While most of the 2022 No Surprise act is related to surprises patient’s receive in emergency care, some parts of the act apply to outpatient care. The emergency services situations include a fairly common situation like when a patient visits a local ER (for which hospital is in network) and receives treatment from ER…
Each year additional ICD10 codes are added and some are retired. While there are a few hundred new ICD10 codes added this year, there is a select number of codes that were updated in the area of Pediatrics (about 150). The most relevant new ICD10 codes in 2022 in the area of Pediatrics include: Category…
The US government approved the CARES Act in April 2020. Part of the initial CARES Act was to provide funds to Health and Human Services for distribution to hospitals and providers for financial relief due to the COVID19 pandemic. HHS created a Provider Relief Fund via the Health Resources and Services Administration (HRSA) Provider Relief…
Pediatric Practice revenue cycle management results can be attributed to multiple stakeholders in the revenue cycle. While the Physician Xpress Account Managers and medical billing team have a significant role on managing claims, follow-up and reporting, the actions of the front desk team and the pediatric providers have an impact on the revenue cycle…
The Pfizer COVID-19 vaccine was approved by the FDA for use in children 5-11 years. Since about 1 out of 4 new COVID-19 cases are for children under the age of 18 and the previous age indication was 12 years and older, this is a very important event in the next stage of preventing…
It has been about one and a half years since the COVID-19 pandemic started within the United States. The COVID-19 pandemic consequentially altered how pediatric practices engage with patients. While the changes were significant, pediatric practice leaders and owners learned how to optimize the situation. The wearing of masks and practice of social distancing throughout…
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…
Clinically Integrated Networks or the acronym, CINs, are quality focused organizations that negotiate with payers to provide potential additional payments to providers based on established criteria. This criteria is usually a shared savings based criteria or a HEDIS-based quality improvement metric. A CIN can be one Health System or a Health System and independent practices…
It has been over sixteen months since the COVID-19 pandemic started in the United States. The COVID-19 pandemic significantly altered how pediatric practices engage with patients. While the changes were significant, pediatric practice leaders and owners learned how to optimize the situation. The wearing of masks and social distancing in the winter of 2020-2021 helped…
There are many learnings from the COVID-19 pandemic related to operating a pediatric practice. One key learning is that the COVID pandemic further confirmed that the core visit role of a pediatric office is the well visit and pediatric vaccinations. Pediatric practice leaders and owners should become even more focused on scheduling well visits for…
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