure codes to ensure physicians and their practice make as most money as they can. That's why we have billing experts, right? Better radiology billing knowledge = better bottom lines.

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Radiology Revenue Cycle Management Billing & Reimbursement

Radiology Billing Changes Coming in 2016

Posted Dec 16, 2015

As with every New Year, change is coming. Over the years, radiology billing has experienced a number of changes, specifically in regards to coding. This year is no different, as there are new codes to learn and more codes to bundle. We’ve put together an overview of the changes from 2015 to 2016 to help your healthcare practice prepare for what’s coming next.

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Radiology Billing & Reimbursement

3 ICD-10 Coding errors + How to Fix Them

Posted Dec 8, 2015

The Healthcare Information and Management Systems Society and Workgroup for Electron in Data Interchange recently released a report on ICD-10’s national pilot program. The results within this report found that only 63% of submitted ICD-10 codes were complete and precise. Although this finding occurred prior to the ICD-10 coding system being enforced on October 2015, it was still able to collect relevant errors and mistakes to avoid while moving forward with this system.

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ICD-10 Medical Coding

5 Orthopedic Billing Guidelines

Posted Nov 18, 2015

The billing process in the revenue cycle is one of the most important functions for orthopedic practices today. With proper billing, revenue will continue to come in with minimal delays minimizing stress and cash flow issues. When it comes to orthopedic billing, practices need to keep several important things in mind if they want to bill as effectively as possible and minimize the chance of claim denials. Here's five orthopedic billing guidelines at the top of our list...

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ICD-10 Medical Coding Billing & Reimbursement

7 ICD-10 FAQ’s

Posted Nov 16, 2015

ICD-10 FAQ's

Since the conversion from ICD-9 to ICD-10 in October 2015, there have been many questions regarding the switch. At HIS, we understand the stress and confusion this change may cause for healthcare providers and their staff. ICD-10 is much more complex than previous coding systems in effect for the last 30 years. Though change can at times be uncomfortable, it can also be good. ICD-10 allows for much more detailed diagnoses and its set rules about coding is far more suitable for the twenty first century.

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ICD-10 Medical Coding

Send Fewer Bills to Collections with these 3 Tips

Posted Nov 13, 2015

Every year the amount of bills sent to collections increases. This is hurting healthcare practices’ pocketbooks, increasing patient debt, and damaging patient credit scores. Because collection agencies are paid by healthcare providers to collect money from patients, healthcare institutions are paying to be paid. This is neither beneficial or a good use of your practice's revenue.

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Billing & Reimbursement

5 Benefits of Outsourced Revenue Cycle Management

Posted Oct 22, 2015

The evolution of the healthcare industry and adaption to ICD-10 is making for many changes, stresses, and distractions for healthcare professionals. In addition to this and daily care for patients, some medical workers are also lending a hand with administrative tasks like helping with bills, paperwork, and claims. It may seem like a good system, but utilizing workers who are not specialized specifically in healthcare billing and administration can actually cause an organization time and money. 

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ICD-10 Revenue Cycle Management

The Top 7 ICD-10 Implementation Resources

Posted Oct 20, 2015

The ICD-10-CM implementation deadline has come and gone. Can you believe it? After years of updates and delays, it finally came to fruition. October 1, 2015 was the official launch. Were you ready?

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What is Next Generation Revenue Cycle Management?

Posted Oct 15, 2015

In the business of healthcare, revenue cycle management covers all of the processes that encompass with collection and measurement of revenue to you and your practice. This should include registration, eligibility verification, coding and claim preparation, claims submission and processing, insurance collections, rejections, denailas, appeals, patient responibility collections,payments posting, financial analysis and reporting, financial projections, and all other relevant tasks for revenue generation and colleciton. In other words, it should help you monitor your claims and payments throughout the life cycle of your practice. The revenue cycle begins when a patient first schedules an appointment and ends well beyond the collection and posting for all payments for that encounter.

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Revenue Cycle Management

Value vs. Volume Based Care: 6 Critical Issues

Posted May 28, 2015

ID-10094648Medical practices, including radiologists and orthopedic surgeons, are facing numerous challenges in 2015 as the entire healthcare industry debates the benefits of volume-based care versus value-based care.  The current volume-based reimbursement model has faced controversy over the idea that doctors may be over-treating patients as a way to generate additional income or in an attempt to keep up with lowered reimbursements.  This has created an ethical and financial dilemma for practices who want to be reimbursed at a rate that can keep their doors open, but without over-treating patients or increasing the volume of patients to unmanageable levels.  The move from the volume-based to a value-based model is supposed to be a step toward resolving these concerns, but it also raises six critical issues when comparing the two models.

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healthcare Radiology Orthopedics

Survey of Available Tools for Converting to ICD 10

Posted May 21, 2015

Survey_of_ICD_10_ToolsPhysicians, hospitals and small medical practices are in a race to make sure they are in compliance with ICD-10 codes by October 1st, 2015.  Switching their systems over has proven to be a bit more complex than anticipated.  The reasons are that ICD-9 codes may have multiple mappings to much more specific ICD-10 codes or no mapping at all.  The complexity of each system switch-over is different depending on the medical specialty, the codes normally used to provide services, and the type of office itself.  Many providers are turning to special tools to help them make the switch, but in the end the usage of such tools will have to be customized to their particular practice.

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ICD-10 Health Information Services

Practices Not Prepared for ICD-10

Posted May 7, 2015

hourglass-620397_640Beginning October 1, 2015, the medical community will be required to switch from the ICD-9 coding system to ICD-10.  This change brings with it many tasks and responsibilities on the part of physicians and their staff.  Even so, there are apparently, many orthopedic practices and other medical practices that have taken little to no action to prepare.

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healthcare ICD-10

What the New "Doc Fix" Bill Will Mean for Your Practice

Posted Apr 22, 2015

ID-10022490While not the first time Medicare funding has undergone revision, (and likely not the last), the "Doc Fix" bill seeks to fix a long term problem with the system.  This bipartisan effort is focused on establishing more realistic funding and for Medicare, affecting both patient care and physician reimbursement.  This bill is considered a long-term fix, and not the more commonly used patch method to secure funding.

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Health Information Services Health-Insurance Practice Management

CMS Delays Final Ruling on Medicare Overpayments - What Could It Mean for Your RCM Payment Program?

Posted Apr 9, 2015

ID-10096057In 2012, Centers for Medicare and Medicaid Services (CMS) published a rule that would require providers to report and refund any overpayments within 60 days from the date the overpayment was found.  As an orthopedic provider, you have probably received some of these notices from Medicare.  However, due to the amount of comments and extensive discussion around the issue, CMS has delayed its final ruling on the 60-Day Overpayment policy.  Of particular concern has been the provision that this requirement could include audits going back as much as ten years.  So what does this mean for your office?  Read on.

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Health Information Services Medical Coding Healthcare Organizations

What you need to know: CMS to shorten 2015 attestation reporting period

Posted Mar 31, 2015

Reporting_Blog_HISBy now, you and your staff are probably quite familiar with the concepts and regulations of "meaningful use" (MU) of electronic health record (EHR) technology which has to be demonstrated in order for hospitals and eligible providers (EPs) to receive the incentive payments from the Centers for Medicare and Medicaid Services (CMS). You are probably also fully aware that there are specific criteria that has to be met and "attested" to in order to document that "meaningful use" has been achieved.

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Health Information Services Medical Coding Healthcare Organizations

Revenue Cycle Management and Contract Compliance: How to Analyze your Payment Variances

Posted Mar 28, 2015

ID-10093467Payment variances may have many causes, but they typically land in two major categories.  The first category is when a payer has updated their payment system to account for issues like a new contract fee schedule.  The second major category of occurrence that can cause payment variances is when a payer has made changes to their payment system, but the configuration wasn’t successfully applied.  Since both of these situations tend to happen at the start of a new contract year, that’s the time to pay attention to issues that crop up by analyzing your payment variances before they get out-of-hand.

