September 18, 2012 in Billing and Collections by support Team | Comments Off on Potential Impact of the 2013 ACA changes in Medicaid Reimbursements to Pediatric Practices
We hear that children are the most important aspect of our Healthcare system and that preventive care has the best return on our health care dollar. So, why are Pediatricians continuously receiving the lowest average pay when compared to other physician specialties? There are many reasons for the low reimbursements including the significant gap in payments between Medicaid and Medicare. Family Practice and Internists rely both on Medicare and Medicaid while Pediatricians, due to almost all their patients being
Patients without a primary Pediatrician seek some of their care at the Hospital ER. Besides breaking the Medical Home concept, treating at the hospital is far more expensive than in a Pediatric office. The formers of the Affordable Care Act made a choice to invest in primary care versus urgent care by changing the law so that Medicaid reimbursements = Medicare Reimbursements. This change should help providers increase their panel of Medicaid patients and should benefit the cost curve as well. Lastly, the patients should see increased access to a Pediatrician. States would see >$10B in new funds from Health and Human Services to pay for the expanded cost (this is an investment by the Federal Government). The goal of this investment is to reward the primary care physician for preventive care.
When will this take effect? Starting in 2013, the reimbursements for Medicaid are to increase to Medicare Levels.
What does this mean? There are a few states that Medicaid currently pays above Medicare (Alaska, Wyoming) according to some reach by Sandra Decker whom is an Economics at the CDC (see article in the Washington Post dated August 6, 2012 http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/06/study-one-third-of-doctors-wouldnt-take-new-medicaid-patients-last-year/ )
Overall, statehealthfacts.org by the Kaiser Family Foundation (http://www.statehealthfacts.org/comparetable.jsp?ind=196&cat=4 ) shows that Medicare to Medicaid Fee index is .66 for the United States. The lowest states are Road Island (.36), New York (.36), New Jersey (.41), District of Columbia (.47) and CA (.47).
Will the New Medicaid pay the same as commercial Insurance? Generally, the answer is no. The reason is that although Sick and Well visits should, in most states, see an increase in reimbursement being paid, there will continue to be a significant gap in payments for Vaccine Administration codes by Medicaid. Recommend read the press release below. If your practice currently does not accept Medicaid Patients due to the low reimbursements, now is the time to consider changing the policy for the practice.
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
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
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.