billing

Minimizing Technology Burden in a Pediatric Practice Using the new IPAD

March 30, 2012 in Blog by support Team  |  Comments Off on Minimizing Technology Burden in a Pediatric Practice Using the new IPAD

Most Pediatricians want to focus on treating their patients and not all the technology burden associated with Electronic Health Records. A Pediatric Health Record system should align with the technology in today’s market. The ‘old’ days of Television sets were large furniture or appliance size devices with low quality screens. Today every person seems to own multiple flat screen TVs in the House. The computer field evolved from a difficult to use device that had a mono chrome (usually green) screen to a wireless tablet that you can check your e-mail and banking while sitting on the couch. Less weight, less technology burden for the owner, less space with more features. The new IPAD (“IPAD 3”) has some features that a small Pediatric Practice could use to reduce their technology burden.

If you purchase the 4G model of the IPAD (about $640 with a $15-$30 4G cost), you can use the IPAD as a 4G Hot Spot. This means that the IPAD appears like a “WIFI” to the other lap tops/tablets in the practice. A small Pediatric practice could have a Desktop, the IPAD with 4G and a previous IPAD or another tablet computer to see patients all day (assuming all your systems are on the cloud). The practice could either use the existing internet connection or the 4G connection provided by the IPAD. Additionally, the physician on call can review charts on the IPAD (vs. using a smart phone) no matter where they are located. What would be the cost of this set-up? Two new IPADs, Desk Top computer and wireless router….less than $1500 brand new. Let’s say you also purchase a ‘good’ copier/scanner/fax machine…another $500. What is the maintenance? No back-ups, no IT people needed, no hassles…..this technology is now here today so that you can reduce the cost and hassle to your practice using the latest technology. Think of the freedom that you will achieve by moving to this model as well as improved operation by using a Pediatric Specific Cloud E.H.R. system.

There is plenty of supply of IPADs available at stores like Best Buy. Speaking of Best Buy, their leaders understand the importance of reducing overhead and space. They understand that due to the changes in technology, cloud systems and the high utilization of smart phones that there is not a need for a large store (the management of Best Buy announced recently that they will reduce the number of large stores and lay off 400+ individuals). Using the ‘right’ technology should lead many Pediatric Offices to evaluate the appropriate space for their practice. No need for the practice to have a file room, a server room (think of a server similar to that old box TV), extra break rooms, large storage. With the right system and devices, Pediatric Practices can be optimized to eliminate the burden of these extra spaces. Additionally, the practice can improve the scheduling so that the focus of the practice is the Exam rooms, Front Desk and small lab/nurse prep area. I recommend you consider leveraging the IPAD in your Pediatric Practice to see if you can remove the administrative and IT burden.

Importance of Appropriate Documentation of Different Sick and Well Visits in a Pediatric Office

February 10, 2012 in EHR Selection by support Team  |  Comments Off on Importance of Appropriate Documentation of Different Sick and Well Visits in a Pediatric Office

Remember during Pediatric Residency when you had more time to document Visits in the clinic? As a Pediatrician in training, you were probably not seeing 25+ patients per day. This slower pace and multiple residents in the clinic allowed time to write and write and write (usually there were paper charts in previous residency programs). Once in clinical practice, many Pediatricians were only able to document a sentence or some key words for the visit due to the time pressures of Practicing Primary care Pediatrics. Although, in most cases, the Pediatrician had a total well visit, the clinical paper chart did not completely reflect what was done during the visit. This level of charting is not optimal for continuity of care as well as documentation related to coding and billing.

A visit at a Pediatric office has a much different look and feel than the visit at a plastic surgeons’ office. When an Electronic Health Record system is designed for all specialties, the system usually misses many of the day-to-day details of a particular specialty (if you are in a Multi-specialty group, you might not have a choice). Even if a general E.H.R. system maintains all the content of a One Physician Specialty, the E.H.R. system has many extra windows/screens/options due to being designed for every specialty. A ‘universal’ design usually causes hours of extra charting time and in many cases misses pertinent information found in a single specialty Electronic Health Record system.

