electronic health record

Billing of Influenza Vaccinations in a Pediatric Practice

September 27, 2012 in Uncategorized by support Team  |  Comments Off on Billing of Influenza Vaccinations in a Pediatric Practice

It is very typical for Pediatric practices to begin the process of vaccinating patients with the flu vaccines during September. Although most Pediatric practices maintain a protocol for medical billing related to giving flu vaccinations, it is a good idea to review the common billing practices.
Some questions to ask related to the influenza vaccine include: Will the physicians be examining the high risk patients as part of the flu vaccination process? Will the office set up a flu clinic for which either a Medical Assistant or Nurse administers the vaccine? Will the practice allow flu shots to be administered on weekends or after hours?
Below is the list of CPT as well as vaccination administration codes associated with influenza vaccination.
90655 Influenza virus vaccine, split virus, preservative-free, for children 6–35 months of age, for intramuscular use
90656 Influenza virus vaccine, split virus, preservative-free, when administered to 3 years of age and above, for intramuscular use
90657 Influenza virus vaccine, split virus, 6–35 months of age, for intramuscular use
90658 Influenza virus vaccine, split virus, 3 years and older, for intramuscular use
90660 Influenza virus vaccine, live, for intranasal use

Vaccine Administration Codes also need to be associated with Flu Vaccinations
If the patient is 18 years of age or younger and obtains vaccine counseling by the physician or other qualified health care professional Report CPT code 90460. If both of the criteria are not met (either over 18 years of age or does not obtain vaccine counseling by the provider), utilize the appropriate code from the 90471-90474 series. Utilize CPT Code 90471 if the influenza injection is given as the only vaccine or CPT Code 90473 if the intranasal form is the only provided vaccine. If the influenza vaccine is provided with other vaccines and the patient is either over 18 or the provider does not provide counseling, report 90472 for the influenza injection or 90474 if the intranasal form. Note that the appropriate diagnosis code for the flu vaccine is v04.8

Proper Management of the Front Desk Team & the link to High Collection Rates for Pediatric Practices

August 3, 2012 in Uncategorized by support Team  |  Comments Off on Proper Management of the Front Desk Team & the link to High Collection Rates for Pediatric Practices

The Revenue cycle is comprised of a front, middle and back end. Practice Managers need to optimize all three components for a practice to achieve an optimal collection rate. The front end of the revenue cycle is the front desk team in the practice. The front desk team members of a practice need to verify insurance eligibility as well as collect co-pays and any outstanding balances. Insurance eligibility can be verified via an automated link from the practice management system/clearing house to the insurance companies, Navinet or by calling the insurance companies. The owner as well as the practice manager of a practice need to insure that this activity is occurring accurately and consistently by the front desk team. The practice should check that the co-pay report for the day matches the co-pays collected. Also, the practice owner/manager should check-in with the back end billing team (billing company) to obtain feedback on the rate of accuracy of entering insurance and demographics by the front desk team. “Sloppy” work and/or lack of attention to detail by the front desk team can cause loss of revenue and/or delays in revenue.

The middle of the revenue cycle is comprised of the providers and clinical team properly documenting the charts as well as recording the diagnosis and CPT codes. This should be completed during the day of service and accurately. The back end of the revenue cycle is the billing team ‘scrubbing’ and verifying complete claims prior to sending to the insurance company. Additionally, the back end team will re-submit claims (make appropriate corrections) as well as send out patient statements and communicate to the front desk team for patients that have balances. The front desk team needs to effectively work with the back-end billing team to close the communication gap. When the front, middle and back-end of the revenue cycle is optimized due to good practice management, practices achieve better collection rates and faster payments than the average. For instance, we have practices that are 50% paid by the insurance company five days after the month closes (e.g. July is 50% paid for all insurance charges by August 5th).

Each member of the team needs to understand their role in the revenue cycle. Practice Managers as well as physician partners should be monitoring performance of the front desk team, the providers as well as the work of the back end billing team. Collaboration and cooperation as well as a skilled and dedicated team are critical to achieving the best success.

The Cost of Maintaining a Server in a Pediatric Practice

July 2, 2012 in Uncategorized by support Team  |  Comments Off on The Cost of Maintaining a Server in a Pediatric Practice

I enjoy speaking with customers, potential customers, vendors and suppliers to obtain feedback as well as perspective. Recently, I was made aware of the actual costs that a practice incurs for appropriately maintaining a server. The ‘old’ method of establishing Electronic Health Records in an office was to install and operate a server with an internal network. Although this is still an option today, there are many expenses such as initial and continued operating costs that cloud computing provides a better choice. The winners of practices that choose client-server E.H.R. Systems are server companies, software companies that supply software for client-server applications and technology/server consultants that maintain servers.

I continue to be made aware by physicians of the cost of operating a server. The range in cost really concerns me and surprises me. For example, I know of a one-physician practice that was spending over $700/month just on an IT consultant to maintain his servers/network. When the Internet was ‘dial-up’ there was not another option for a physician practice. Businesses of all sizes began moving from client-server applications to cloud-based applications for many reasons. Some of these reasons include: most up to date software, lower operating costs and easier establishment of additional computers/users.

Evaluate the total cost of the option when deciding to choose client-server vs. cloud computing. Here are some items to obtain cost ranges when comparing a cloud-based option to a client server option:
-Cost of the servers, network gear and estimates of how often this equipment needs to be replaced.
-Cost of installing the network
-Cost of maintaining optimal up time of the network as well as maintenance
-Cost of software for the server (initial and yearly cost).

Consider conducting some ‘basic’ research by calling a local IT consultant to obtain a price quote. Also remember that you or an office manager will need to be the project manager/coordinator of the people and vendors once the practice decides to choose either cloud-based application or a server-based application. With a cloud-based application, the practice will need to maintain an internet connection as well as a wireless network. If there is not a person in the office whom is comfortable setting up a wireless network, usually a lower cost group such as the Geek Squad can set this up for the office. With a client-server application, the office will need to purchase servers, network gear, software for servers (in addition to their E.H.R. software) as well as incur an expert to install the system and maintain the system. The practice will also need to install battery back-up and a maintenance plan with all the components. These are examples of some of the hardware maintenance costs of a server.

There are many articles on the economic benefits of cloud-computing. For instance, see the April 30, 2012 article in Forbes Magazine titled “Cloud Could Cut $12 Billion from US Government Annual Deficit”. The study quoted in this article states that the US Government could reduce the annual IT Spend from about $80 B to $68 B. The winner would be the cloud-computing companies while other groups would either lose their contract or have reduction in services. Do not under estimate the amount of lobbying, PR and Marketing that the groups impacted by this migration to cloud computing will exhibit. Remember, the practice is ‘on the hook’ for the short term and long-term cost of a decision of client-server vs. cloud computing (not an external consultant whom might have minimal to no experience optimizing revenue for a practice). Internet speeds continue to increase dramatically which further enhances the positive aspects of cloud-computing.