Managing Payer Edits to Achieve Optimal Reimbursements of Claims

Revenue Cycle Management of a pediatric practice is a team effort. Influences on pediatric revenue cycle performance include the front desk team members, medical assistants, providers, and the medical billing team. Previous blog articles include articles on the importance of each of these roles, and the potential impact they pose on practice revenue. The medical…

Phone Consultations vs. Secure Messaging Engagement with Patients

Are documenting/submitting phone consultations and/or secure message exchanges worth the time and effort needed to appropriately do so? Many consultants may come up with ideas on how to enhance practice revenue without taking into consideration if the work required of the pediatric providers is worth the results, whereas a pediatric practice owner/administrator is more prone…

Monthly Report Key Performance Indicators to Monitor

A monthly report should provide data associated with Key Performance Indicators for operating a pediatric practice. Some of the Key Performance Indicators (KPIs) to monitor via the monthly report include: Average AR Days: Average Accounts Receivable (AR) is a measure of, on average, how fast the practice is being compensated for services performed. The lower…

Review Reporting Requirements for HRSA related to the Provider Relief Fund

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…

Checklists for Optimal Revenue Cycle Management

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…

Evaluating Clinically Integrated Networks (CINs) for Pediatric Practices

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…