Documentation | Keeping Notes Compliant
Cooking Up a New Plan Can Dr. Ben make the commitment to find a better way to achieve fast and compliant patient notes? Ben arrived home after a busy day to find Carmen reading to Jonathan on the couch. He swung Jonathan up in his arms and gave him a firm hug. “How was your day, Daddy?” asked Jonathan. “It was so busy,” Ben said. “I’m tired but very happy to be home!” Jonathan gave Ben a big hug back, then turned to Carmen. “Mommy, I’m hungry,” he announced. This was not surprising, because Jonathan was always hungry. “Jonathan, why don’t you go upstairs and finish your homework,” said Carmen. “Your daddy and I will get started on some dinner for everyone.” Carmen squeezed Ben’s hand as they walked toward the kitchen. “So tell me about your busy day,” Carmen said. “Well, Luisa and I had a really good conversation this morning and I’ve been thinking about it all day,” Ben said. “We’re both getting pretty frustrated with patient notes. I have to write everything down – every single detail of each patient visit – and then Luisa has to take my notes and enter them into our system, along with images, forms, test results and more.” “That sounds like you’re doubling the work for yourselves,” mused Carmen. “Plus, you know, I’ve heard Luisa give you a hard time for your handwriting.” “Yes, that’s certainly a continuing topic of discussion in the office,” admitted Ben. “But it’s so important to capture every detail. Medical professionals have it drilled into their heads that if we don’t write it down, it didn’t happen.” “Sounds just a bit like our inventory process at the pizzeria,” said Carmen. “Every tidbit of food that gets pulled out of the freezer or off the shelves has to be recorded. I have to know how much we use of everything and how quickly, or else I may not reorder in time. If we don’t have the ingredients customers want, they may never return – and they certainly won’t refer us to their friends and family.” “Luisa and I were talking about that today,” said Ben. “The less time we spend on patient notes, the more time we can spend on patient interactions and care. Happy and healthy patients are going to be much more likely to refer us to others.” Carmen nodded. “Plus, my bookkeeper needs to track my inventory costs in exquisite detail, or else we might be in trouble if there’s ever an audit,” he continued. “So even though I grumble about what a pain it is to manage and report on our inventory, I make sure to dedicate enough time to the process to do it right.” “You know, our Genesis coach, Charlie, has warned us that every practice that has been in business for more than five years will likely be audited by a state board or insurance regulatory agency,” said Ben. “It’s been a while since our last audit – we really need to do better with our documentation. We need to be able to have notes that are both fast and compliant with state, federal and insurance rules.” “You know what we really need to do better with?” asked Carmen. “Preparing dinner, or else Jonathan might grow weak with hunger!” Ben laughed and opened the refrigerator to get out the salad fixings. But he knew he’d be thinking more about this issue in the coming days. What are Dr. Ben’s options to simplify the patient notes process while enabling him to remain in 100% compliance with state, federal and insurance rules? Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.
Visual Embedded Analytics in Your Software
Can of Worms What do the numbers mean to you and your practice? Opening your own practice means opening a whole new can of worms. That’s because there are so many elements that they don’t teach you about in school: aspects of running a business that you’re left to learn on the fly — all while attempting to provide quality care for your patients. One of the most critical components of achieving practice success is making sense of the numbers. There are numbers everywhere, from revenue to no-shows, from patient visits to accounts receivable. When you first start to look at them, it can almost seem like you’re staring at signs in a foreign language, hoping that the context might shed some light on what they mean. Practice management software can help, but until you know what numbers are most important to your practice — and how they signify growth or, conversely, difficulties — you’re still left wading through a mess of mathematical gobbledygook. Fortunately, there are analytics — tools to help you make sense of the data — available, and the best chiropractic software solutions, such as Genesis, embed those tools into the program so that they’re easily and immediately accessible. Offering a visual presentation of the numbers, these analytics finally make it possible for you to interpret and understand the numbers that drive your practice. Examples include: Radar chart — Visually resembling a spiderweb, the radar chart shows multiple variables on axes starting from the same point, radiating outward like spokes on a wheel. The length of the spoke is proportional to the magnitude of the data. This allows you to examine the correlation of values — say, accounts receivable and NFAs — that aren’t otherwise measured in comparable units. Trend report — A trend report presents data on a traditional line graph, thereby allowing you to see the peaks and valleys of your information — and the inter-relation of different data sets — over time. Histogram — With a histogram, you can choose three charts to show you a graphical representation of a single area of your practice over a given time period (weekly/monthly), depending on the selection. This allows you to gauge how your practice is doing comparatively for a set amount of time. Dashboard — A dashboard is an organized presentation of the numbers, so you can get an at-a-glance picture of where your practice stands on collections and outstanding work. Genesis, for example, can show you failed claims, AR > 120 and outstanding tasks — or “tickets” — on a single screen through its homescreen dashboard. Billing Stats Report — This type of report allows you to view claims by date of service. The report can then be broken down in a number of different ways, depending on what you’re looking for (customizable by practice). The Billing Stats Report, or BSR, is very useful for digging into problems. Ultimately, it’s up to you to determine which numbers provide the best snapshot of practice success; however, analytics are the tools that help bring that snapshot into focus.