Clinical Templates provide a list of options for a visit (e.g. Asthma Template) that can also serve as reminders of options for treatment. Template design is also important for ease of documentation. A template that looks like MS Excel with boxes and many pop-ups is generally much more different to see, use and document than a template with appropriate ‘white space’ that looks more like paper. Differences in design also might provide an indicator of how up-to-date the vendor is on their User Interface.

Here are some areas that all Pediatric-Specific E.H.R. systems should contain:
• Layout and design of system based on today’s Pediatric office. This means easy to use and see screens, different views of the system depending on role of individual in the practice (Front Desk, Medical Assistant, Nurse, Practice Administration, Billing, Physician, other Providers).
• Templates based on content similar to either bright futures or Denver development.
• Growth charts based on today’s recommended standard per the AAP/CDC.
• Listing by family, linking siblings, ability to copy medical and social history from siblings
• Communication tools such as e-mail reminders, voice message reminders and announcements.
• Patient Portal.
• Link of Back-end Medical Billing to Front Desk team to communicate/flag charts that have a balance to be collected on next visit.
• Ability to link to Vaccine Exchanges, Quest, Lab Corp and Health Exchanges.
Some other questions to consider: Was and does the system continue to be developed via a Pediatric Office? Is this office similar to your office in operations (for instance, do they accept Medical Assistance and have integration with Vaccine for Children)?

Pediatric Office Revenue Cycle Management/Medical Billing – Today vs. Yesterday

October 12, 2011 in Billing and Collections by support Team  |  1 Comments

I am amazed at the number of Pediatric offices for which the partners use modern technology in their
home life and have a dated revenue cycle for their office.  Their home activities are expenses while the
office revenue cycle provides the revenue stream for their practice and their income.   Because the insurance companies routinely update systems and processes, the average Pediatric office is at a disadvantage to managing the revenue cycle.  Interesting that I have observed a practice owner drive to the nearest cell phone dealer and within an hour walk out with a new phone and abandon the old phone.  This same practice owner is unable to make a change that will increase their compensation.    Many pediatricians have systems in their office that were either designed prior to the 21st and still being sold today or are using a system that the practice purchased before the start of the 21st century.

I have met ‘Sally the biller’ whom has done the billing for years but is years behind on optimal coding
techniques for the office.  Also, we have picked up work from ‘Sally the biller’ for which thousands of
dollars have been missed in charges not resubmitted or reprocessed correctly.  It is expensive and time
consuming for a practice owner to continuously train and challenge their billing team.  Consultants have a solution – hire them to manage the billing team.   This could increase their billable hours – might be better approach to utilize the consultant a few times a year to audit account and measure versus national benchmark (if they are a high skilled consultant, they are probably busy and flexible on the arrangement).  Hiring a practice manager to manage the billing team as well as other functions might or might not be a good idea based on the size of the practice.  These challenges are especially difficult for a 1-3 physician Pediatric group where the extra headcount might only add cost and complexity to the practice and actually reduce the profit margins.

Some of the items to manage for back office revenue cycle management include: insure qualified Pediatric billers are continuously managing the revenue cycle, monthly deep dive into the account to calculate benchmark performances and evaluate aged claims, auditing, training, change of codes, change of claim file standards, change of scrubbers and claim edits, evaluate distribution of sick coding.   The larger practices also require other factors like the evaluation by provider.  Most pediatric practices become more profitable by focusing on increasing patients and revenue versus spending significant amount of time on these management issues.

Why are major corporations outsourcing?  Because the activity is being outsourced is not the core activity
of their business.  Xerox has run an advertisement campaign that they announce Marriott, a hotel, and
Ducati, an Italian motorcycle manufacturer, outsource their back office operations to Xerox so these
companies can focus on serving their customers.  Shouldn’t a pediatric office focus on their patients and
not back office management?  Optimizing profit margin and reducing administrative burden is always on the ‘grid’ for executives in companies.  Business owners of Pediatric Practices either become too busy to think strategically about this approach or might not have the proper advisers.  The links below show these videos:

Xerox – Ducati http://www.youtube.com/watch?v=e6reT9Ux_gI

Xerox – Marriott  http://www.youtube.com/XeroxCorp#p/c/7/wdi43UA2ofE

Xerox – Virgin Airlines  http://www.youtube.com/watch?v=4YFK54c2qYA

It is confusing for a practice owner to know how to identify a company that performs consistently in
Pediatric back office operations/medical billing.  There are many companies not meeting their growth
objectives of their EHR software and/or consulting practice so they might add in Medical
billing as a service.

