pediatric practice billing

2012 Pediatric Practice “To-Do List” or Establishing Goals

December 22, 2011 in Billing and Collections by support Team  |  2 Comments

As we head to the end of 2011, it is a good time for administrators of Pediatric Practices to establish goals for the practice. To establish appropriate goals, the practice needs to take some inventory on how they are doing in different areas of Pediatric Practice Management. Some of these areas include:

Practice Growth: What is the average growth rate in new patients to the practice per month in 2011 vs. 2012? How can the practice increase the growth rate? Does the practice have appropriate staffing to manage the growth rate of the practice? What are the total patient visits in 2011 vs. 2010 and % change? Was there a change in average revenue per patient visit? What marketing channels should the practice invest that provide the best return on investment? Which marketing channels in the past has yielded the best return?

Patient Satisfaction: Does the practice have a formal or informal feedback system related to patient satisfaction? If the system is informal, it is important to establish a formal patient feedback system that can help the practice identify areas to improve. If the system is already formal, in what areas has the practice increased their patient satisfaction versus last year? What areas has the practice decreased patient satisfaction? Some areas to consider are front desk interaction, Medical Assistant/Nurse Interaction, Physician/Provider interaction, website, tools and treatments. Evaluate the patient satisfaction scores by provider. There can be good feedback to provide a specific provider on how to improve their impact with patients.

Provider Satisfaction: Which providers are most satisfied with treating patients? What are their drivers to obtain optimal performance? Which providers are least satisfied with treating patients? What are the reasons for their level of satisfaction (e.g. patient interaction, challenging patients, call schedule, disconnect between their expectations of position and actual position)?

Billing & Revenue Cycle Management Operations: What is the collection rate for the practice? Is this above or below the Medical Group Management Association (MGMA) benchmarks? What systems can the practice implement to further improve the collection rate in 2012? What is the cost of paying the Billing Company or Billing Staff (remember with own staff to include cost of facility space, postage, taxes, management time for billers)? Is this cost above or below the MGMA Benchmarks?

Update Practice Charges: This is a good time to review all the CPT codes on the super bill and make updates in the billed rate as well as cash rate. Also, include a plan that requires a review of the insurance contracts and reimbursement rates for the top 4-6 carriers. The insurance company, in general, will pay a reimbursement rate that is the lowest of the Billed amount or the contract amount with the insurance company. There are practices that have not updated their billed rate whom send bills to the insurance company that is below their contract rate. A strong billing team will be able to manage this appropriately and proactively. Physician partners should verify this each year by obtaining a list of the CPT codes, the current billed rate for the practice.

Cost Structure: Review the primary cost items to the practice. How can the practice appropriate reduce overhead expenses while still providing high-quality care? Some areas to review include: leases for facilities, general and Malpractice insurance, telephone charges, supplies, vaccines, general office equipment. Health plans are just beginning to understand that higher overhead does not mean higher quality care. In fact, there is an acticle in the Boston Globe on December 20,2011 titled “Insurer to Reward Patients for Finding Cheaper Care” – Harvard Pilgrim plan seeks to reduce costs.
The article provides some background on what is occurring in the state of Mass: “Two reports from Attorney General Martha Coakley over the past two years have documented disparities in what hospitals and doctors are paid by insurers for the same services.” If this is just the ‘start’ then there could be a major change in payments which would benefit high quality Pediatric Groups with lower overhead (regardless of size).

Being proactive on the 2012 goals for the Pediatric Practice early in January of 2012 should help the practice optimize the benefits of these results.