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Customer Service and Pediatric Practice Management

May 11, 2012 in Blog by support Team  |  Comments Off on Customer Service and Pediatric Practice Management

I had a HORRIBLE customer service experience with a technology company this week. During business hours, I waited on hold for 29 minutes prior to a representative being available. After about 20 minutes on the phone with the customer service representative, it was obvious that she did not understand the issue
or how to resolve. She asked for another 20 minutes to check out some aspects of the issue but was unsure if she would be able to resolve the issue (technical issue with a phone they support for us). At this point I was extremely frustrated and needed to take charge of the call to provide options to her (she should have provided the options to me). She did not have an understanding of the problem for us – unsure if it was lack of listening skills or lack of knowledge. Investing more of my time on hold would have increased my frustration so we terminated the call with no resolution – missed opportunity. What could have this organization done differently? Plenty. First, no customer should wait more than 5 minutes to speak to a customer service representative. Management needs to be on the hook for staffing as well as monitoring customer service. Second, the company posted a ‘green light’ on their systems while the customer representative stated there is a major problem with their systems. The internal processes and procedures need to align when there is a problem. There are other items this company could do to further the customer service experience after they can move to an acceptable/basic level. Although we are not perfect, we are on the pursuit of perfection each day which causes continuous improvement of a ‘good’ customer experience. Constant re-engineering of processes and methods should be the norm with all organizations including the investment of people and resources.

How does this relate to Pediatric Practice Management? Pediatric practice management requires good customer service. When a patient calls during business hours, they need to be able to speak to a live person without waiting for more than a few minutes or receive a voicemail that they can leave a message when the question relates to a bill or other administrative function (e.g. follow-up on insurance information). Also, patients need to be able to leave a message any time after hours (this saves them time). We have picked up clients for which the previous billing service did not provide this level of service. Appropriate level of service is critical to managing the revenue cycle and the revenue cycle is a ‘team’ effort.

Some Questions to Ask when Starting a Pediatric Practice

May 3, 2012 in Blog by support Team  |  1 Comments

Although Integrating Delivery Networks in the United States are growing, there are still many Pediatricians whom leave a large group, a Hospital Group or other Integrated Delivery System to start their own practice. Starting a Pediatric Practice can be both an exciting and scary at the same time. Before any Pediatrician considers staring a practice they should look at the primary reasons why they are interested in starting a practice. Is it financial? A different level of service? What if they start the practice and makeSome of these questions include:

1. What is the demand in my market for another Pediatric Group and what additional value will my new group bring? Patients and parents need a Pediatrician. How fast your practice grows depends on the market and their choices within this market. If they have 5 other choices of Pediatric groups within a small radius and two of the practices have availability to new patients as well as many hours, the growth rate of the practice will be much less than in a town for which there is only family practice physicians. The research that should be done is to look at the population demographics and match this up with the number of Pediatricians in the area then evaluate the number of Family Practice Physicians in the area. I know of cases in which very good clinical Pediatricians make minimal salary due to the demand in the area and growth rate of their practice.

2. How should my office be configured and what are the best options for commercial real estate? When establishing a new practice, know what your goal is for the practice as well as the needed space. Fortunately, this is a buyers/renters market so the practice should be able to negotiate some favorable terms. Before looking at any commercial real estate, decide what is the appropriate square footage needed for the practice. You might consider calling a contact or service that has a background in Medical Space planning. Be careful to not over size your start-up practice: many start-up practices can manage with 2-3 exam rooms (8X10 feet), a reception area, a small lab/kitchen area and a waiting room. Some commercial real estate spaces manage the rest rooms outside of the practice while others will require the tenants to have bathrooms in their space. The location, quality and cost of the space is very important. Choosing a ‘great’ facility in a ‘bad’ location can cost the practice significant growth. Also, choosing a facility that is much larger than what is needed can cost the owner in higher expenses (this is reduced salary for you as the owner).

3. Should I start on my own or with another Pediatrician? This is a personal decision. The advantage of another owner is someone else to divide the work load with managing a Pediatric practice including seeing patients, managing staff, after-hours call, administrative items and other tasks associated with managing a practice. Some disadvantages with another partner in the start-up phases are: need a larger patient load for both Pediatricians to meet the previous income when you were a salaried employee, conflicts on choices/decisions, different work ethics/beliefs, two decision makers is less efficient than one. Being in a practice together with a partner is similar to a working marriage. Make sure that you explore this option real closely prior to joining together.

