The Differences between Teaching Pediatric Medical Billing and Managing the Revenue Cycle for a Pediatric Practice

October 19, 2011 in Billing and Collections by support Team  |  Comments Off on The Differences between Teaching Pediatric Medical Billing and Managing the Revenue Cycle for a Pediatric Practice

While in college and graduate school I wondered why it was rare for a professor to have experience
managing companies.  After accumulating over two decades of experience in healthcare in various roles I have the perspective to understand why this is:  teaching is a different skill set than managing.  Similar to this, there are companies and businesses that fail because they move outside their core skill set.  For example there are many software companies that have no experience in medical billing but have experience selling software.   One of these companies started as an EMR system about 10 years ago.  Although they developed their software using the most current technology at the time, they were providing a general software solution for any specialty.   This company then moved to provide their software and medical billing for 7% of revenue.  This company lasted less than 2 years with this offering.  The leaders of the company probably realized that they were not familiar and did not have the proper resources to manage the revenue cycle (I am sure their customers voiced their concerns).  The revenue cycle is filled with daily management issues and challenges.   I am sure the company leaders realized that the systems, processes and skills needed for providing both software and medical billing services is much different than providing a general software offering.
   The Healthcare system in the United States has many disconnects.  When a company only provides the software the disconnects become the management issue of the users (for example, if an insurance
company has a different coding logic than the standard – in this case, they need to identify the issue and then develop a process solution).  We have interviewed billers that were hired to clean up the issues of a publicly traded stock company whom claim to be the model in practice management/revenue cycle management.  I have also learned from other Pediatricians examples of poor collection and revenue cycle management from a number of companies that provide the service in the industry.   

The challenges of managing both software and medical billing services include:
-The company leaders need to provide the proper technology strategic direction.  Are the leaders still holding onto ‘yesterday’s technology’?  Are the leaders familiar and able to develop a team that moves toward the future versus holding on to the dated technology?

-The company needs to have qualified and up to date technology team members…some questions to ask are there staff with computer science and engineering degrees?  Has the company been able to link
directly with Surescripts for both formulary advice and sending/receiving prescriptions?  

-The company needs to be able to benchmark their billing performance and use continuous improvement to optimize the systems/processes as the market changes. Ask the company to provide their billing performance for their pediatric practices versus national averages provided by the Medical Group Management Association (MGMA).  If they are not familiar with MGMA benchmarks and can not provide the mean performance as well as minimal/maximum… away from this option!
-The company needs to be able to identify, develop and maintain billing team members whom achieve
performance for the practice.   Ask how often and the sources of training.  Our billing team participates in quarterly training provided by the American Academy of Professional Coders, the American Academy of Pediatrics and/or the Medical Group Management Association (this takes time and keeps us ‘humble’ since the rules are constantly evolving).
-The company needs to have expertise/focus in Pediatrics – we wouldn’t select a pickup truck for street racing so why do pediatric practices select an EMR system designed for geriatrics?  Because of the high cost of developing and marketing software, companies will provide a general system and leverage their sales and marketing channels to optimize the revenue for each segment.  The field of Pediatrics is too small for a company to become a large company if they focus solely in Pediatrics.  I met a few users of ‘general’ Electronic Health Record Systems this weekend at the American Academy of Pediatrics National Meeting in Boston, MA that are spending 2-3 hours a night completing their charts.
-The company needs to manage the ‘right’ type of technology to optimize medical billing and software
EMR/practice management for a practice.  Client server systems are not the optimal solution – this is why the largest player in general medical billing (AthenaHealth) uses cloud computing and start up capital is ‘chasing’ cloud solutions and not client-server solutions (strong Venture firms have the ability to forecast the future and are able to abandon the past/dated technology) .

Our company meets these challenges by leveraging the PhysicianXpress system:  a cloud-based system for Pediatric Offices to manage the Revenue Cycle, their electronic Health Records as well as their practice.  We maintain a qualified billing team that receives quarterly training in Pediatric coding, we continuously benchmark the performance of the practices we manage, as well maintain a qualified technology team.  We are committed to help Pediatric practices increase revenues while decreasing operating costs as well as administrative burden to the practice.   Practices that implement the PhysicianXpress system do not need to spend time or extra money on maintaining a server or a database/data.  When you go to sleep tonight, do you know that your practice is collecting at >99% of the contract amount?

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