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How the front Desk Team Optimizes the Front End of Pediatric Revenue Cycle and Billing

May 24, 2012 in Billing and Collections by support Team  |  Comments Off on How the front Desk Team Optimizes the Front End of Pediatric Revenue Cycle and Billing

The revenue cycle for a Pediatric Practice consists of a front and back end. The processes and procedures of claim submission and patient statements are usually established and led by the group that manages the back-end of the revenue cycle. If you outsource your billing for your Pediatric practice, this is the Medical Billing Company that manages the billing of insurance companies and patients. This billing company should have defined processes and systems to manage their billing and collections for clients. They should provide the practice with a billing manual on how they manage the billing for the practice. This manual helps insure there is good communication and compliance with a process. Make sure to select a company that has processes and procedures with focused experienced in Pediatrics. If your practice utilizes a biller in-house, you need a practice administrator to develop processes and procedures then monitor these processes on a routine basis to insure adherence to these systems. Some questions include: what % of claims is sent to the insurance company within 3 days of being seen in the office? What is the rejection rate at the clearing house? What are the trends in re-submissions? How often do you train your billing team? Is the biller aware of the current changes in codes and coding rules? What is your management plan? Although physicians have the intellect to learn these items, does this extra management and learning reduce revenue generating areas like new patients and alliances with other providers? No matter if the billing is managed by a professional billing service or in house, the practice will need to manage the front end of the revenue cycle.

What is the front end of the revenue cycle? The most important aspect of the front-end of the revenue cycle is managed by the front desk team. Prior to a patient checking in, a front desk team member needs to verify the patient’s insurance, collect the co-pay, scan the insurance card and collect any outstanding bills. How well the ‘back end’ casino online of the revenue cycle communicates with the front end is important to optimize the payment due from payments. This level of coordination and communication is dependent on the system being used as well as the people using the system. For instance, a good system will allow the billing team to flag a patient that has a balance so that this information shows up on the schedule when the person checks in. The staff at the front desk needs to be coached and provided feedback on their consistency on collecting any flagged balances. A person in the practice (usually a physician partner) should be reviewing each week to verify that all co-pays are collected, insurance cards scanned in and patient balances collected when the patient shows up.

These are some examples of what the front desk team needs to do. Managing the front end of the revenue cycle is usually very simple and not time consuming. No matter if the practice leverages a professional billing company or decides to utilize their own billers, it is in their best interest to manage the front end of the revenue cycle.

Phase I Meaningful Use for Pediatric Practices: The Need to Change or Modify Practice Processes

May 18, 2012 in Blog, Healthcare Protocols and other Tech by support Team  |  Comments Off on Phase I Meaningful Use for Pediatric Practices: The Need to Change or Modify Practice Processes

I was on the phone with one of our valued customers this morning discussing Phase I Meaningful Use and the details on the “how” related to Meaningful Use. The overall goal of Health and Human Services is that providers utilize a certified E.H.R. in a meaningful way. A group of individuals invested months of discussions and feedback to obtain a list of parameters. One challenge for the group is to provide a universal list that applies across all fields of medicine. Some of the parameters in Pediatrics only apply to a certain segment of the population. For example, smoking status is for patients greater than 13 years of age. There are core measures that each provider needs to meet the benchmark for all these measures during the 90 day period being measured as well as selecting a list of 5 of the 10 menu measures.

A good E.H.R. system should provide a simple manner for a physician and/or Practice Administrator to evaluate performance of each of these benchmarks as well as very easily ‘drill down’ to identify how to correct/update patient data associated with the measure. How to use a meaningful use dashboard should take minimal training and review. The E.H.R. vendor should be able to guide an individual in the practice on the process via a web meeting or teleconference. So if you selected the ‘right’ E.H.R. system for Pediatrics, using the software and monitoring meaningful use should be straight forward.

The ‘tough’ part of Meaningful use: Changes to how the practice operates. For example, most practices did not record language, race and ethnicity as part of their intake/demographics. This needs to be captured for over 50% of patients seen during the 90 day measurement period for Phase I. If your E.H.R. system is well design, the practice should be able to click on a link and show the patients that do not have this information during the 90 day period. The most efficient way to enter this information is to capture the data when the patient visits the office. The “ah-ha” moment for many individuals is when they first run a meaningful use report, then they make the changes to their office flow and intake forms as needed.

Some questions to ask related to Meaningful use and your Pediatric Practice: Are we entering all medications in the system and sending medications via electronic prescriptions? Do we list the problems for each visit and maintain the patient problem list? Are we maintaining our Medication list and Allergy List? Does our standard protocol for demographics include recording smoking status of patients >13 years of age? Do we record vitals on each visit? Can we connect to the immunization registry? Are we connected to the lab companies that we send the majority of our labs?
This is not meant to be an a complete list of questions but a list to stimulate thinking around meaningful use. There are many resources, websites and references to obtain detailed information. Good luck on meeting Phase I Meaningful Use!

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.