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Medical Coding Revenue Cycle Management

CMS to Audit for Code 99233

Posted Mar 19, 2015

ID-100206709Correct documentation is crucial for physician billing to Medicare.  Over the past few years, The Department of Health and Human services has been strongly focused on correcting and minimizing healthcare fraud.  Currently, evaluation and management (E/M) services are under high scrutiny, especially CPT code 99233. What does this mean for your practice, and how can you protect your assets?  We’ve compiled a list of three ways to prepare for random CMS audits of 99233.

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Medical Coding Healthcare Organizations

MQSA Regulatory Accommodation for Changes to the ABR Certification Examination Process: FDA Guidance

Posted Mar 5, 2015


Medical residents who are preparing to graduate this June and who wish to be classified as an interpreting physician according to the MQSA need to be aware of requirements changes that went into effect last year.  The ABR made changes to their certification process which led the FDA to come out with guidelines to accommodate those ABR changes.  This confusing process, and attendant requirements, are explained below.

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Certified Professional Coder

PQRS Penalties in 2015

Posted Feb 26, 2015

2015_PQRS_PenaltiesOrthopedic providers may be subject to a reimbursement penalty on all claims submitted to Medicare for 2015. If you are an eligible professional (EP) that participates in the Physician Quality Reporting System (PQRS)  or a group practice participating in the Group Practice Reporting Option (GPRO), then you’re in danger of receiving a negative payment adjustment (penalty) of 1.5% on all covered services rendered this year. The 1.5% is to be deducted from the normal Medicare Physician Fee Schedule (MPFS) for services provided. Keep reading to find out if your practice will be affected by the adjustment.

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PQRS Health Information Services Orthopedics Practice Management Billing & Reimbursement

How the 2015 CPT Coding Changes can effect your Orthopedic Practice

Posted Feb 26, 2015

orthopedic_practiceThe 2015 CPT coding changes will affect many different venues of healthcare with new and combined coding as well as removed codes. CPT 2015 code changes include: 134 revised, 143 deleted, 264 new as well as changes in guidelines. For orthopedic practices the new coding is already in effect, and needs to be adhered to immediately to ensure proper billing and payments.

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Health Information Services Orthopedics Practice Management

4 Barriers to Private Practice for Med School Graduates

Posted Feb 4, 2015

ID-100171785Released in September of 2013, Epocrates' 8th Annual Future Physicians of America Survey asked more than 1,000 U.S. medical students to share their opinions about healthcare reform, their career goals, evolving technology and other hot button topics.  The survey found that today's medical students are overwhelmingly planning to join group practices or hospitals instead of starting solo or partnership practices.

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Health Information Services Revenue Cycle Management Practice Management

4 Key Signs It's Time to Outsource Your RCM

Posted Jan 22, 2015

ID-10052928 Like many other physician practices, you may be undecided whether or not to outsource your billing and Revenue Cycle Management (RCM) functions.  You may have already outsourced payroll and transcription, but when it comes to billing, you might think twice and say, “Won’t that be a mistake?”

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Revenue Cycle Management Certified Professional Coder Billing & Reimbursement

Summary of 2015 Medicare Physician Fee Schedule Final Rule

Posted Jan 13, 2015

ID-100259413Summary of 2015 Medicare Physician Fee Schedule (MPFS) Final Rule

On October 31st, 2014 CMS released final ruling on the  2015 Medicare Physician Fee Schedule (MPFS). This is a summary of that final rule.

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Health Information Services Health-Insurance

EHRs Play Critical Role in Radiology Decision-Making

Posted Dec 29, 2014

ehr_medical_recordsAs the use of electronic medical records (EMRs), now electronic health records (EHRs), becomes more prevalent, users are beginning to really understand their ultimate value and critical use. One of the most illuminating ways EHR data is helping out the healthcare industry is in their aid with decision making.

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Radiology Health Information Services EHR

Business Analytics for Radiology

Posted Dec 23, 2014

IAnalyticsn today’s competitive healthcare environment, radiologic service providers must operate under increasing requirements and constraints as they face decreasing resources and reimbursements. Consequently, they must continuously demonstrate values to their clients and look for ways to continually make improvements. Service providers must go beyond simply managing operations and measure upgrades in their processes as it relates to productivity, efficiency, quality, and safety.

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Radiology Health Information Services Practice Management

Insurance Verification and Pre-certification: Two Separate Issues

Posted Dec 4, 2014

ID-100272857Over the past several years, orthopedic revenue cycle management has been impacted by the number of changes taking place throughout the healthcare industry. Not only have government programs such as Medicare and Medicaid reduced physician reimbursement, but third-party payers have also implemented negotiated fee-for-service contracts. These changes have a negative impact and tend to result in less than 100% reimbursement for charges accrued.

As if these changes aren’t enough, certain provisions contained within HIPAA have also made claims data submission more stringent. Consequently, many practices are looking for ways to improve their revenue cycle processes.

Insurance verification and pre-certification are two issues in orthopedic practices that can affect reimbursements. Implementing strategic changes in the business processes related to these areas can enhance the bottom line of any practice.

Verification at your practice

The staff that you have assigned to verify your patient's benefits plays a critical role in your practices reimbursement rate.  Verification may be the most effective method to lowering denials from the payer as they are the ones making decisions that will determine whether you will be paid appropriately for services rendered-- if paid at all.  These employees’ must focus not only on obtaining benefit information before a patient arrives for an appointment, but must ensure that the benefit information they obtain is accurate and correct.

The best practices for ensuring that the verification process at your practice works to the optimal level includes the following elements:

  • Identify the best resource use--typically online based on the insurance plan.
  • Initiate the insurance verification process as soon as the patient is scheduled for a procedure.
  • When you require detailed information speak to an insurance company representative rather than perusing the website or using an automated system.
  • Know what questions you need to ask in order to obtain the correct benefits for your patients.

Well-trained staff can get the bulk of this information by simply looking at the insurance ID number, group, or plan on the patient’s insurance card. Make sure that new employees or individuals promoted to the verification staff have the proper training on the appropriate processes.


Pre-certification or pre-authorization has always been a thorn in the side of physicians and their billing staff. According to a study published in the Journal of the American Board of Family Medicine, it is estimated that the cost for prior authorization activities, per full-time equivalent physician to be between $2,161 and $3,430 a year. Many insurance carriers are now requiring pre-authorization for more procedures and services than ever before. In addition, many insurers have made it a policy to disallow retroactive authorizations.

The process of obtaining prior authorization can be challenging and time-consuming. However, getting proper pre-authorization on the front-end before rendering services increases the likelihood of prompt payment and decreases write-offs on the back-end.

If your practice has more than one location, consider creating greater efficiencies by centralizing the responsibility for obtaining pre-certification. You can also seek blanket approval from insurance carriers for a “plan-of-care” for specific conditions and treatment protocols, which minimizes or eliminates the need to call every time for authorization.

The degree to which you effectively manage your revenue cycle will determine the level of success your practice will have. With reimbursements from private insurance carriers and the government on the decline, conduct an evaluation of how you manage your processes, especially as it relates to verification and pre-certification procedures.

After you conduct the assessment, you should have a better understanding of the underlying issues affecting your bottom line. You will now be prepared to take the necessary steps to remove the impediments and improve your revenue cycle processes.

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Health Information Services Revenue Cycle Management

Two Risks & Five Benefits of Outsourcing your Revenue Cycle Management Functions

Posted Dec 1, 2014

Outsourcing_RCMAs the healthcare industry continues to grow in terms of capacity and complexity, there is one thing that clinics and private practices have in-common; the need for an efficient revenue stream. For many healthcare administrators this presents a bit of a dilemma since, to provide quality care and secure a reliable revenue cycle, they must wear two very different hats.

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Health Information Services Revenue Cycle Management

The Benefits of Lean Processes in Radiology Practice Management

Posted Nov 29, 2014

Lean_ProcessesThe increasing competition in private practices puts a significant burden on your shoulders. You’re no longer just required to deliver excellent results but you also want to cut on costs by increasing efficiency to maximize resources.