The Deadline Approaches
Is Ben’s practice ready for the EHR deadline… or will he have to make more changes? Does he have questions about meaningful use? Ben and Carmen Wilson said goodbye to their friends at the door and walked arm in arm to their car. “That was fun,” said Carmen. “It looked like you and Richard were having some intense conversation.” “Shop talk,” said Ben, opening the car door for his wife. He walked around the car and slid into his own seat. “It was all about Meaningful Use.” “Wow — I haven’t heard about that in a while,” said Carmen. “Wasn’t that what got you to change to electronic health records in your office?” “That’s right. Back in 2009, there was a big push to make the switch to Meaningful Use of electronic health records, and I did. But at that point, there wasn’t a lot of clarity about what exactly would count as Meaningful Use. We knew the solutions we used would have to be certified, but the powers that be hadn’t certified anything at that point. And of course things have changed since then, both in technology and in our office.” “Very true,” mused Carmen. “Our little boy wasn’t even born yet. Time flies when you’re having fun!” Ben chuckled. “So why did that come up tonight?” “Back in 2009, the goal was to get everyone to Meaningful Use of electronic health records in five years. Well, it’s been five years. October 1st is the deadline, and anyone who isn’t using an ONC-certified EHR by October 1st faces penalties.” “But you’ve already done what you were supposed to do!” objected Carmen. “Things have changed,” Ben repeated, pulling into their garage. He turned off the car and turned to Carmen. “I remember reading the New York Times that year that small practices like mine –” “It was just you!” his wife broke in. “Right. So making changes was pretty easy. Smaller practices were leading the way and the biggest organizations were putting significant funds into big five-year plans. But you know, something like 10 percent of doctors weren’t even online yet.” Carmen slowly shook her head. “Hard to imagine now, isn’t it?” “Very. Still, the deadline is approaching, so I need to make sure that what I did way back when meets the requirements now.” “The babysitter is going to be wondering what we’re doing out here,” Carmen said, climbing out of the car. “It doesn’t sound like this is going to be a big problem.” “No,” Ben agreed. “It’s just one more thing to think about.” Is Ben’s practice in compliance… or will he have to make more changes?
