Billing and Collections

The Impact of Proper Coding to a Pediatric Practice

March 9, 2012 in Billing and Collections by support Team  |  Comments Off on The Impact of Proper Coding to a Pediatric Practice

The revenue cycle depends on teamwork between the front desk, providers, Medical Assistants, Nurses as well as the back-end billing team. Coding of the visit is dependent on the reason for the visit, complexity and time. Each provider should invest at least 2-3 minutes per visit to insure they are capturing the proper codes. A well-designed Pediatric Electronic Health Record and Practice Management system should help link the front end to the providers to the back-end office team. The providers are busy managing patients each day and usually do not have much free time and in many cases do not choose to invest in taking quarterly courses related to the Pediatric Revenue Cycle.

The practice could consider hiring a Practice Manager that completes at least quarterly training on the revenue cycle and have this person educate the providers and office as needed. The challenge with this is that the providers/partners need to achieve a certain level of understanding of the revenue cycle to insure they have an “A” rated Office Manager. An average office manager on the revenue cycle cost the practice twice – once in their salary/benefits while a second time with inappropriate/under coding. I call this the “hidden” lost revenue – a physician partner does not know what is missing until they work with a high caliber team that corrects their issue. Leveraging a company that spends all day only on Medical Billing for Pediatrics can increase the overall profitability of the practice while reducing the workload. Additionally, the office manager can focus efforts on the front end of the revenue cycle as well as Marketing to optimize the growth of the practice.
We have some clients that were missing up to 18% of revenue prior to us optimizing their revenue cycle – imagine an 18% change in your income with less administrative work. Usually, from the perspective of a Pediatrician, managing the revenue cycle for a Pediatric Practice does not excite them. There are a few Pediatricians that are on top of every claim and patient statement. This level of detail is usually redundant work and not needed (why spend all your free time looking at every claim if the audit report as well as your own audit functions shows above a 99.5% collection rate?).

We have competitions each month to see which biller can achieve the highest collection rate, who can improve patient collections the most as well as achieve the best AR days. What concerns me is that the Medical Group association benchmark data shows that the average office collects 95% of their contract amount and 70% of offices have theft at the front desk. This is easy found money with the right systems and billing team that know how to optimize the Pediatric Revenue Cycle.

What have you done this year to simplify your Pediatric Practice?

March 2, 2012 in Billing and Collections by support Team  |  Comments Off on What have you done this year to simplify your Pediatric Practice?

If you are spending more than 5 hours a week managing your Pediatric Practice as a physician owner/partner, then you should evaluate simplification techniques. How do processes move from simple to complicated? Usually it is a function of a process that has added features and needs with minimal looks at re-design. Redesign changes to a process shift a practice toward simplification and do not happen with a one-time change (there needs to be multiple small changes). An owner and/or operations lead of a Pediatric practice need to make incremental changes each week. Some suggestions on how to move your Pediatric Practice to optimal simplification include:
• Once a year, make a list of all the items that you spend time managing outside of Patient interactions (recommend spend 30-40 minutes to gain some depth without moving too granular). Identify how much time per month you spend on each item.
• Place each of the items in the list into different categories (Employee, physicians, marketing, Managed Care, finance, supplies, facilities, etc.).
• Rank the categories and the priorities that ‘matter’ most to the practice (e.g. which items increase revenue and reduce work load).
• Highlight the items that consume more than two hours per month and do not significantly increase revenue (a good question: would I pay someone $100/hour to manage this activity? If the answer is no, look to move off or eliminate from your work stream).
• Allow a week to pass then spend an hour (uninterrupted), to ask some basic questions: Do I need to service my processes (e.g. do you need to use your time to manage billers, IT personnel, back-ups)? What is the level of training and expertise of my practice personal? How do they benchmark in skills and performance versus the industry standards as billers and practice admin personnel? Do I have the skills/training to educate and assess them in the admin areas?
• Wait another week and evaluate 2-3 Pediatric Specialty Billing Companies – ask what is there collection rate? What is the range in increase revenue for Pediatric Practices that switch to their system? What support personnel will you as a Pediatric Office need if you leverage their resources?

A word of caution, this is a task that cannot be delegated to another staff member due to conflict of interest (e.g. billing team concern that the new process will show more productive to the practice – this was not ‘their issue’ probably just a system/process and/or training issue). Simplification, if done correctly, will provide the Pediatric partners with more income, less work and less stress.

Simplification of Pediatric Medical Office Operations

February 17, 2012 in Billing and Collections, EHR Selection by support Team  |  Comments Off on Simplification of Pediatric Medical Office Operations

There are many vendors and sales people that want to sell you extra ‘stuff’ for your Pediatric office. Does the product you are being sold simplify your operations, management time and increase revenue or increase your overall burden and cost? This is a basic question that every decision maker of a Pediatric Practice needs to make. The goal should be able to see 30-40 patients per day without hours of work on charts, processes, computer systems, servers, and people. Keeping this simple approach can be done with a few basic questions: what is the time I spend on charting? What is the collection rate of my practice? Does my billing team obtain continuous training on Pediatric Medical Billing? What is my audit system? Is my electronic Health Record system only designed for Pediatrics? Are we collecting above the Medical Group Management Association(MGMA) Benchmarks? Does my system require me to be the manager of Servers, IT Protocols, data back-ups as well as management of vendors whom manage these items?