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Radiology Health Information Services Medical Coding

The Pro's and Con's of Physician Group Hospital Employment

Posted Nov 26, 2014

ID-10033375_(1)According to a recent report, the trend for hospital physician employment may not be as beneficial to hospitals and physicians as some previously thought. Although there may be some advantages for physician groups to be owned by a hospital, by and larger there are numerous of reasons such an arrangement may not be the best one.

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Health Information Services Medical Coding

Impact of Payer Mix Shift on Orthopedic Practice Payments

Posted Nov 7, 2014

Impacts_of_Payer_Mix_ShiftIn order to maintain a healthy revenue stream, it is key that your practice has a well-balanced mix of payers. If your revenue stream seems to be sagging it could be that your payer mix has shifted in a negative direction. That is, you may have seen patients with coverage from lower, poor, or slow payers.  Here are some things you can do to address that situation.

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Health Information Services Medical Coding Orthopedics Billing & Reimbursement

OIG Looking at Mis-Coding of E&M Claims

Posted Oct 29, 2014

OID_Study_and_SurveyA recently released study from the Office of the Inspector General (OIG) of the US Department of Health and Human Services focused on improper Medicare payments for evaluation and management (E/M) services. E/M services include visits to non-physician and physician practitioners that aim to manage and assess a patient's health.  In 2010 Medicare paid $32.3 billion for all E/M services which made up almost 30% of all Part B payments for the year. 

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Health Information Services Medical Coding Orthopedics

The Importance of Time in Orthopedic Patient Payment Collections

Posted Oct 27, 2014

Time_for_Othropedic_Billing_PatientsWhen it comes to collecting payments for orthopedic services rendered, time is the enemy.  As time passes, the likelihood for reimbursement decreases. What can a practice do to ensure the collection of payments?

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Health Information Services Practice Management Billing & Reimbursement

Credentialing Effects on Reimbursements for Orthopedic Practices

Posted Oct 20, 2014

credentialingOrthopedic practices often suffer from revenue stream issues stemming from a number of different causes. The reimbursement process is complicated enough without holding it back due to issues within a practice, and yet there are common concerns which plague orthopedic practices if not carefully monitored. One of these issues is the credentialing process for providers.

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Health Information Services Practice Management Billing & Reimbursement

Why Are My Receipts Down?

Posted Oct 16, 2014

A healthy revenue stream is the lifeblood of any healthcare practice, but with so many variables in play, maintaining a steady flow of incoming revenue can be a challenge. It's situations like this which call for investigation into the practice's revenue cycle management. 

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Health Information Services Medical Coding Revenue Cycle Management

The Impact of ACOs on the Bundled Payment Program

Posted Oct 2, 2014

ID-100231194On January 30th, the Centers for Medicare and Medicaid Services (CMS) released financial figures which showed savings of approximately $380 million.  These savings, according to HHS secretary Kathleen Sebelius, could be directly attributed to various Accountable Care Act and Bundled Payment initiatives.

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Health Information Services Practice Management

Unbundling the Bundled Payment Program

Posted Sep 25, 2014

ID-100176423The Bundled Payments for Care Improvements (BPCI) initiative of the Centers for Medicare and Medicaid (CMS) seeks to improve the quality of care - the outcome - while limiting the cost of the services provided for a particular episode of care for specific patients.  The approach is not unlike that taken by CMS in the mid-1980’s with the implementation of the Inpatient Prospective Payment System (IPPS) based on particular discharge Diagnosis Related Groups (DRGs).  That saw the change from a “time and materials” type of reimbursement for inpatient care to hospitals, to a “flat fee” basis for a particular discharge diagnosis.  This caused the change of various hospital departments, like radiology, physical therapy, rehabilitation and occupational therapy, lab, etc., from being “revenue centers” to being designated as “cost centers”. Hospitals were no longer reimbursed based on the amount of services provided to inpatients, but strictly on the discharge diagnosis.  The DRG-based IPPS reimbursement program only applied to inpatient reimbursements to hospitals.  The reimbursement to physician providers and for hospital outpatient services were still based on the volume of services provided.

The bundled payment program is an attempt to expand the DRG reimbursement concept and extend it to a whole “episode of care” as opposed to a particular “length of stay” as a hospital inpatient.  As structured by the CMS, the bundled payment program has four different models for implementation.  

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Health Information Services Practice Management Billing & Reimbursement

Payor Contract Compliance & Tracking Reimbursements: Are You Being Paid Correctly?

Posted Sep 4, 2014

Payor_Contract_ComplianceIf you are a practicing physician in this market, you may wonder why you are working long hours and seeing as many patients as you can, yet the amount of money you are collecting seems to be decreasing.  You cannot identify the problem and it seems as though your billing system is working.  Bills are going out and collections are coming in but something is just not right.

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ICD-10 Health Information Services Medical Coding

HIS accepts ALS Ice Bucket Challenge and raised funds to donate to research

Posted Aug 29, 2014

HIS was challenged and accepted the ALS Ice Bucket Challenge:

HIS is a tight-knit group and often act as a family.  On Friday August 29th, 2014, we honored one of HIS' family members and the memory of her husband who died from ALS. 

More than twenty people participated in the ALS Ice Bucket Challenge and together raised close to $1500 for ALS research.  See the video below or you can also see the video here.

Keeping with the spirit of the challenge, Dave Wold CEO of HIS challenged the Administrators from Illinois Bone & Joint Institute.  With this, they are now on the clock. 

  • Michelle Flaherty, IBJI-Chicago
  • Melody Winter-Jabek, IBJI-Glenview
  • Maureen Zizzo, IBJI-Morton Grove
  • Grant Mayer, IBJI-Arlington Heights
  • Sally Mangano, IBJI-Bannockburn
  • Clara Joyce, IBJI-Libertyville
  • Peter Jabek, IBJI MRI
  • André Blom, IBJI Rehab
  • Kristie Martinez, IBJI-Gurnee
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Revenue Cycle Management in Healthcare: Managing Insurance Denials

Posted Aug 29, 2014

ID-10059317Eliminating claim denials is a crucial aspect to revenue cycle management.  Successful healthcare providers have streamlined operations and made the revenue cycle more efficient.  They understand that every step counts when it comes to securing reimbursements and obtaining revenues for their services.  An operation that lacks efficiency, the necessary staff skill set or effective processes in place can have unnecessary insurance denials which can have a costly impact on your bottom line. 

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Health Information Services Revenue Cycle Management Health-Insurance Billing & Reimbursement

Moving from Volume-based to Value-based Reimbursement

Posted Aug 28, 2014

Patient_Satisfaction5 initial Steps to improve operations and increase patient satisfaction.

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Health Information Services Revenue Cycle Management Practice Management

Collecting Small Patient Balances - A/R Best Practices

Posted Aug 21, 2014

ID-1002311942014 has certainly had the medical profession dealing with major changes in every facet of healthcare.  From procedure documentation and coding, to billing and coding policy changes, and even the collection of patient balances; just about every aspect of the physician practice has been affected by changes in policy and regulations.  The Affordable Care Act (ACA) has made the already confusing and oft times, costly and time consuming recovery of the patient insurance copay and deductible portion of medical claim even more frustrating.

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Practice Management

Assuring Safe Patient Health Information (PHI) in Radiology

Posted Aug 12, 2014

ID-100259388PHI may be referred to as "personal health information" or "patient health information", and both of these acronyms are technically true, as the information in question is personal to the patient. However, according to the HIPAA Privacy Rule, PHI is short for "protected health information". According to the HIPAA website, this information includes: “patient names, addresses, and all information pertaining to the patients’ health and payment records". It can also extend to financial information, SSN numbers, and even photos of patients.

Keeping this information private and secure is essential in order to avoid negative repercussions for the patient (should their personal, medical and/or financial information fall into the wrong hands) and to avoid civil and criminal penalties which could be incurred if a practice fails to comply with HIPAA Rules.

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Radiology Practice Management

ICD-10 Delay: What You Can Expect Over The Next Year

Posted Aug 6, 2014

ID-100250014The latest delay in ICD-10 implementation has caused both frustration and relief for people in the healthcare field.  Now that the official date for implementation is October 1, 2015, here’s what you can expect to see happening during this interim period.