New Genesis Network Members | April 2014
Ninety-seven new members across fifty-six practices joined Genesis Chiropractic Software and Billing Network in April 2014! There is strength in numbers due to the shared knowledge – we call it the “Billing Network Effect,” as the billing performance of each member practice improves in step with the total volume of processed claims. Each office that uses our chiropractic software will benefit. Please welcome our new Genesis network members: Cassidy Karls of Action Chiropractic, LLC, Steamboat Springs, CO. Megan Grimes of Advanced Chiropractic, Yuba City, CA. Linda Banman, Michael Banman and Jessi Rattink of Aligned Chiropractic Corporation, Kelowna, BC, Canada. Ann Wise of Art of Life Chiropractic, Nolensville, TN. Carol Berg of Back On Track Family Chiropractic, Chippewa Falls, WI. Jodi Belter and Emma Kronebusch of Back To Health Chiropractic And Wellness, Winona, MN. Devon Smith of Bartholomew Family Chiropractic, Ithaca, NY. Jenny Berry, Kaylea Cohen, David Phllips and Paige Samora of Benchmark Medical Group, Inc., Windsor, CO. Rebekah Kumm of Bridge to Health Chiropractic, Hillsboro, OR. Brandon Bishop, Sharon Camp, Dr. Trent Camp, Dr. Andrew Chas, Sarah Craig, Cori Demott, Audra Emerson, Laura Foskey, Jennifer Haldas, Sandee McMullen, Amanda Nichols, Nikki Patel, Megan Shand and Krissy Shorb of Camp Chiropractic, Inc., Middletown, DE. Andy Brooks of Carolina Chiropractic Of Charlotte, LLC, Charlotte, NC. Jessica Stanziale of Central Jersey Spine & Wellness, LLC, Freehold, NJ. Amber Stewart of Dr. David S Chalke Chiropractic PSC, Paducah, KY. Maria Gonzalez of Claborn Chiropractic, Corp., Granada Hills, CA. Alexis Mcleod of Columbia Family Chiropractic, Columbia, SC. Esperanza Marin of Connected Chiropractic, LLC, Johnstown, CO. Alli Damas of Courtley Chiropractic, Lenoir City, TN. Dr. Katally Strauss and Dr. Seth Strauss of Creation Health, LLC, Mt. Pleasant, SC. Meagan Simmons of Crouch Family Chiropractic, Bowling Green, KY. Janice Barthel of Delano Chiropractic Center, Delano, MN. Laura Dilday, Dr. Christi Shuppe and Dr. Jake Shuppe of Family Healing Chiropractic, Charlotte, NC. Joann Huff of Fort Bend Corrective Health Center, Missouri City, TX. Sandra Herbenson and Erika Urban of Hallie Chiropractic, Chippewa Falls, WI. Chad Huston of Heritage Family Chiropractic, Olathe, KS Lisa King of Integrated Spine & Disc, Mandeville, LA. Dr. Melanie Gartside and Brad Holtgrave of Invision Family Chiropractic, LLC, Bentonville, AR. Jodi Ebert and Brittany Holzer of James E. Judge, St. Charles, IL. Sarah Mancha of Keen Family Chiropractic, Austin, TX. Meaghan Martin of Life Is Good Chiropractic, LLC, Brodheadsville, PA. Amanda Childs of Livingood Family Chiropractic, Cary, NC. Janette Tlaseca of Lombard Chiropractic, Lombard, IL. Cameron Nyman and Milton Sniadach of Longmont Spine and Physical Medicine, Longmont, CO. Lauren Nicholas of Maryland Chiropractic, Silver Spring, MD. Zulma Valerio of Milonas Chiropractic, Naperville, IL. Dr. Brent Fetzer of New Life Chiropractic, Brentwood, TN. Joanna Munoz and Heather Pfeiffer of Next Level Health, Rockford, IL. Yolanda Barbosa, Veronica Ortiz and Tierney Rattler of North Dallas Chiropractic Center, Dallas, TX. Adam Ponchick of Pacific Spine & Joint Medical Group, Inc., Daly City, CA. Erin Cleary of Paris Chiropractic, Rockville, MD. Stephen Ramirez, Fija Reed and Nicole Stasio of Postureworks, San Francisco, CA. Dr. Jacqueline Buscemi of Proactive Chiropractic, LLC, Rockville, MD. Linda Blackshear of Pss Injury Wellness – E D Schneider DC PC, Atlanta, GA. Leslie Clements and Dr. Marty Lorentz of Purpose Chiropractic, LLC, Onalaska, WI. Britteny Robrahn of Rivertown Family Chiropractic, LLC, Grandville, MI. Dionna Couch and Lauren Oldham of Rock Springs Family Chiropractic, Smyrna, TN. Kent Gallego and Birgit Hefler of Shin Wellness, LLC, Miami, FL. Vicky Letson of Sports & Spine Chiropractic, Dallas, TX. Penelope Ortega of Stability Spine & Wellness, Seattle, WA. Olivia Schinski of Summit Family Chiropractic, Coeur D Alene, ID. Sheryl O’Toole and Kristine Sharpe of Sweeney Chiropractic Wellness Center, LLC, Franklin, TN. Dr. Khaled Azizi, Zoe Frassetto, Stephanie Knaeble, Ryan Mahrt, Robin Rath and Koreana Schmittat of Symmetry Spine And Wellness Center, Alameda, CA. Dr. Kayla Glover of Tri-City Family Chiropractic, LLC, Arlington, TX. Desiree Pardo of Trinity Chiropractic – Bohemier, Naples, FL. Joessa Austin of Woodbury Family Chiropractic, Woodbury, MN. Cortnie Belmonte and Dr. Robert Belmonte of Woodland Family Chiropractic, LLC, Kentwood, MI. Soria Mam of Zenaptic Chiropractic, Vancouver, WA.
