Most independent pediatric practices receive the majority of the practice revenue from patients with either commercial or managed Medicaid insurance. The payments to the practice are based on the fee schedule established between the insurance company and the Pediatric practice. Due to their depth of training and experiences, pediatricians have strong clinical knowledge, knowledge of how to engage optimally with patients and families, as well as approaches to navigate the medical system for patients. Pediatricians have limited experience in contracting, understanding payer plan design, appropriately managing the rules of payers and responding to requests from payers.
Many pediatric practices, due to a number of factors, do not achieve consistent and optimal Pediatric Medical billing. For most of these practices, the leaders are either not aware of or do not have the time to manage the issues, gaps and opportunities. Through our experiences over the years working with Pediatric practices, we learned that Pediatric practices that were managing their medical billing in house or with another medical billing company prior to switching to PhysicianXpress have inefficiencies, missed opportunities and limited monitoring on the details related to the AR.
While there are a number of reasons a Pediatric Practice switch their medical billing to a Pediatric Medical Billing company, the seven common reasons for switching include:
1. Low average revenue per office visit
Average revenue per office visit depends on a number of factors including the mix of visit types (e.g. well visits, sick visits, etc.), the associated services/coding, the contract rates with payers and the collection rate of the contract amount. A pediatric medical billing company should have the ability to provide consistent results as well as help Pediatric practices in these core areas.
2. High Accounts Receivable (A/R) days
Accounts Receivable days is the amount of accounts receivable expressed in a number (for more on AR days see an early blog article on AR days https://physicianxpress.com/understanding-the-concept-of-accounts-receivable-ar-days/ ). The lower the number, the less AR pending to collect for the practice. For example, an AR of 60 means that a practice has two months of total receivables waiting to be collected. If the practice providers close most of their charts within five days, total AR days should be below 30. A pediatric – specific medical billing company provides the AR information to practices monthly and should be able to explain what the practice can do to enhance their AR. Detailed management and follow-up of patient and insurance AR consistency is how quality pediatric medical billing companies like PhysicianXpress perform above MGMA benchmarks.
3. Inconsistent knowledge of billing staff on how to manage quarterly issues that occur with different payers
The medical billing knowledge varies greatly across Pediatric practice. For each practice, the medical billing skill and knowledge is limited to a few individuals with their current experience related to the circumstance of the practice. In addition to the performance of the inhouse medical billing staff varying widely, the cost to the practice includes staff, training, management, space, supplies, clearinghouses, computers and other equipment/supplies. Note that certain payers change their claim edits each quarter that require adjustments such as resending claims either electronically or sometimes on paper to be paid appropriately. A pediatric specialty Medical Billing company, like PhysicianXpress, maintains years of experience with various practices, insurance companies, proven processes and managing different situations.
4. High amount of time, effort and focus on the medical billing details
The opportunity for most Pediatric practices is optimal well care management, identification of patients to receive vaccines and daily operations of the practice. For pediatric practices that leverage PhysicianXpress, the Pediatric practice leaders can focus their efforts and hiring in three areas: Pediatric Providers, Front Desk, Medical Assistants or Nurses. There are a number of administrative details of Medical billing including staying current on payer edits, training and management. These administrative items are a burden, cost and performance issue for most pediatric practices. A high-performing Pediatric Medical Billing company will manage the revenue cycle for insurance claims, patient statements including follow-up in a manner that exceeds billing benchmarks.
5. Inconsistent medical billing results
Many of the software companies started to add a billing service that provides very inconsistent results. Some pediatric practices have experienced drops in their average revenue per visit due to the software company focusing on selling to new pediatric practices and growth of their organization versus investment in processes, time and management of existing pediatric practices to achieve consistent performance. A pediatric specific medical billing company should have years of consistent results. PhysicianXpress focuses on consistent medical billing performance first prior to adding new Pediatric practices.
6. Inadequate reporting
Inadequate reporting or reports with many pages of non-focused information causes extra work by the Pediatric practice leader. The practice leadership should receive a monthly report that summarizes billed amount, paid amount by month for the overall practice as well as each provider. Additionally, the monthly report should provide the current AR by the insurance company and details related to the patient or insurance AR that is aged more than 120 days. PhysicianXpress consistently provides the leaders/owners of the practice with monthly reports and annual reports. Additionally, the practice leaders can view the real-time financial and clinical dashboards to stay up to date on the performance of their Pediatric practice for Key Performance Indicators.
7. Unknown profitability of commercial vaccines leverage at Pediatric practice
Many practice owners are aware of their vaccine expenses but are unaware of the actual profitability of each vaccine per insurance company for a calendar year. A Pediatric specialty medical billing company should provide this information on an annual basis to the practice leadership. PhysicianXpress provides an annual report for Pediatric practice owners and leaders to identify the actual profitability of their vaccine business and the breakdown per vaccine per insurance company.
PhysicianXpress, Inc. has been a Pediatric practice Medical Billing Company since 2008 providing a high value Pediatric E.H.R. (PediatricXpress) and Revenue Cycle Management Service for independent Pediatric groups. We are committed to providing high-value Pediatric E.H.R. and Medical Billing with consistent results.