Healthcare Organizations Taking Advantage of the Delay

The primary purpose behind the several delays has been to give healthcare practices more opportunity to prepare for the transition.  A great number of companies have taken advantage of this most recent delay to go far beyond mere readiness.  Instead, they are investing more time in training their staff in the new codes.

This is not a question of simply learning a few new codes.  ICD-9 already had 17,000 codes and five positions.  ICD-10 will contain 69,000 codes and seven positions.  Even people already well-versed in coding practices need a considerable amount of preparation to learn the new codes and their various permutations.

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Shared Risk Reimbursement: 5 Challenges & Opportunities for Radiology

Posted Jul 28, 2014

man-96868_640Market forces and the implementation of the Patient Protection and Affordable Care Act have combined to transition radiologists and other healthcare service providers from a traditional fee-for-service payment model to other types of payment agreements, including medical shared risk reimbursement.  Radiologists and other stakeholders must put into practice strategies that will enable them to balance potential revenues and profit with the financial risk.

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Revenue Cycle Management

Radiology Billing Guidelines: 6 Best Practices

Posted Jul 25, 2014

Using the practices referenced above can go a long way toward ensuring that any practice's radiology billing process will become more streamlined and efficient, thus allowing for greater success for the healthcare provider in question

512px-Radiology_01204_NevitAccurate and efficient radiology billing can prove tricky, especially with so many factors influencing the final outcome.  Still, maintaining a healthy revenue stream is possible for any healthcare provider so long as the practice adheres to a handful of best practices.  Many of them are fairly common sense but, if ignored, can prove detrimental in the long-term.

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Billing & Reimbursement

5 Steps to Improving Receipt of Patient Payments

Posted Jun 11, 2014

2204277278_cbf43f4146_bIncreasingly, the healthcare industry has been shifting toward patient cost-sharing, which includes high deductibles, co-pays, and coinsurance. Consequently, collecting from patients has taken on a higher level of importance than in the past. According to ACA International, 29 percent of adults have medical debt.  Many of these people have problems paying their medical bills.

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5 Benefits of Orthopedic Group Purchasing

Posted Jun 6, 2014

6869772267_859961ebb2_bA study conducted by Dr. Eugene Schneller, Professor of Supply Chain Management at Arizona State University: ‘The Value of Group Purchasing 2009: Meeting the Needs for Strategic Savings’,  reports that group purchasing saves the healthcare industry $36 billion annually.  For decades, hospitals have used the advantages of group purchasing to leverage their combined purchasing power to receive significant discounts and realize tremendous efficiencies and savings.

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Group Purchasing Organizations Orthopedics

Next-Generation Revenue Cycle

Posted Jun 5, 2014

money-1-1290130-mWith the increasing adoption and implementation of the Patient Protection and Affordable Care Act and its various components, the financial reimbursement picture is drastically changing.  We now have an increased emphasis on value-based reimbursement, risk sharing and bundled payments instead of just volume-based reimbursement.  In addition, there is now an increase in the patient portion of reimbursement that needs to be taken into account.

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Revenue Cycle Management

5 Tips To Ensure Timely Patient Payment

Posted May 29, 2014

Consider contracting the healthcare revenue cycle management functions to a third party such as Healthcare Information Services.  This will allow you and your staff to focus your efforts on other core areas, such as recruiting, providing new services, and improving other areas of you practice.

ID-100138472For physicians and other healthcare providers, the healthcare revenue cycle management (RCM) function for patients can be an administrative nightmare.  To help your practice do a better job of collecting on patient accounts, you must place a priority on educating patients and helping them understand the insurer’s payment policies, as well as their own billing and payment responsibilities.

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Revenue Cycle Management

7 Best Blogs To Follow About Healthcare Legislation

Posted May 28, 2014

healthcare blogs hisThe Affordable Care Act has generated more interest in healthcare legislation than any other single piece of legislation to have been enacted in decades.  For the healthcare industry, the flurry means more sources to use in our exploration of this and similar topics that we’ve followed throughout our careers.  

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Healthcare Organizations

5 Signs You Should Outsource Your Medical Billing

Posted May 22, 2014

outsourcing HISAs a healthcare professional, your focus and strength should be on your patients and their treatment plans rather than on managing your office financials.  In looking at how you handle medical billing, you may be tempted to stay with what you have in place rather than spend the time to make a change.  But in today’s volatile economy, you should pay attention to the signs that it’s time to take that leap.  Here are five signs that you should outsource your medical billing.

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ICD-10 Revenue Cycle Management Billing & Reimbursement

4 Myths About The ICD-10 Delay

Posted May 15, 2014

ID-100260502_(1)-1The process of switching over to ICD-10 has caused a lot of stress in healthcare circles even before many companies begin to make the change.  While the repeated delays in the mandate to convert record-keeping processes bring a relief to some, they also cause more confusion. These delays have generated a number of myths that need to be dispelled so that coders and billers can get on with the real work involved in moving on to ICD-10.

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ICD-10 Medical Coding Healthcare Organizations Billing & Reimbursement

8 Major Advantages of Dictated Medical Documentation and Transcription

Posted Apr 30, 2014

ID-100229190Due to incentives offered to physicians by Centers for Medicare and Medicaid Services (CMS) for using electronic health records (EHR), physicians have been experimenting with different ways to do this that are both efficient and cost-effective.

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Medical Coding Practice Management

ICD-10 Delay: What It Means To You

Posted Apr 15, 2014

ID-100246949When President Obama signed H.R. 4302 into law, it pushed back the compliance date for ICD-10 by at least one year.  The 10th revision of the International Statistical Classification of Diseases and Related Health Problems introduces a significant change to the coding system.  That has some practitioners scrambling to accommodate the over 67,000 coding options in ICD-10. The extra year offered by H.R. 4302 buys them time to complete the transition, but at what cost?

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Reducing Documentation Costs for Physician Practices

Posted Apr 2, 2014
ID-100181544Stagnant reimbursements and rising costs make finding ways to improve efficiency a critical initiative for healthcare providers.  Documentation costs for physician services can represent a very significant expense.  Better billing processes and more efficient management of electronic health records (EHRs) could help turn the tide. Upcoming changes to billing and coding, along with the implementation of the Affordable Care Act will make hospitals and physician practices turn to efficiency improvements as a way to cut costs, without cutting the quality of services.Billing and Coding Changes
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EHR Practice Management Billing & Reimbursement

End-to-End ICD-10 Testing: Are you Prepared?

Posted Mar 18, 2014

According to a recID-10064588ent survey, less than 10% of physician practices are ready for the upcoming transition to International Classification of Diseases, 10th Edition (ICD-10), up from less than 5% a half year prior. Will you be ready for the 2015 changeover deadline or will this be HealthCare.gov all over again?

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Eight of the Funniest ICD-10 Codes

Posted Mar 18, 2014

ID-100211592The new ICD-10 medical billing codes that go into effect next year, are totally replacing the current ICD-9 codes. The majority of these new codes will be helpful in narrowing down the location, type and severity of the injury. The treatment provided will also be more carefully documented.

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Are Your Vendors Ready for ICD-10?

Posted Mar 18, 2014

are_your_vendors_ready_for_icd_10Being ICD-10 ready within your organization is great, but it is not the only thing you need to worry about. It's imperative that your vendors are also ICD-10 ready. While more than likely, your EHR vendors are prepared with the new codes, it is important that you know that your billing company, clearing houses, and insurance carriers, among other vendors, are also ready. 

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Addressing Patient Wait-time Woes

Posted Feb 12, 2014

patient_wait_time_woesIt's no secret that some patients get upset at long wait times in healthcare offices, but a recent survey from Software Advice put numbers to the patient experience problem. According to the survey, 97 percent of patients report being frustrated with wait times, even though 45 percent of respondents said they waited less than fifteen minutes to see a doctor.

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Orthopedic Coding Updates for 2014

Posted Jan 31, 2014

orthopedic_coding_updates_2014The expected coding changes coming with the ICD-10 implementation of next year are having a big impact on all physician billing practices. In the mean time there are changes to the Current Procedural Terminology (CPT) codes effective as of January 1 that orthopedic practices should be aware of. If you are just catching up on all this now, here are a handful of key areas in which the most important changes have occurred.

