Insurance companies have more complex systems and insurance editing processes today. For instance, we have seen some insurance companies split individual codes within a visit into two claims for a provider (two codes were in-network rules while one code was out-of-network rules). These complexities in the edit and rule process by insurance companies need the right level of system design and focus to manage the revenue cycle and achieve results for the Pediatric Practice. Here are some of the must-have features you should consider when evaluating Pediatric specialty billing and practice management companies.
- Pediatric Specialty Billing: Pediatrics calls for a billing system that is designed per the specific needs of optimal revenue management of a pediatric practice. Make sure the mechanisms of the billing and practice management system are customized with features aligned with the requirements of Pediatric practices.
- Claims management: Claims management is an important task for a Pediatric practices. The system must be inclusive of features such as claims and payment processing, continuous claims monitoring and repair, claims tracking and custom claims edits.
- Practice management: From reviewing the claims and charges to monthly reporting, the administrative tasks should be easily manageable by the staff and physicians. The Pediatric Billing company should provide Pediatric Billing Benchmarks of how the practice is performing. An elite Pediatric billing service will provide monthly reports, an account manager and a telephone number for patients to call with questions.
- Patient management: Patients have questions about their patient statement. An account manager for the practice can answer questions on the invoice, collect credit card payments from the patients and help optimize the total collection rate.
- Electronic Remittance (ERA): The billing system should also be embedded with Electronic Remittance Advice (ERA) which enhances management of insurance payment posting.
- Denial management: With our elite medical billing service, you will spend less time in managing claims denials and focus more time on patient care or free time for yourself.Managing the denials and follow-up is a task that enhances the total collection rate of the practice.
- HIPAA-compliant Transaction: HIPAA standards require the providers and billers to submit the bill electronically by adhering to an approved format. An updated system meets the current standard of sending claims to the clearing house and insurance companies.
- Software updates: A system built on the cloud that includes updates to the software provides value to pediatric office. Many Pediatric offices are still using software that is not up to date.
Improve the practice financial performance by collecting more than 99% of reimbursable claims and maintain an average of less than 25 days outstanding Accounts Receivable with pediatric billing services of Physician Xpress. Learn more.