Pediatric EMR

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.