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Dictation vs. Scribes for Documentation Productivity

Posted Jan 27, 2014

dictation_vs_scribesWith the development and expansion of electronic technology comes additional ways to save time, and to incorporate more productive input into the time we utilize. It is the same in the world of medicine as it is in the world of logistics, manufacturing or even marketing. However, in medicine, sometimes the use of standard computer technology can compete with or hinder the achievement of the intended goal.

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Practice Management

Radiologists not Paid for ED Procedures?

Posted Jan 21, 2014

radiologists_not_paid_for_EDIt's a simple fact that the only way to maintain a practice is to be compensated for procedures. Unfortunately, according to a recent study presented at the Radiological Society of North America's annual conference in Chicago, over a quarter of ED radiological services were completely uncompensated from 2009 to 2012. This study wasn't looking at isolated events: it covered 40 states and examined radiology billing claims for 2,935 practitioners (approximately 8% of radiologists in the United States).

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ICD-10 compliance: Are You Behind?

Posted Jan 17, 2014

ICD-10_ComplianceAccurate coding for completed medical procedures impacts reimbursements from insurers. In an attempt to reduce errors and improve the level of documentation on completed procedures, healthcare providers must switch to an updated coding process, moving from ICD-9 to ICD-10. Learning how to prepare for ICD-10 can be a challenge. Many providers have fallen behind schedule for the recommended timeline, and according to a survey conducted by Workgroup for Electronic Data Interchange, four out of five providers will not be in a position to begin testing the new coding process by the new year. At Healthcare Information Services, we help providers get back on track and implement the highest accuracy standards for billing and coding.

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Why Approach ICD-10 With A Sense of Urgency

Posted Jan 14, 2014

ICD-10_urgencyAs the 2015 deadline approaches, the necessity for immediacy in preparation for the transition from ICD-9 to ICD-10 is crucial. The ICD-10 coding impacts every step along the patient treatment process from the initial encounter with the examining physician to the billing department submitting requisitions for reimbursement of services. However, the billing department will face the greatest challenge in claim submissions if the coding is not properly structured. Orthopedics, in particular, will be hard-pressed to receive correct reimbursement with incorrect coding. Over 60% of the ICD-10 pertains specifically to Orthopedics and Musculoskeletal (MSK).

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The Importance of Patient Focused Care

Posted Jan 7, 2014

patient_focused_careRadiologists need to become more involved with their patients; partnering with their patients is absolutely necessary to foster the kind of relationship required for optimal patient care. That was the basic message delivered by Radiological Society of North America president Dr. Sarah Donaldson to the RSNA 2013 attendees. On December 1, 2013, in Chicago, President Dr. Donaldson, current professor at Stanford University School of Medicine in Stanford California, former nurse, research assistant and high school cheerleader, delivered an impassioned plea to radiologists to recognize the importance of getting more up close and personal with their patients.

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ACR & RBMA Jointly Publish New Contracting Guidelines

Posted Dec 30, 2013

joint_guidelinesWe at Healthcare Information Services (HIS) would like our clients to be aware of the new Managed Care/Commercial Insurance Contract Evaluation Guidelines, published by the American College of Radiology (ACR) and the Radiology Business Management Association (RBMA), and how they may affect you.  These guidelines are intended to make it easier for all sides to evaluate and negotiate managed care contracts involving radiology or radiation oncology.  The guidelines contain definitions and strategies for negotiating and implementing managed care contracts.

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RSNA 2013 Recap and Review

Posted Dec 18, 2013

ID-100207351The 99th Annual Meeting of the Radiological Society of North America in Chicago was a resounding success.

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RSNA Image Share Project

Posted Nov 25, 2013

RSNA_image_shareThe Radiological Society of North American (RSNA) began their Image Share Project in 2009 to give people more control of their own medical records.  It used to be that medical images were taken, processed and sent to the patient's doctor of record.  It was a simple one-step process.  Now however, we live in an era where people want the freedom to have their images looked at, and treatment given by the specialist of their choosing.  This means the images must be shuttled from one office to another.  The RSNA Image Share project improves the patient experience by giving them control of where their images are sent.

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RSNA 2013 Annual Meeting In Chicago

Posted Nov 20, 2013

chicago-138901_640The Radiological Society of North America is geared up to host the RSNA 2013 annual meeting in Chicago, Illinois.  It will be held at the beautiful McCormick place in Chicago from December 1st to the 6th.  This year's program promises to be an extraordinary gathering with a host of special lecturers.  This will be the 99th Scientific Assembly and Annual Meeting, so attendance is expected to be very high.  Registration is now open and you are encouraged to register early for this prestigious event.

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The Importance of Having an ICD-10 Champion on Your Team

Posted Nov 12, 2013

2818462063 05f06b31b8Medical care providers all know that beginning in 2015, claims for reimbursement must use ICD-10 billing codes. Claims using the old ICD-9 codes for any services provided after the change takes place will be rejected.

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EHR Meaningful Use: How to Prepare for Stage 2

Posted Oct 18, 2013

describe the imageTo prepare for Stage 2 Meaningful Use (MU), you first need to have met the Stage 1 core and menu structure criteria.  For the remainder of this article it will be assumed you have already met the Stage 1 requirements.

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Meaningful Use

How to Prepare for ICD-10

Posted Sep 30, 2013

how to prepare for Icd-10 HISEdit: ICD-10 implementation has been delayed until after Oct. 1, 2015

There are just 300 working days left until October 1, 2014.  That date should ring a bell because it is the day that the tenth edition of the International Classification for Disease (ICD-10) will be put into effect.  If that seems like plenty of time you are probably far behind in your preparations.  Anyone who has already begun the transition can tell you that the work load is significant.  If you want to catch up or stay on track with your transition from ICD-9 to ICD-10, take a few tips from the people who are already learning how to prepare for ICD-10.

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ICD-10 Medical Coding EHR

Top Tips for Orthopedic Coding in Your Ambulatory Surgery Center (ASC)

Posted Sep 24, 2013

top orthopedic icd-10 coding HISWith more and more orthopedic procedures being done on an outpatient basis, proper coding of those procedures is one of the most important elements for today’s ambulatory surgery centers (ASCs) to consider. This is especially true in light of the projected changes in procedure coding resulting from implementation of ICD-10.  Ambulatory surgery centers have certain procedures that they need to understand how to code, so that they can keep their operations running smoothly and get reimbursed for the work done there. There are several things to remember to provide the best possible physician billing process.

1) Familiarize Your Practice With New Coding Protocols

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ICD-10 Medical Coding Orthopedics Billing & Reimbursement

How to Convert Your Top Orthopedic ICD-9 Codes to ICD-10

Posted Aug 6, 2013

converting from Icd9 to icd10 HISWith the impending switch to ICD-10, orthopedic practices must begin preparing to convert their ICD-9 codes over to ICD-10 if they want to keep their operation running smoothly and profitably with steady management of both patients and data.  The Centers for Medicare & Medicaid Services has provided some helpful online resources for medical practitioners looking to ease the transition to this new coding system, including timelines, checklists, and implementation guides.  To help convert your most commonly used codes from ICD-9 to ICD-10, there are several important steps to take.

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ICD-10 Medical Coding Orthopedics Health-Insurance

2013 Radiology CPT Code Changes

Posted Jun 5, 2013

2013 Radiology CPT Coding Changes HISHere at Healthcare Information Services, we want to make sure that your radiology billing is ready for 2013.  Because of the Health Insurance Portability and Accountability Act, the valid medical code set has to be used based on when the service was provided.  This means that you needed to update your billing systems by January 1st, in order to keep billing nightmares from happening.

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Radiology Medical Coding

Why Ignoring ICD-10 Won't Make it Go Away

Posted May 14, 2013

ignoring icd10 hisThe US Dept. of Health and Human Services has directed the supplanting of the ICD-9-CM code sets, those currently utilized by physicians, medical billers and coders to report healthcare procedures and diagnoses, with ICD-10 codes.  Implementation is to be effected after October 1, 2014.  Its implementation will impact and completely change the current coding system.  It will necessitate a huge amount of effort to implement, and it isn't going to go away.  Individual and organizational health providers need to get on board with training if they expect to get paid for their services after October 1, 2014.