When evaluating a company/business to manage your revenue cycle some questions to ask include: what is your collection rate, what % of your customers/clients uses your billing service vs. only your EHR.  Since you have been in
business, what % of the time have you been actively managing pediatric billing and the revenue cycle? If
they have been in business for more than 5 years and started medical billing within the last 5 years, their
processes and company systems were not built from the ground up around the revenue cycle
management of clients.  How do you audit my account?  How do I audit your actions?

Transitions from the old model means some changes for the practice:  new systems, processes and potentially a new
billing team.   If done properly, at the end of the rainbow is additional revenue, higher profit margins, reduced work and more free time for the practice owners!

Tricare and Under Payment of Rotateq

August 5, 2011 in Billing and Collections by brooke  |  Comments Off on Tricare and Under Payment of Rotateq

We have found that Customers are another set of ‘ears and eyes’ on the revenue cycle. We are fortunate to have some customers that share information they hear and see. One of our customers received an article/blog listing related to underpayment for Rotateq in patients with Tricare. Due to this information, we were able to go back an analyze all of our customers whom provided Rotateq to a Tricare patient. Although the occurrence described will not occur in all instances (some customers had no occurrences since January 2010 while others had 15 occurrences in the 18 months since the change). Although the Health Plans have many individuals and usually ‘good’ technology team, some decide to make their own rules outside the norm. Since vaccines are usually the #2 cost in Pediatrics (behind HR costs), optimizing the vaccine payment cycle is a must.

Practices that leverage the PhysicianXpress system can closely monitor the details of their vaccines reimbursements via running a report. In the practice admin section of PhysicianXpress there is a place to enter in the cost for vaccines for a date range by CPT code. If this cost information is entered into the system, there is a report that will show the # of claims per cpt code per insurance company that is paid below cost (can actually ‘drill’ down into the system to view the actual date of Service including reimbursement received). A practice admin user can also click on a different button to view the average payment above the actual cost per vaccine CPT code per insurance company.

The Issue related to reimbursement of Rotateq for Tricare Patients:

You need a Tricare patient whom received Rotateq and for which the resubmission was sent as units (we identified through this process that the unique nature of the claim submission for Rotateq at Tricare causes the resubmission – since this is not a top rejection rate across practices, it is difficult for the issue to appear on the radar as a trend). The number of patients varies for Tricare by Practice – if a resubmission was done with Rotateq as “Package” for a Tricare patient, the total amount would be paid, if resubmission for Rotateq as “Unit” the amount you indicated would be paid.

Interesting that Tricare/Healthnet is aware of this issue but appear not be updating their claim system. We called Tricare and spoke to two different representatives, Tamara (first call) and Robin (second call) to verify the contracted amount for cpt code 90680 and received a reply that Tricare pays $/unit or a $/package (for Rotateq to receive the full reimbursement – needs to be per package).
To differentiate a package vs. unit: first of all, both reps said that it is usually per unit — per 1 vial of vaccine, using 1 dose is = 1 unit; using 2 doses = 2 units and if the whole vial is used then it becomes a package. However, for Rotateq it should be considered package because of the way the Practice buys them. It is usually bought per box of 10 single dose tube (even though the doctor only used 1 single dose of 2ml).

To correct and resubmit the claims, rep advised to list the claim numbers only with patient’s names and date of service. We don’t need to send them corrected claims. It can just be in a spreadsheet and fax it to Tricare at 888-432-7077. According to these representatives, practices are allowed 6 years on corrections because of this NDC codes confusion for most practices.
We also verified of changes/updates on their system because this was not an issue prior to January 2010. The representative from Tricare EDI said there was a change on their system on 1/25/2010.