The Impact of Proper Coding to a Pediatric Practice

March 9, 2012 in Uncategorized by support Team  |  Comments Off on The Impact of Proper Coding to a Pediatric Practice

The revenue cycle depends on teamwork between the front desk, providers, Medical Assistants, Nurses as well as the back-end billing team. Coding of the visit is dependent on the reason for the visit, complexity and time. Each provider should invest at least 2-3 minutes per visit to insure they are capturing the proper codes. A well-designed Pediatric Electronic Health Record and Practice Management system should help link the front end to the providers to the back-end office team. The providers are busy managing patients each day and usually do not have much free time and in many cases do not choose to invest in taking quarterly courses related to the Pediatric Revenue Cycle.

The practice could consider hiring a Practice Manager that completes at least quarterly training on the revenue cycle and have this person educate the providers and office as needed. The challenge with this is that the providers/partners need to achieve a certain level of understanding of the revenue cycle to insure they have an “A” rated Office Manager. An average office manager on the revenue cycle cost the practice twice – once in their salary/benefits while a second time with inappropriate/under coding. I call this the “hidden” lost revenue – a physician partner does not know what is missing until they work with a high caliber team that corrects their issue. Leveraging a company that spends all day only on Medical Billing for Pediatrics can increase the overall profitability of the practice while reducing the workload. Additionally, the office manager can focus efforts on the front end of the revenue cycle as well as Marketing to optimize the growth of the practice.
We have some clients that were missing up to 18% of revenue prior to us optimizing their revenue cycle – imagine an 18% change in your income with less administrative work. Usually, from the perspective of a Pediatrician, managing the revenue cycle for a Pediatric Practice does not excite them. There are a few Pediatricians that are on top of every claim and patient statement. This level of detail is usually redundant work and not needed (why spend all your free time looking at every claim if the audit report as well as your own audit functions shows above a 99.5% collection rate?).

We have competitions each month to see which biller can achieve the highest collection rate, who can improve patient collections the most as well as achieve the best AR days. What concerns me is that the Medical Group association benchmark data shows that the average office collects 95% of their contract amount and 70% of offices have theft at the front desk. This is easy found money with the right systems and billing team that know how to optimize the Pediatric Revenue Cycle.

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