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ICD-10 Medical Coding EHR HIPAA

3 Steps to Avoiding Denials in Orthopedic Billing

Posted Apr 19, 2013

avoiding denials hisMaking sure you get paid on insurance claims is a daunting task for any orthopedic office.  There are multiple reasons why claims get denied by insurance companies.  Many of them are easy fixes for office personnel, while others require time and attention or expert and detailed review by a certified professional coder.  The following are three top steps in avoiding billing claim denials.

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Medical Coding EHR Orthopedics Billing & Reimbursement

Coding Corner: Change in Medicare Reimbursement for the Breast Biopsy Clip Placement

Posted Apr 4, 2013

his coding changes The Coding Corner highlights the most up-to-date medical coding tips, information, and legislation.  HIS has over 60 Certified coders, who are experts in ensuring proper coding to guarantee compliance and maximize reimbursement.

By: Trudie Galan, CPC, Sr. Mgr. Coding Education, Healthcare Information Services, LLC.

At the end of January it became apparent in the Radiology Industry that Medicare had changed its reimbursement policy for the Breast Biopsy Clip Placement Procedure (19295).  Radiology Groups across the country began receiving denials for this procedure.  When the final 2013 Medicare Fee Schedule was posted at the end of January, Medicare had changed the classification of this code to a Supply Code--no longer allowing Physician reimbursement.

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Medical Coding

An In-depth Look at Our Medical Transcription Solution

Posted Mar 28, 2013

Med trans HISAccurate documentation of each patient encounter is the foundation for all healthcare providers' businesses and partnerships.  Medical transcriptions serve as reference for diagnosis, treatment, continuity of care, and billing activity between healthcare providers.

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Medical Coding EMR

5 Key Considerations for Enhancing Your Radiology Group's Revenue Stream

Posted Mar 7, 2013

5 key rev cycle HISThe following considerations for revenue cycle management can help ensure the maximum revenue stream for your radiology group.

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Radiology Revenue Cycle Management Health-Insurance Practice Management

Orthopedic Coding Changes in ICD-10 {List}

Posted Feb 28, 2013

Orthopedic coding hisAll health care providers are required to move from ICD-9 to ICD-10 sometime after October 1, 2015.  ICD-10 will replace and update the current ICD-9 system and has two parts as follows: 

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ICD-10 Orthopedics

Six Advantages of Dictated Medical Transcription

Posted Feb 20, 2013

MED TRANSCRIPTIONMedical Transcription, is the system in which information given by a physician or other medical professional is converted into text and stored either electronically or as a hard copy in a patient's paper file.  This offers many advantages for most medical practices, which are covered briefly below.

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Medical Coding

Solving Common Problems Faced in Medical Transcription

Posted Feb 12, 2013

Med transcription HISMedical transcription services offer a wide variety of benefits to any practice, but as with any program, they have certain problems that you should be on the lookout for. Here are some of the most common problems, along with solutions that you may wish to implement.

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Medical Coding

Top Do's & Dont's for Managing Self-Pay Collections

Posted Jan 10, 2013

ID 10052916Self-Pay patients present a certain risk for payment that must be taken into account by any practice who will be accepting them. However, following certain guidelines can increase the rate of collection for services rendered.

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Top Differences Between ICD-9-CM & ICD-10-CM

Posted Jan 8, 2013

ICD 9 and 10With the upcoming switch to ICD-10, major changes are being made to the way things are being done.  To help smooth out the transition, here are the most important differences between ICD-9-CM and ICD-10-CM that you need to know.

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ICD-10 Medical Coding

Medical Billing - Do Your Communications Encourage Payment?

Posted Dec 27, 2012

ID 100146100

As owners, managers and administrators in the medical field you have to know your business in-and-out if you want to be successful, and one area of particular importance is communicating with your patients.  This is true not only in regard to their medical conditions, but also in explaining and collecting payments on their bills.

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Revenue Cycle Management Practice Management Billing & Reimbursement

How ICD-10 Will Affect Worker’s Compensation

Posted Dec 11, 2012

ID 10058688ICD-10 is not required for entities and organizations that are not covered by HIPAA, including worker's compensation programs. However, not adopting ICD-10 and requiring a different billing method can be expected to impose significant hardships, so many worker's compensations are voluntarily making the switch.

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ICD-10 Health-Insurance

7 Things You Need to Know About GEMs (General Equivalence Mappings)

Posted Nov 29, 2012

ID 100133158General Equivalence Mappings or GEM as it is popularly called comes into use if you are looking to translate lists of codes, coded data or code tables while converting a system or any other application containing ICD-9-CM.  GEM is developed as an essential tool to assist conversions of ICD-9-CM (International Classification of Diseases, 9th Edition, Clinical Modification) to ICD-10 (International Classification of Diseases, 10th Edition) and vice-versa.

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ICD-10 Health Information Services

Understanding the Official Guidelines for ICD-10 Coding & Reporting

Posted Nov 27, 2012

ID 100106649ICD-10 (International Classifications of Diseases) Coding and Reporting guidelines are provided by National Center for Health Statistics (NCHS) and Centers for Medicare and Medicaid Services (CMS) - agencies within the Department of Health and Human Services (HHS) of US Federal Government. The guidelines are aimed to be used as a guide for the official version of ICD-10-CM (Clinical Modification) to classify reasons for visits and diagnoses in health care settings and ICD-10-PCS (Procedure Coding System) which relates to in-patient hospitals only.

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ICD-10 Medical Coding Practice Management Healthcare Organizations

Innovative ICD-10 Implementation Steps

Posted Nov 21, 2012

ID 10021516In less than two years the WHO's new International Classification of Diseases (10th edition) will be implemented by the Centers for Medicare and Medicaid Services (CMS), rendering the previous ICD-9 code sets obsolete. It will also, therefore, render all medical practices that have not adopted and implemented the ICD-10 code sets outdated. This will have a serious negative impact on the speed and efficacy of information sharing and processing, and also on the revenue cycle management of a practice.

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ICD-10 Revenue Cycle Management Healthcare Organizations

How to Decrease Your Orthopedic Practice's Costs

Posted Oct 15, 2012

HIS decrease costsMedical practice costs have risen over 50% in the last decade, far outstripping the Consumer Price Index and Medicare payment rates (ama-assn.org.) More specifically, orthopedic practices are facing declines in patient numbers, reimbursements, and elective surgeries (according to beckersorthopedicandspine.com). Physicians are looking for ways to avoid making the difficult choice between reducing their practice costs and maintaining practice efficiencies and service. Your office might be able to cut costs from various places in your practice, from overhead costs to revenue cycle management.

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Group Purchasing Organizations Revenue Cycle Management Orthopedics Health-Insurance

Election 2012: What's At Stake for Radiology

Posted Oct 5, 2012
2012 elections HIS

This article originally appeared on Auntminnie.com. Copyright 2012 Auntminnie.com - All Rights Reserved

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Healthcare News

5 Ways to Ensure a Seamless EHR Implementation

Posted Jul 30, 2012

EHR Implementation HISEHR implementation is less a choice of "if" than of "when" and "how." With patient records steadily moving online, it is imperative that medical service providers stay ahead of the curve and implement electronic health records on their own terms. While EHR implementation will usually help your bottom line, the transition can be time-consuming if not managed properly.

Here are five tips for ensuring a smooth and successful transition to EHR:

1) Choosing a Partner

There are many providers of EHR out there, and it can be difficult to find the one that is right for you. All things being equal, it is best to choose a provider that has a long history of experience, a successful track record and a network of enthusiastic references. Healthcare Information Services has all three. With more than twenty years of experience, HIS is dedicated to helping you ensure a seamless EHR implementation.

2) Adaptability

So much of an EHR's successful implementation depends on the system it is made up of. A good EHR system will adapt to a medical service provider's existing workflow and network, rather than the other way around. In a seamless EHR implementation, staff and doctors should have no trouble learning a new system if it is optimized to fit software that they already know. SRSsoft is one of the most adaptable systems out there.

