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Does Your Pediatric Practice have a clear and consistent Billing Policy Manual?

October 4, 2012 in Uncategorized by support Team  |  3 Comments

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 In some of these cases, the practices were missing thousands of dollars a month in unrealized revenue due to outdated practices and processes.

How the front Desk Team Optimizes the Front End of Pediatric Revenue Cycle and Billing

May 24, 2012 in Uncategorized 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.

Some Questions to Ask when Starting a Pediatric Practice

May 3, 2012 in Uncategorized by support Team  |  1 Comments

Although Integrating Delivery Networks in the United States are growing, there are still many Pediatricians whom leave a large group, a Hospital Group or other Integrated Delivery System to start their own practice. Starting a Pediatric Practice can be both an exciting and scary at the same time. Before any Pediatrician considers staring a practice they should look at the primary reasons why they are interested in starting a practice. Is it financial? A different level of service? What if they start the practice and makeSome of these questions include:

1. What is the demand in my market for another Pediatric Group and what additional value will my new group bring? Patients and parents need a Pediatrician. How fast your practice grows depends on the market and their choices within this market. If they have 5 other choices of Pediatric groups within a small radius and two of the practices have availability to new patients as well as many hours, the growth rate of the practice will be much less than in a town for which there is only family practice physicians. The research that should be done is to look at the population demographics and match this up with the number of Pediatricians in the area then evaluate the number of Family Practice Physicians in the area. I know of cases in which very good clinical Pediatricians make minimal salary due to the demand in the area and growth rate of their practice.

2. How should my office be configured and what are the best options for commercial real estate? When establishing a new practice, know what your goal is for the practice as well as the needed space. Fortunately, this is a buyers/renters market so the practice should be able to negotiate some favorable terms. Before looking at any commercial real estate, decide what is the appropriate square footage needed for the practice. You might consider calling a contact or service that has a background in Medical Space planning. Be careful to not over size your start-up practice: many start-up practices can manage with 2-3 exam rooms (8X10 feet), a reception area, a small lab/kitchen area and a waiting room. Some commercial real estate spaces manage the rest rooms outside of the practice while others will require the tenants to have bathrooms in their space. The location, quality and cost of the space is very important. Choosing a ‘great’ facility in a ‘bad’ location can cost the practice significant growth. Also, choosing a facility that is much larger than what is needed can cost the owner in higher expenses (this is reduced salary for you as the owner).

3. Should I start on my own or with another Pediatrician? This is a personal decision. The advantage of another owner is someone else to divide the work load with managing a Pediatric practice including seeing patients, managing staff, after-hours call, administrative items and other tasks associated with managing a practice. Some disadvantages with another partner in the start-up phases are: need a larger patient load for both Pediatricians to meet the previous income when you were a salaried employee, conflicts on choices/decisions, different work ethics/beliefs, two decision makers is less efficient than one. Being in a practice together with a partner is similar to a working marriage. Make sure that you explore this option real closely prior to joining together.

4. How should I finance my practice? There are a number of options to finance a practice including taking a line of credit on your home, obtaining a SBA loan or working with a banker to obtain a business loan. I helped my wife start her Pediatric practice through using 0% interest credit cards and our savings in the bank then moving the debt from the credit cards to a line of credit on the house. I would not suggest this method for most individuals but this allowed us to minimize the interest payments and delay a loan until we understood the amount of debt we would need. For most individuals that are pursuing financing, recommend either a SBA loan or a business loan.

5. Do I hire a medical biller or outsource my Medical Billing? Managing the revenue cycle for most Pediatric practices can be done more effectively by outsourcing to a Pediatric Medical Billing company. I have seen some pediatric practices move the ‘brink’ of bankruptcy because they had the medical billing managed by a front desk person or a biller with minimal experience in Pediatric Medical billing or questionable performance. Most Pediatrician owners can manage the front desk and Medical Assistant/nursing staff very effectively since both of these work functions are in the middle of their work flow. Managing a back office billing team requires monthly verification processes to check the claims as well as training and re-training of billing staff in the area of Pediatrics. This is outside of the scope of the expertise of most Pediatricians. Even some larger practices with Medical office staffs are not aware that half their billing staff is out of date and they are personally losing thousands of dollars a month. Unfortunately, according to the Medical Group Management Association, a high percentage (>50%) of practices have theft at the practice. Establishing strong processes and leveraging an outside Pediatric Medical Biller can help with these risks while optimizing the revenue for the practice. Additionally, this team can reduce the work load from the Pediatric Owner(s).

These are a few of the questions to ask when starting a Pediatric Practice. There are many more to ask prior to starting up a practice.

Is Your Pediatric Practice Achieving >99% Collection Rate versus the Contract Amount?

April 27, 2012 in Uncategorized 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.