All practices have accounts receivables. There is a wide distribution of how efficiently Pediatric practices manage the revenue cycle to minimize the amount of revenue in accounts receivable. A common measure in the industry for benchmarking how well a practice manages the revenue cycle is Accounts Receivable Days or more commonly known as AR Days. What are AR days? Let’s look at an example. If a practice has an average of $100,000 in gross charges a month and currently has $200,000 in accounts receivable (waiting to be paid by insurance companies and patients), the practice has approximately 60 AR Days. All practices should continue to optimize their processes and systems until the practice consistently operates at less than 30 AR days.
There are many inefficiencies that slow down the revenue cycle for practices. For instance, some practices leave a copy of all their charges each week for a biller to ‘pick up’ then send to the insurance company. The biller/billing company then needs to enter these charges in their system, review and send to the clearing house. In some cases, at least two weeks pass prior to the claim being uploaded to the insurance company. I am aware of some hospital systems that wait to the end of the month to send all claims – what a wasteful practice! A strong Pediatric Billing company measures, monitors and benchmarks these processes and looks for ways to improve the AR days for the practice. This usually requires best practice sharing and routine evaluation of pain points in the revenue cycle. This is difficult for an average biller of a practice to do successfully due to their time and focus need to focus on the daily management of claims. Pediatric practices are dependent on the practices systems, processes and back-end billing team to minimize the AR days for the practice.
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.
November 16, 2011 in EHR Selection by support Team | Comments Off on Items to Consider when Selecting a Pediatric Electronic Health Record System
How do I select a Pediatric Health Record and Practice Management System? There are many questions to ask when looking for a Pediatric E.H.R. and Practice Management System. Some items to consider include:
1. Identify a company that focuses solely (preferred) in Pediatrics or primarily in Pediatrics. Don’t be ‘fooled’ by the companies that try to provide the impression that they are focused in Pediatrics via their Pediatric-Specific advertising when they are actually an Internal Medicine/Family Practice System (look on their web sites and see what other specialties they implement their system). Just like kids are not ‘small adults’, a Pediatric E.H.R. is not just some Pediatric Templates. A properly designed Pediatric Specific E.H.R. system should be simple and intuitive to use so that you are able to see 30+ patients a day and have your charts completed within 30 minutes of seeing your last patient. The system also should have Pediatric Specific billing rules and be updated at least monthly.
2. Obtain a demonstration from the Vendor. Is the system ‘simple’ or ‘complex’? Don’t let a seasoned sales representative whom knows how to navigate your obstacle cloud your judgment on what is simple. From your years of experience, you know what is a simple/easy to use and a better design for you as a Pediatrician. Keep in mind that it is very difficult to design a system that is simple while still being complete. Some of the ‘dated’ systems are complex since that was the old model in technology as well as the old thinking around design. In the defense of vendors that are trying to maintain the ‘old’ technology, it is very expensive to redesign a system so many companies just keep adding on to their base system developed over a decade ago. In the programming world, a decade is forever (think what has changed – smart phones (e.g. IPhone), Facebook, Twitter, I Pad, etc.). One of our advisors (an executive in the Technology field), is shocked at how ‘dated’ some of the technology companies are in the Healthcare space. Interesting that some of the vendors with ‘dated’ technology is proud to answer ‘how many installs’. This is a ‘weak’ argument. Consider that there are probably more ‘tube’ TVs (old technology) than Plasma/LCD (new technology) – would you purchase a ‘tube’ TV today based on number of installs of the dated technology? Electronic stores do not sell ‘dated technology’ in TVs but E.H.R. companies continue to sell systems that were built in the pre-plasma TV/IPAD days. Their fear is that customers will see the new technology – which is better, easier to use and lower cost to the practice than the ‘dated’ technology.
3. Does the vendor provide options to customize the system? What are the costs? Some companies will not provide small customizations at a nominal to no cost (especially if they did not develop their own software but paid an outside company to develop their software). Your Pediatric Practice, in most cases, is not a ‘cookie cutter’ of the beta site for which the vendor developed their product. What can be changed and customized? Find out the cost and time frame to make changes? Ask if the company employees full-time developers or if they outsourced their development (this will provide an idea of their level of technical expertise)?