3) Hardware and Features

There are choices when it comes to EHR. Part of ensuring a seamless implementation is partnering with a provider that can help you choose the software and features that are right for your practice. Find software like SRSsoft from HIS that is quick, accessible and that uses state of the art security features can make for a seamless EHR implementation. Look for features such as cloud connectivity and automated prescriptions to help with the transition.

4) Training

Even though a good EHR is easy to learn, training can always help make the implementation a smooth one. Look for a company that provides staff training along with its EHR services, as HIS does. Keep your staff up-to-date and well-versed in the system's ins and outs.

5) Bundled Services

One way to make EHR implementation seamless is to bundle your EHR with other services, saving you money in the process. HIS offers revenue cycle management along with its EHR. If you've already been thinking about outsourcing your revenue cycle management, pairing with with EHR is the perfect way to make both transitions smoothly.

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Revenue Cycle Management EHR

Discontentment with Current EHR Leads Orthopedic Group to Purchase SRS-EHR

Posted Jun 18, 2012
SRS-EHR Healthcare Information Services Productivity Focus of SRS-EHR & Unparalleled Customer Service Drives Purchase Decision for Group of 11 Specialists. This article originally appeared on srssoft.com. All rights reserved ©2012 SRSsoft.

MONTVALE, NJ – June 7, 2012 –SRS, the leader in productivity-enhancing EHR technology and services for high-performance physicians, today announced that Western Kentucky Orthopaedic & Neurosurgical Associates (WKONA) has selected the SRS EHR for its 11 physicians across 5 locations. WKONA provides quality orthopaedic and neurological care to the south-central region of Kentucky.

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Three Steps to Effective Revenue Cycle Management

Posted Jun 8, 2012

3 Steps to Effective Revenue Cycle ManagementRevenue cycle management is critical for any orthopedic practice. It is how cash flow is generated, which it is the lifeblood of your practice. 

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Revenue Cycle Management

SRS-EHR for Orthopedists: A Successful Implementation Track Record

Posted Jun 5, 2012

SRS-EHR for Orthopedics | HISHealthcare Information Services is proud to provide SRSsoft EHR technology to a wide variety of medical practices. By partnering with HIS, these healthcare professionals have ensured they have access to a robust and functional system that maximizes time spent with patients and increases their efficiencies and workflow.

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EHR Orthopedics

3 Ways to Know When it's Time to Outsource Your Billing

Posted May 14, 2012

3 Things to Know about Outsourcing Your BillingMaintaining your medical billing management internally may seem to be a good choice for your practice, many providers feel keeping billing "in house" allows them more control over both coding and billing.  However, numerous other practices have discovered the benefits of outsourcing their medical billing management to a team of professional coders and billing experts. There are three factors that signal it may be time to consider outsourcing your medical billing management:

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Revenue Cycle Management Practice Management

Top Factors That Will Effect ICD-10 Conversion

Posted Apr 20, 2012

professional codersAlthough it's more than a year away and the timing of any delay is not yet set in stone, the mandatory switch for healthcare providers from ICD-9 to ICD-10 will have a lasting impact. As one of the largest changes to ever hit the industry, healthcare providers need to be ready for this huge industry shift. With errors in coding and denied claims already a major burden on many companies providing healthcare, the switch to ICD-10 will only exacerbate the situation.

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ICD-10 Medical Coding

Industry Updates: 5010 HIPAA Compliance, Health Reform, and ICD-10

Posted Mar 26, 2012

Industry Updates: Medical5010 HIPAA Electronic Transactions Update from HBMA

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Radiology ICD-10 Medical Coding HIPAA

Discount EHRs to Quality EHRs: What's the Difference?

Posted Mar 24, 2012

Quality EHR SolutionManaging your EHR implementation is a decision that will affect you medical practice for years to come. Opting for a discount EHR can save you money up-front, but patient records are too important to trust to a company without a proven track record. The smart choice is to select a quality EHR. Unlike discount EHRs, quality EHRs offer systems that adapt to your workflow and that will save you money in the long run.

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The Warning Signs of a Failing EHR

Posted Mar 20, 2012

success failureElectronic health records (EHR) are quickly becoming a necessity for healthcare providers. In addition to making it easier to capture and store patient data, an EHR makes information transferable between institutions, key for sharing medical data when a patient moves or sees multiple specialists. Like any system, however, some EHRs are prone to breakdown if it is implemented improperly. If you find that your doctors are spending more time entering data in a computer than seeing patients, it may be time to look for alternative EHR solutions. Look out for these warning signs that your EHR is failing.

1. Difficult to Use: One sure sign of a failing EHR is when doctors have extreme difficultly entering and retrieving patient information. In muddled and overly complex systems, physicians end up spending inordinate amounts of time trying to figure out the system. The result is less contact time spent with patients, and overall decline in quality of care. HIS offers SRSsoft: an EHR solution that is easy for anyone to use. It prioritizes speed and usability without compromising quality, allowing doctors to get away from the computer and back to their patients.

2. Incompatibility:
A common complaint about EHR is that physicians have to learn an entirely new system, leading to decreased productivity during implementation and less time for seeing patients. If your doctors are still having trouble learning an EHR system even weeks after implementation, you should look for other EHR solutions. The EHR solutions offered by Healthcare Information Services is compatible with your existing workflow system. Instead of having to learn an entirely new system, our technology adapts to your standards, making implementation an easy transition.

3. Customer Support: No matter how easy a system is to use, healthcare providers will always need ongoing support from their EHR provider. One sure sign of a failing EHR is if your vendor becomes less and less available to address your questions and concerns. If you find yourself speaking to voicemail more than a person on the phone, you need to look for a new EHR solution. With Healthcare Information Services, support is always available. Whether you have a pressing concern or a more general question, staff is available to chat with you one-on-one to come up with a solution.  With HIS we're not a separate EHR team, we're your partner in quality healthcare.

A good EHR system should start saving you time and money almost immediately after implementation. When you start to detect warning signs that the system is failing, look to HIS for top-performing and top-rated SRS-EHR.

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Coding Corner: Medicare Documentation & HH Service Certification

Posted Mar 9, 2012

Coding CornerThe Coding Corner is a bi-monthly feature, which highlights the most up-to-date medical coding tips, information, and legislation. HIS has over 60 Certified coders, who are experts in ensuring proper coding to guarantee compliance and maximize reimbursement. Following is a coding tip that we sent to our clients.

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Billing & Reimbursement

The Pros and Cons of Outsourcing Your Medical Coding

Posted Feb 23, 2012

Outsourcing BillingEnsuring that your practice's medical billing and claim processing is handled quickly and efficiently is vital to your practice's success and ability to provide high quality patient care.

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Medical Coding EHR

The Difference Between Certified Coders and Non-Certified Coders

Posted Jan 18, 2012

Certified CodersThere is a significant difference between certified and non-certified medical coders. While there are no legal requirements for certification to be a medical coder, certified medical coders possess credentials that identify them as experts in their field. In addition to passing rigorous exams for medical coding, a certified coder has passed exams in gross anatomy and medical terminology, giving them critical knowledge and proficiency important for reading and interpreting patient charts correctly.

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ICD-10 Medical Coding Billing & Reimbursement

The Dynamic and Ever Changing World of Medical Coding

Posted Jan 15, 2012

Every Changing World of Medical CodingWith a complicated, frequently changing coding system, medical billing services teams are constantly challenged to stay current. The healthcare industry, ergo, medical billing and coding, is dynamic due to advances in technology, surgical procedures, treatment protocols and changes in how payers reimburse physicians and hospitals. The medical billing services company with whom you partner must have proven processes for identifying, tracking and reporting variances and abberations in billing patterns. It is not sufficient to rely on software and technology to correctly code and bill for services: a combination of certified medical billing coders, a rigorous compliance system, well designed software and excellent analytics is required.