Stop Your Staff From Fighting | Genesis Webinar | Q&A
Does your office staff argue about who is responsible for completing tasks generated by your patient visits? How do you assign those tasks to your staff? How can you see if the tasks have been completed? Can you track those tasks automatically? Do you micro-manage your employees? How can you foster teamwork, promote autonomy and reduce the time you spend on management? These are questions that each chiropractic practice owner has to answer. Each patient visit generates a list of tasks that need to be completed. Each patient needs an account set-up with their complete demographic information, their insurance information and other details you need to file insurance claims and to collect cash or co-payments. If you break those tasks into a step-by-step list, then how do you assign those tasks to a member of your staff? How do you determine if every task has been completed for every patient? What happens if steps are forgotten? How will your patients judge your chiropractic practice if your CA forgets something? Would your patients think your office is unorganized? Q: What’s the problem? A: Office staff including the front desk, the office manager and any employee chiropractors are supposed to make life easier for the practice owner. However they often inadvertently create additional challenges regarding patient retention, revenue and compliance. Many of these challenges are related to issues that the practice owner simply doesn’t have time for. If your staff goes on vacation or calls in sick then a backlog of tasks is created, resulting in tasks being forgotten about and mistakes being made. Every member of your team needs to be managed and be held accountable to ensure that each task is completed correctly. Q: Why is this problem important? A: The short answer is Cost, Compliance and Patient Attrition. Cost – Front office tasks prevent the practice owner from seeing patients, which is the only billable time for your practice. Mishandling of billing and collections results in lost revenue with denied claims and delayed payments. Ineffective patient relationship management leads to attrition. Compliance – Includes incomplete/incorrect documentation, interrupted care plans, incorrect CPT/Diagnosis codes, staff unfamiliarity with procedures and employee failure to collect co-pays leads to over payment by the Payers. Patient Attrition – Failure by staff to follow-up on no shows, incomplete care plans and patients with no future appointments. Q: Why is this problem difficult to solve? A: There’s high front office staff turnover which could be due to poor training, lack of knowledge and unorganized micro-management. Some staff have a poor attitude towards training on new procedures and systems and they’re more comfortable with the old way of doing things. There’s also a lack of redundancy leaving tasks undone when somebody is absent and the ultimate responsibility falls to the practice owner. Q: What’s the Genesis approach or solution? A: A complete practice management solution for your office. Improve staff teamwork with effective training to ensure optimal practice performance. Improve teamwork and staff autonomy with automatic checklists of tasks that need to be completed when patients are checked-in. Track practice goals to more easily improve the number of patient visits, increase revenue, submit every insurance claim, follow-up with every no show and schedule patients with no future appointments. Manage staff remotely on your laptop or your smart phone by tracking task completion. Genesis is a complete practice management solution that includes: office workflow patient relationship management and staff management while also incorporating everything else you need like: scheduling billing EHR claim scrubbing claim submission claim follow-up staff task checklists training, etc. Genesis also includes a Coach to ensure your practice uses everything in the most efficient way possible.
