One of the first steps to optimizing the revenue cycle for a Pediatric Practice is to develop and incorporate a consistent Billing Processes, Procedures and Policies Manual for the practice. This manual should be customized to the practice based on how the revenue cycle is managed for the Pediatric Practice. Some items to include in this manual are:
• Payment Plan Agreement
• Examples of letters that will be used for final collections, payment plan, etc.
• List of responsibilities for front desk team members
• Registration forms
• Notices such as privacy policy
For all of our new billing clients we develop or edit the Billing Processes, Procedures and Policies Manual to the needs of the practice. This written document helps to provide clarity to all parties involved related to the Processes, procedures and policies for managing the revenue cycle of the Pediatric Practice. Developing and implementing this manual is an important first step to optimizing the revenue cycle for the Pediatric Practice. If you develop your own manual, recommend you obtain assistance from either a Pediatric Practice consultant or from another Pediatric Practice Administrator to identify if the manual is within the current standards of the industry. We have obtained new clients that were managing the practice based on revenue cycle rules of the late 1990s. In some of these cases, the practices were missing thousands of dollars a month in unrealized revenue due to outdated practices and processes.
practice management
Does Your Pediatric Practice have a clear and consistent Billing Policy Manual?
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.
http://www.hhs.gov/news/press/2012pres/05/20120509b.html