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ICD-10 Medical Coding

Optimizing Electronic Health Records

Posted Jan 11, 2012

EMR SolutionsOptimization of your selected EHR system is key to healthy ROI and maximizing its potential benefits; however, it can take months for practices to develop a good, working knowledge of all the functions of their EHR system.  Best outcomes for EHR implementation occur when medical practices adopt a goal of integrating the EHR into their entire operation, and view EHR implementation as a journey, not a destination. 

Preparation is key: Do not select an EHR system without careful planning. Technological changes nonwithstanding, there will be process changes also, and if you select a poorly designed system or do not provide sufficient training and support, low adoption rates by your staff and providers may result, causing reduced productivity and dissatisfaction.

Review your present workflow: Analyze your existing paperwork process, eliminate inefficiencies and incorporate best practices into your redesigned workflow for integration into your EHR implementation.

Select the system with the right amount of capacity for your practice. Too much or too little capacity increases the potential for inefficiency, resulting in loss of revenue. Additionally, Access and "up time" are two critical factors to consider in your selection process. Also consider where you would like your practice to be in the future. Look for a system that can scale with you.

Involve your staff: Engaging the people who will be using the system day to day is just good common sense. Soliciting their inputs and incorporating their needs into the EHR selection will improve the "buy-in" from your staff, but will also provide a blueprint that will facilitate EHR implementation.

Don't implement alone: The initial impressions of your staff and providers is critical to the EHR systems's acceptance and successful adoption. Partner with an EHR company and utilize their training programs to plan and implement your EHR system.

Be patient: Even the most well designed, user friendly, efficient EHR will have an adjustment period. Together, with the company from whom you purchased your EHR system or the consultants hired to guide your practice through EHR implementation, continue to provide support and encouragement.

Acquisition, implementation, and integration of an EHR system can be one of the best decisions you can make for the future of your practice. The key points to remember are: preparation, partnership, and patience.

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Top Seven Questions to Ask Before You Hire A Medical Billing Service

Posted Dec 30, 2011

Top Billing QuestionsStrong revenue cycle management is integral to a financially healthy physician practice, and a medical billing services team plays a prominent role in the process. Accurate billing and coding will increase a practice's cash flow by improving the payment process. Hiring a medical billing service can be a great decision for your practice, resulting in increased revenue due to improved quality of claims, however, not all medical billing services are created equal. HIS (Healthcare Information Services, LLC) a leading provider of healthcare management solutions, suggests asking the following seven questions before hiring a medical billing services team:

1) Are Your coders certified? Medical coding is complicated, requiring extensive training and keen analytic skills to determine the right code for the treatment. HIS medical coders are certified and stay abreast of changes that occur due to new technology, advancements in medical treatment, and changes to treatment protocols.

2) How are your coders preparing for ICD-10 implementation? With implementation less than two years away, the time to prepare is now. Is your company conducting beta testing to determine what kind of training will be necessary as the launch date approaches?

3) What is your clean claims rate?  Clean claims translate into fast payment. The typical clean claims rate for in-house medical billing teams is somewhere between 70-80%.

4) Do you offer a guarantee for your medical billing services? Only a company with a high level of confidence guarantees that they will boost your revenue.

5) What type of benchmarking do you perform? Do you track percentage of A/R outstanding, and what intervals do you measure? These benchmarks help determine of your practice is meeting the benchmarks established by groups like the Medical Group Management Association (MGMA).

6) What kind of follow up methods do you utilize to ensure that I am realizing maximum benefits from my relationship with you medical billing services team? Will your medical billing services team communicate via email, telephone, one-to-one (or any method of my choosing) to ensure that the program is working well for my practice?

7) What collection methods do you use to increase physician practice revenue? With the rising levels of patient deductibles and co-pays, payment up from can significantly increase your revenue.

Affirmative, knowledgeable, and proactive answers to these questions sets your practice up to achieve your goals from your physician billing service; stronger revenue, improved billing consistency, and stability to your practice's financials.

Feel free to contact us or leave a comment below.

Photo courtesy of Karen Eliot
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Billing & Reimbursement

Impact of ICD-10 - Healthcare Revenue Cycle Management

Posted Oct 26, 2011

ICD-10 and Revenue Cycle ManagementWhat is the impct that ICD-10 will have on Healthcare Revenu Cycle Management?

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ICD-10 Medical Coding

5 Common Medical Coding Errors and How to Avoid Them

Posted Oct 18, 2011
Coding ErrorsAt HIS, we have over 60 certified coders, who assist both hospital- and office-based physicians to submit proper coding and documentation to payers.  Our coding team came together and developed the following common coding errors and what can be done for your office to provide optimized and compliant medical billing services: 
  1. Wrong interpretation of operative reports – Often coders do not bill for a particular procedure unless they see it specifically documented by the doctor.  Even if the description of the procedure is listed in the procedures performed, coders are hesitant to code it without the actual operative description.  This problem can be helped in two ways:  the provider can make sure to write down the specific operative description needed, and second, an experienced coder should be able to interpret an operative report properly and provide correct coding.
  2. The coder does not know about the bilateral procedure/services – Often the medical coder is at a second location, in an office away from the provider and the patients.  If the doctor forgets to write bilateral procedure or service such as injections, medications, X-rays, and so forth, the biller will have no way to code for them.  The provider must remember that he or she is a very important part of the coding process and that the bilaterals must be circled in the report to result in proper medical billing services.
  3. Unbundling – This means separating into pieces a procedure and charging for each part separately when there is already a comprehensive code.  Besides being unethical, unbundling is illegal and it will attract an audit.  Have your coders know their comprehensive codes well.
  4. Code not to its highest specificity – Some ICD-9-CM codes need a fourth or fifth digit to get to their highest specificity.  If incomplete, the claim will be rejected.  If a coder is unsure whether a diagnosis is coded to its highest level of specificity he or she can look it up in the code book or on the internet.
  5. Wrong codes used due to outdated reference material – The codes change and the staff needs to be up-to-date with those changes.  Sending coders to seminars or having them attend web-seminars, as well as running internal check-ups and purchasing sufficient supporting material for the staff, can prevent lost or delayed revenue that can be lost due to coding errors.  

Photo courtesy of 123rf.com

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Medical Coding

Top Medical Coding Resources

Posted Oct 7, 2011

HIS Medical Coding

Although medical procedures, operations and diagnosis all have officially titled names, there’s a matching resource code attached to it. This code represents the procedure for paperwork and medical billing services. Coding condenses the necessary information placed on a billing statement, as most medical terms and operations have a rather long technical name. For individuals in charge of inputting the coding into a computer databank, it is essential to match the correct code with the corresponding term. There are thousands of different codes though, so regardless of how familiar the staff is with coding, having several available resource options on hand is wise, to prevent possible errors from entering a medical billing services record system. 

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Medical Coding

The Coding Corner: Magnetic Resonance Cholangiopancreatography (MRCP)

Posted Sep 21, 2011

The Coding Corner is a bi-monthly feature, which highlights the most up-to-date medical coding tips, information, and legislation. HIS has over 60 Certified coders, who are experts in ensuring proper coding to guarantee compliance and maximize reimbursement. Following is a coding tip that we sent to our clients.

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Medical Coding Billing & Reimbursement

The Coding Corner: Post Stereotactic Breast Biopsy Procedure Mammograms to Verify Clip Position

Posted Aug 24, 2011

The Coding Corner is a bi-monthly feature, which highlights the most up-to-date medical coding tips, information, and legislation. HIS has over 60 Certified coders, who are experts in ensuring proper coding to guarantee compliance and maximize reimbursement. Following is a coding tip that we sent to our clients.

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Medical Coding

Physician's Profitability [Video]

Posted Jun 29, 2011
In this video, our CEO, Dave Wold, and our COO, Dave D'Silva, discuss why our team of certified coders is so essential to physicians' profitability.  Wold shares that, in 2010 alone, we recovered over a million dollars in underpayments. If you've having trouble viewing the video, click here.
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Medical Coding Billing & Reimbursement

Is Your EHR Hurting Your Practice’s Productivity?

Posted May 20, 2011

A few weeks ago, Brandon Betancourt wrote an interesting post titled, “10 Hidden Costs When Implementing an EMR.” While all ten points have some validiity, number nine really struck me:

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