Note-Worthy
Staff and Office personnel have to work together to make transition easier. Can Ben’s self-improvement plans cause trouble for his staff? Pam looked up as Ben bustled into the office. “You’re energetic today!” “I’m feeling inspired,” smiled Ben. “We’ve made some smart changes in the practice, and we have more coming up, so I think I’m ready to tackle changes in documentation.” “I’m impressed,” said Pam, “but I hope you’re not going to make too many changes. I feel like I’ve had just about all the change I can stand.” Ben was surprised. “I don’t think this is going to be a problem, Pam. We know that the new ICD-10 codes that go into effect in October are going to require more detailed documentation. I’m just going to get a handle on the new requirements.” “I understand that,” Pam sniffed, “but I feel like I have just gotten to where I can completely understand your notes and pick out the important keywords for coding. If I have to get used to a whole new system… well, if it’s not essential, I’d rather we didn’t make any more changes, that’s all.” Ben took a seat. “You know there are a lot more codes in the ICD-10 system than with ICD-9 codes–” “Don’t I know it! Almost 70,000 total.” “And one of the reasons there are so many more is that the codes have to be a lot more specific. If you don’t have very specific clinical documentation, it’ll be easy to get the codes wrong.” Pam said nothing. “If we have too many coding errors, or inaccurate documentation, it becomes a compliance issue.” Pam frowned. “I see what you’re saying. We could face non-payment issues, or even be audited. That would be a lot more trouble than getting used to a new style in documentation.” “Exactly.” Ben stood and stretched. “Tell you what, I’ll work on my handwriting and punctuation at the same time.” Pam laughed — or, thought Ben, maybe it was a snort. Either way, he was ready to get on top of the new demands for documentation. It felt good to have a clear goal. Can Ben’s self-improvement plans cause trouble for his staff? See our ICD-10 page for more information and more blogs on the diagnosis codes.
Chiropractic EHR software | Improve patient retention with Care Plans
Does paying your monthly overhead stress you out because your chiropractic clinic is plagued by patient no-shows? It is impossible to predict your clinic’s cash flow when your patients are non-compliant with your prescribed care plans. Needless to say, patients who miss their appointments won’t get better. Inconsistent patient flow also hinders practice growth and profitability. But your clinic’s cash flow can take an even bigger hit when you have to return payments for unfinished care plans. Not to mention the possible compliance issues resulting from this. You can figure out how much your chiropractic clinic might be losing due to unfinished care plans when you replace the assumptions below with your own numbers and complete the calculations. For example: Assumptions: 1 visit = $30 1 care plan = 30 visits Average number of no-shows per care plan: 15 Calculations: Potential income and losses from unfinished care plans per patient: Potential income from 1 care plan: 30 visits x $30 = $900 Potential loss from no-shows per care plan: 15 visits x $30 = $450 Conclusion: You risk losing half of your income when patients don’t finish their care plans! Just how can you identify patients who don’t understand the need for multiple visits to achieve their health goals? First of all, you need to know what the entire care plan looks like in order to track multiple visits. All patients go through a traditional treatment step-down ladder, such as four visits per week for the first four weeks, then three visits per week for the next three weeks. Such unique nuances on many patient schedules are difficult to track manually, and this difficulty grows dramatically with each added chiropractic care plan. Tracking the respective discounts given for each care plan is nearly impossible without a tool. Thousands of care plans are created for new patients every month, to schedule multiple appointments and then track all payments and visits in your Genesis EHR software. When patients don’t show up for their appointments you can receive automated notifications in form of tickets on your Genesis chiropractic software workbench. When patients don’t have a future appointment scheduled or when they cancel their existing appointments you can receive alerts via tickets. That way you can assign your staff the task of scheduling the next appointment. Another useful tool for helping your patients stay on track with their care plans are appointment reminders sent via phone, text, or email. Genesis chiropractic software has integrated several apps which serve this purpose. To set up chiropractic care plan when your patients come into your clinic, simply go to the Genesis Scheduler and click on the “More” tab to open the wizard. You can also create a full care plan from the patient account. Make sure you turn on the settings in your Genesis chiropractic software for Patient Relationship Management and Reminders.
Chiropractic EHR Software | Symmetry Spine and Wellness Center Dream Practice of the Month
Dr. Cynthia Boyd knows how to build a chiropractic dream practice: it takes hard work, a concerted team effort, and the expertise of Genesis chiropractic software and billing staff. “I have my dream practice,” says Dr. Boyd. “There are not many areas that need improvement.” The key to success for Dr.Boyd is balancing all aspects of practice management using Genesis cloud-based chiropractic software: “The [Genesis] system is amazing. I was 3,000 miles away for a month and I knew exactly what was going on.” Dr. Boyd doesn’t have time to micromanage her staff. With Genesis, she can easily track everyone’s individual performance anytime from anywhere. Dr. Boyd can also keep an eye on vital Key Performance Indicators, such as chiropractic billing, with the Genesis Radar. Best of all, Dr. Boyd does not have to change the way she runs her practice to optimize her workflow, complete her patient SOAP notes, and control compliance. As Dr. Boyd keeps growing her practice, she uses Genesis workflow engine to help manage teamwork among her staff and Genesis support team. The staff at Symmetry Spine and Wellness Center keeps the AR past 120 days low at 8 percent by consistently clearing the claims workbench while the weekly phone communications with her Practice Success Coach Heather Miller ensure her practice gets paid in full and on time. Coach Heather Miller: “Dr. Boyd is passionate about what she does and her business. She has found a balance with her practice and all of the other projects that she works on. Dr. Boyd trusts her employees to do their jobs without having to micromanage them. She has a great staff that works well together to get the job done and continue to grow the practice. In the end it all comes down to teamwork.”