4. How should I finance my practice? There are a number of options to finance a practice including taking a line of credit on your home, obtaining a SBA loan or working with a banker to obtain a business loan. I helped my wife start her Pediatric practice through using 0% interest credit cards and our savings in the bank then moving the debt from the credit cards to a line of credit on the house. I would not suggest this method for most individuals but this allowed us to minimize the interest payments and delay a loan until we understood the amount of debt we would need. For most individuals that are pursuing financing, recommend either a SBA loan or a business loan.

5. Do I hire a medical biller or outsource my Medical Billing? Managing the revenue cycle for most Pediatric practices can be done more effectively by outsourcing to a Pediatric Medical Billing company. I have seen some pediatric practices move the ‘brink’ of bankruptcy because they had the medical billing managed by a front desk person or a biller with minimal experience in Pediatric Medical billing or questionable performance. Most Pediatrician owners can manage the front desk and Medical Assistant/nursing staff very effectively since both of these work functions are in the middle of their work flow. Managing a back office billing team requires monthly verification processes to check the claims as well as training and re-training of billing staff in the area of Pediatrics. This is outside of the scope of the expertise of most Pediatricians. Even some larger practices with Medical office staffs are not aware that half their billing staff is out of date and they are personally losing thousands of dollars a month. Unfortunately, according to the Medical Group Management Association, a high percentage (>50%) of practices have theft at the practice. Establishing strong processes and leveraging an outside Pediatric Medical Biller can help with these risks while optimizing the revenue for the practice. Additionally, this team can reduce the work load from the Pediatric Owner(s).

These are a few of the questions to ask when starting a Pediatric Practice. There are many more to ask prior to starting up a practice.

Is Your Pediatric Practice Achieving >99% Collection Rate versus the Contract Amount?

April 27, 2012 in Billing and Collections by support Team  |  Comments Off on Is Your Pediatric Practice Achieving >99% Collection Rate versus the Contract Amount?
2011 Pediatrician Pay versus other Specialities

2011 Pay of Pediatrician versus other Physician Specialities

Many Pediatricians look at their deposits in the practice bank account as well as track the increase/decrease in revenue. The practice has to provide optimal Pediatric care and achieve >99% collection rate to optimize the revenue collection process. Given that Pediatrics are the lowest paid specialty (per the 2011 Medscape Salary Survey – see link at http://www.medscape.com/features/slideshow/compensation/2012/public?src=ptalk&firstbullet), insuring that the practice achieves the revenue due per the contract is a necessity.

Increasing revenue year on year is important but an increase in revenue might not mean increased income/profit for the practice. For instance, if the practice has a 10% increase in visits that is due primarily to higher rates of vaccine visits, and the practice has vaccine leakage (loss of vaccines) as well as sub-optimal coding and billing follow-up, the overall practice profit might decrease. How could this happen and how could I prevent this from happening?

How a lower profit margin could happen? According to the Medical Group Management Association (MGMA) via benchmarking of collection rate, the average practice collects 95% of their contract amount. If a practice has ‘average’ billing systems and processes in place, per the MGMA benchmark of 95%, the practice would not see 5% of their revenue. If the practice had revenue of $1,000,000, they did not collect $50,000 of the contract amount (either the insurance or the patient did not pay). In addition to this, some practices lose entire visits because of the disconnect between the biller and the clinical (common when the practice fills out paper charts and paper billing sheets for a biller to complete). Some other ways that a practice has reduced revenue is improper coding. For example, if a child has a well visit and receives a MMR Vaccine, some billers miss the 90461 CPT code with 2 units. Some billers might send this CPT code but miss that the EOB only paid one of the units and they need to re-file the claim (e.g. 99391, 90707, 90460, 90461 (2 units)).

How could I prevent this from happening?
#1 insure that your Pediatric Practice leverages a medical billing system that is designed, developed and utilized only for Pediatrics.
#2 The Pediatric Medical Billing team needs to be trained and re-trained (at least 1x per quarter) in Pediatrics. The Pediatric E.H.R. should be integrated with this Pediatric Practice Management. The office needs to have audit systems in place to verify that co-pays are collected and match the insurance card as well as a monthly audit of the Pediatric Medical Biller.
#3 There also needs to be redundancies in the Medical Billers to manage the claims while a Pediatric Medical Biller is out sick or on vacation. I have seen both large (>8 providers) and small pediatric practices for which the entire revenue cycle was outdated and disconnected. Unfortunately, I have even seen a large Pediatric Group where the entire team had a significant gap in their knowledge and skills.
This will never be perfect BUT every practice should achieve >99% collection rate and strive for 99.8% (we have a few practices at 99.7%). At least each quarter and preferably once/month the practice should measure and monitor the collection rate.