Your Pediatric Billing Vendor (or internal team) should be able to provide a simple monthly report that answers the billing and claim follow-up. This report should also provide trends of billing and collections by provider in the group as well as a list of summary of claims by Insurance Company.
A practice management and E.H.R. system should be designed to first optimize your Pediatric Office as well as for the clinical workflow of Pediatrics. Our clinical system is designed and developed by Pediatricians only for Pediatrics by first optimizing the payment systems so that the offices we manage achieve >99% collection rate (significantly above the MGMA benchmarks). Not all vendors are meeting these standards. Many products are very difficult to use that requires so much training and change in workflow design. The system should not ‘feel like working in Microsoft Excel’. If so, maybe the vendor is out of date.

Some vendors hold their clients ‘hostage ‘ to their own data. All vendors should provide the practice data in a usable format if they decide to switch. There are many vendors, both large and small, that make it very difficult for practices to pull their data out of the system (this includes Client-Server software vendors that lock the data into their application….all because the server is in your office does not mean that you are protected for a hostile tactic of a vendor). If a system is simple, increases revenue, decreases hassle then a vendor does not need to move to these tactics.

Continuous improvement should be the norm in the industry. Pediatricians work very hard. If the existing system in your office is complicated and/or date, look at other options. If your collection rate is below 99%, look for a vendor whom specializes in Pediatric Medical Billing.

Verification of Proper Insurance Retractions in Pediatric Practices

January 20, 2012 in Billing and Collections by support Team  |  Comments Off on Verification of Proper Insurance Retractions in Pediatric Practices

Insurance retractions occur routinely in a busy Pediatric Practice. A retraction of money occurs when a practice owes insurance plan money due, usually, to the insurance company overpaying or incorrectly paying the practice. Some reasons why an insurance company might incorrectly pay a practice for a patient visit include:

• The patient’s insurance expired or is invalid.

• The claim system of the insurance company incorrectly paid higher than the contract amount.

• The patient has a high deductible plan and the insurance company incorrectly paid the practice prior to the patient deductible being met.

A practice management system should be able to adjust to these changes at a claim level and appropriately record the retraction. A retraction for one patient can be split over multiple payments. Note that each retraction needs to be verified by the Biller after they receive the payment summary or other documentation of the retraction from the managed care plan. These adjustments happen for various reasons and require the biller to continuously update the claim in the system.

Let’s look at an example:

Patient John Smith Visits ABC Pediatrics on January 4, 2012. ABC Pediatrics bills the Insurance provided by John Smith, receives a payment of $431 on February 2, 2012 then on April 10, 2012, ABC Pediatrics receives a statement that John Smith was not a valid member of the insurance so the practice needs to pay back the $431. The next payment is for $200 on a different patient – so the plan documents that the practice now owes the plan $231 ($431-$200) and that the EFT check for that patient is $0 (since the plan reduced the liability to the practice by $200 for John Smith’s correction).

The practice management system should have a method to update the claim for the changes so that these changes are properly documented as a credit and debit in the system. If you are unsure, call your practice management vendor for help and assistance.

Protection of Your Pediatric Practice from Theft

January 13, 2012 in Billing and Collections by support Team  |  Comments Off on Protection of Your Pediatric Practice from Theft

Unfortunately, theft is more common in Pediatric Practices than most practice owners anticipate. Businesses in general, according to some estimates, lose approximately 7% of revenue due to Theft and Embezzlement. According to a September 2010 article in MGMA Connexion, the magazine produced by the Medical Group Management Association, the Association of Certified Fraud Examiners (ACFE) estimates that the typical organization loses 5% of its revenue each year to fraud. Think that because you run background checks on all hires that you are protected? Think again – in a 2010 ACFE report, 86% of individuals that were charged or convicted of fraud were first time offenders.

Some examples of fraud in a Pediatric Practice include: employees stealing through theft of receipts, cash on hand, disbursements such as forging or altering a check, submitting fictitious invoices, paying personal expenses with company funds, payroll and expense reimbursement. More than 50% of the time the employee stole alone and had 3 or more years of experience.
Using Risk Management principle of trust and verify with proper oversight and systems can mitigate much of the risk. This includes:

1. Assess your processes and monitoring for high risk areas including co-pay management, payroll, reimbursement, patient refunds.

2. Make sure the front desk team and other members understand that there is an on-going audit of these activities (if a partner is monitoring 1 hour/1x per week, there should be enough clarification each month for the employees to understand there is an audit system).

3. Minimize the individuals involved with high risk areas (such as access to banking, payments and payroll) and insure there is a partner in the business that audits this function (recommend switching this role in a larger group so all partners have an equal share in the audit function).

A well-designed Pediatric Practice management system should have the ability to print the co-pay report per day so that the practice can insure that the books balance. This is similar to a bank teller verifying that the cash balances in their drawer. If you are unsure how to use their audit system, obtain some training then implement this with the front desk team each day. If your Practice Management system vendor does not have this function, request that they build this into the software since this is an important function. Insure that your Pediatric practice is not one of the practices that loses a percent of their revenues each month due to not implementing auditing systems and controls. By consistently implementing an appropriate audit system, you can minimize your risk of fraud/theft, protect your practice, and maybe even sleep a little better at night.

http://www.mgmaconnexion.com/connexion/201009?pg=40&pm=2&u1=friend#pg40