Genesis Chiropractic EHR | New user tip #1 – Practice makes perfect
By Lisa Ogden ~ Profitability Coach for Genesis You can achieve success with the Genesis Chiropractic EHR system and build your dream practice when you and your staff complete the recommended training prior to going live. Chiropractors who wait until they actually see patients to learn the system “on the go” commonly run into the following 4 problems: Frustration: Not being able to use something when you most need it can be very frustrating for anyone. Even more so when your livelihood depends on it. Wasted time: Without establishing a level of comfort, documenting a patient visit can take much more time than Genesis is designed for. Compliance issues: Very similar to the paperwork that might be piling up on your desk, not getting to know your Genesis system can often result in incomplete and/ or unsigned SOAP notes. Unsigned notes are a major compliance or audit risk. Delayed payments: Payers don’t submit payment for incomplete or unsigned notes. The good news is that these four issues do not occur for practices that take the following 4 steps PRIOR to going live with their Genesis platform: Step 1: Participate in live online training session with Genesis staff: Our staff will walk you through proper visit documentation, step by step. Step 2: Create mock patient accounts: Spend time documenting several test patient visits including note sign-off and claim submission. Document the type of visits that are common for your practice. Document initial and follow up visits. Initial visit documentation will obviously take more time than follow up. You should be shooting for under 2 minutes for documenting initial and 10 seconds for most follow up visits. Step 3: Customize your Genesis platform: After you have spent some time getting to know your new platform, you may discover that minor customization is needed to improve efficiency. Schedule a second live training session to learn how easy it is to improve your user experience with customization. Step 4: Practice documenting: Now that you have made some minor tweaks to your documentation platform its time to practice documenting again to ensure you have everything set the way you want it. Your goal should be to document a visit, sign off on your notes, and submit a claim while the patient is still in your office. If you haven’t achieved this level of efficiency yet, it is important to contact your profitability coach and discover what might be holding you back. Take the time to get to know your new platform to eliminate frustration and achieve the top tier performance you are looking for with your chiropractic EHR.
Optimize your Chiropractic Office Workflow with Custom EHR software
Do you feel anxiety because your chiropractic Electronic Health Record system doesn’t match your clinic’s workflow? Your productivity can suffer if your documentation and forms are not integrated into your clinic’s workflow. And if your EHR software does not match your workflow your clinic’s profitability will also take a hit since you don’t get paid for documenting. Updating your chiropractic software for the ever-changing documentation requirements can be just as costly as customizing your forms since those need to be distinctive for your specialty and practice. Aside from those financial aspects, you also need an EHR system that is easy to use since you don’t have time to learn new software or enhance your limited technological skills. Ideally, your system should help you streamline your office and save you time on documentation. Features like scoring and computation should be included for increased accuracy of your patient documentation. Genesis chiropractic EHR increases efficiency and ease of use for you with customization options to match your clinic’s unique needs. You can make our EHR documentation (xDocs) entirely your own by integrating your old forms and practice logo. You can save time by using checkboxes and auto-population of patient data when creating new notes for existing patients. All new forms are automatically and instantly tied to your patient database. Best of all, you can create them while still table-side with your patient instead of having to catch up on documentation after office hours. You can also have your patients fill out their intake forms at your clinic’s patient kiosk to speed up and improve patient data collection. Genesis EHR Documentation (xDocs) also includes insurance verification forms, chiropractic notes, and a specialized package for chiropractors: the Chiropractic Bio Physics Suite. Contact your Profitability Manager to activate your xDocs within your Genesis EHR system.