Five items to Qualify a Pediatric Specific Medical Billing Company

April 21, 2012 in Billing and Collections by support Team  |  Comments Off on Five items to Qualify a Pediatric Specific Medical Billing Company

1. Determine if the company is structured Primarily for Pediatric practice billing. There are a number of
EHR companies that are in Pediatrics that started as software for electronic health records and then
developed a practice management system then offered billing. The order of development of systems and
processes is important for developing holistic systems and processes. Optimizing collection rates to above
99% consistency is important. Unfortunately there are many consultants whom have good knowledge of
meaningful use with absolutely no knowledge of Pediatric practice management. Solid practice
management and financial management are critical to each pediatric practice.

2. Evaluate if Their ENTIRE business is based on optimizing Pediatric offices in both medical billing and
Electronic Health Records. There are a number of companies that market themselves as a specialty
medical billing company in pediatrics while they are really a general medical billing company with a
marketing campaign focused in pediatrics. Their software processes and usually medical billets have
general medical billing training. This lack of ‘organizational focus’ can mean thousands of dollars in missed
revenue per month for your pediatric practice.

3. Does the pediatric medical billing company reduce burden on the providers and the practice? System
design can decrease burden and increase accessibility. A good pediatric decal billing service will provide a
monthly report that monitors the top benchmarks needed to manage a Pediatric practice. Some of these
benchmarks include collection rate account Receivable days versus national standards such as benchmarks
provided by the Medical Group Management Association. Just as today’s technology allows you to access a
book you purchased on Amazon or a song on iTunes in multiple locations and multiple devices, so should
the software provided by your Pediatric Medical billing service. The is NO NEED for the practice to have to
purchase, maintain, back-up, maintain server firewalls, stay on top of the latest firewall and virus
technology, and update servers. This is an old dated model that provides an extra burden on the Pediatric
practice.

4. Ask about training of their billing staff. Does the billing company train in Pediatrics? The billing and
coding rules in pediatrics change each year. It is difficult for a biller whom is provided general billing
training stay up to date in pediatrics. This lack of pediatric billing training can cost your practice thousands
of dollars.

5. Do they have Standard Operating Procedures (SOPs) designed and developed solely for Pediatric
practice billing? The revenue cycle contains the co-pay, the insurance responsibility as well as the patient
liability. Although the revenue cycle is similar in medical practice management, there is great variation on
how to optimize the revenue cycle by specialty. For instance, understanding all the rules in vaccine
administration codes is not a benefit to billers for surgeons but is critical in Pediatrics.

Choosing the ‘right’ Pediatric medical company should Increase revenue, decrease administration burden
and reduce stress to the practice.

Continuity of Care in Pediatric Practices & the Link to Cloud-Based E.H.R. Systems

April 13, 2012 in Blog by support Team  |  Comments Off on Continuity of Care in Pediatric Practices & the Link to Cloud-Based E.H.R. Systems

While at the pharmacy waiting for prescription Medication, I experienced the gap in knowledge by the average patient. One patient requested a medication to treat his wife’s pink eye from the pharmacist. When she explained that his wife will need an antibiotic he asked if he could use the antibiotic he was using to treat his ears. She explained to him that his wife needed a health care provider to exam her then based on the diagnosis, prescribe the appropriate medication for her red eyes. The husband was not coordinating care with his wife’s primary care physician.

Many in the health care system are missing the big picture when they do not call their primary care physician. In pediatrics, the outcome of the patient can be improved via strong continuity of care. If a patient is atopic and calls the office about a reaction to a medication, the pediatrician can use this information to appropriately manage the patient as well as record the incidence in the patient’s history. From the patient’s point of view, strong coordination with their pediatric office could reduce their burden and costs associated with using the Emergency Room. The pediatrician receives calls after office hours. The information available to the pediatrician should be able to be accessed easily at any time. Cloud-based Pediatric E.H.R. systems provide the best option for easy access to patient information on multiple devices in multiple locations…smart phones, IPads, lap tops, home computers. Who wants the burden of ‘dial in’ to the office server as well as maintaining constant security of the server?

As coordination of care continues to evolve as well as the option in wireless devices, Pediatricians can continue to reduce admin burden, costs and improve continuity of care with cloud-based E.H.R. Systems.