4. Does the vendor have ‘fair’ and ‘reasonable’ pricing and contracts? I am shocked at the variation of contracts by Vendors. Some vendors will have an initial cost and maintenance cost for a client server system which requires the customer (practice) to incur all the costs of a server, backups, IT team to maintain the server while providing a high maintenance fee to the practice. Many vendors make it ‘difficult’ to provide access to your data (including vendors of client-server systems). They might ‘fool’ a practice owner that they are ‘safer’ with a client-server system, but the actual occurrences in the field show that this is not true. For example, some companies do not have an export feature of their client server system so that if you want your own data out of the servers that you have paid to maintain with your own IT people, you need to pay thousands of dollars to the vendor to extract the data. The contract should state the data is yours and that you can obtain your data with a nominal fee (spelled out in the contract) or no cost. The form should be a continuity of Care Record (CCR) or similar format. If a client wants to leave our service, they will receive their data in CCR form (in our current agreements).
5. Customer Service – can you actually speak with a technically knowable person during business hours? Some companies provide either ‘leave a voice mail’ or a customer service line managed by individuals whom have strong phone skills but minimal technology skills. Call the customer service line during the day and see how long it takes for the vendor to return your call.
6. Updates – What updates are included in the price? How often are the updates? Some client-server systems only update 1-2xs per year! Many cloud systems, update continuously with this cost included to the customer. This is how this should work.
7. After your demonstration online, take a test drive for yourself of the system. Is the system easy to use? Can you call and obtain feedback and answers to your questions from team members of the vendor prior to buying? Try to schedule and see a few patients. Ask how the practice management system is integrated with the E.H.R.. What Pediatric-Specific Billing rules are in the system? Does the system have a “Pediatric Specific Scrubber” for claims? How often is this scrubber and coding system updated? 1-2xs per year is definitely not acceptable to optimize the revenue cycle.
8. Ask yourself when evaluating the options for a Pediatric E.H.R. and Practice Management System: What is the worst that can happen and best that can happen if you choose this vendor? Consider cost, how current is the technology, ability to transition to other systems, focus in Pediatrics and how much ‘hazel’ will the system be for me (e.g. there is a cost in time and effort to buy servers, maintain servers, back-up data). For example, if the vendor provides a five year agreement without a clause specifying the data format if you leave, you might be in for a costly ride. Ideally, the E.H.R. Vendor should have a one year contract with a 90 day out clause at any time after that. The vendor should also provide the data back to you in a CCR format so that all the digital data can be converted into another E.H.R.. With this contracting, there is only the risk of not liking the system since you as a practice owner can always move the data to another system without having to move through the paper to data conversion again. This is how we word our contracts – minimizes the risk to the customer (practice) and assures that the contract favors us performing continuously.
9. Do I have options for the vendor to provide billing so that I can manage my practice with less staff and does the vendor have repeatable results? Many Pediatric offices would make additional revenue with less hassle by leveraging an expert in the Revenue Cycle Management. There are many obstacles in the revenue cycle to manage that require consistent processes and management systems in place. There is a major difference from developing, selling and training on software versus managing the revenue cycle. Some vendors are trying to ‘cash-in’ without their processes and systems designed from ‘day one’ to manage the revenue cycle for their clients. Contact analysts, venture capitalists and investors, they will all point to cloud-based systems where these leaders believe today’s technology and tomorrow’s is as well. Also, you will see that the outsourcing vendors in other industries usually leverage cloud based technologies. This is very important when selecting a company to manage your billing. Some questions to ask: What is the vendor’s collection rate? What type of report do they provide the practice monthly? What is their range in A/R days for their clients? How do they train their billers to obtain new information? How do they assure that your account has follow-up and resubmission of claims? Can you view your claims real time as they manage the revenue cycle?