Introduction: As the holiday season approaches, pediatric practices must prepare for the unique challenges and opportunities that come with managing patient care, staff schedules, and overall practice operations. This time of year can be hectic for both families and healthcare professionals, but with thoughtful planning and strategic management, pediatric practices can ensure a smooth and…
As the Thanksgiving season approaches, pediatric practices must strategically manage their schedules to ensure a balance between providing quality care and allowing staff to enjoy the holiday festivities. Here are some essential considerations for pediatric practice management during Thanksgiving and the holiday season: 1. Early Communication: Begin by communicating with your staff well in advance. Discuss…
Background The RSV prevention, Beyfortus (nirsevimab) which is a monoclonal antibody, was approved by the FDA on July 17, 2023. The CDC and ACIP provided recommendations which were published in the MMWR on August 25, 2023. The FDA accelerated approval of Beyfortus since the RSV prevention was categorized as “Breakthrough Therapy Designation”. Note that Beyfortus…
Introduction In the world of healthcare, pediatric practices play a crucial role in nurturing the health and well-being of our youngest population. While many pediatricians choose to join larger healthcare systems or hospital networks, there’s a dedicated group who opt for independence. Operating an independent pediatric practice comes with a unique set of challenges and…
Over coding by pediatricians refers to a situation where the services provided to patients are coded or billed at a higher level than warranted based on the documentation and medical necessity. This can have several impacts on the pediatric practice: Compliance risks: Over coding or over billing can lead to compliance issues and potential legal…
Under coding or under billing by pediatricians refers to a situation where the services provided to patients are not accurately coded or billed at the appropriate level, resulting in lower reimbursement than deserved. This can have several impacts on the pediatric practice: Financial implications: Under coding or under billing can lead to decreased revenue for…
Overview: Managed care payers in the United States negotiate contracts with healthcare providers, such as pediatric practices, to set payment rates for services rendered to their members. These payment rates may be based on a fee schedule or a negotiated rate. One way that managed care payers may control costs is by “down coding” claims…
Overview: Pediatric phone triage protocols are structured interviews that help a nurse or other medical provider make a decision about whether a patient needs to be seen immediately. This decision is referred to as telephone triage, and it’s an important part of the patient phone call process. There are several approaches to pediatric phone triage…
A managed Medicaid plan is a type of health insurance plan that is designed for individuals who are enrolled in the Medicaid program. These plans are managed by private insurance companies, known as Managed Care Organizations (MCOs), that have contracts with state Medicaid agencies to provide health coverage and other services to eligible individuals. Managed…
As discussed on a previous blog article a few years ago, Accounts Receivable Days is a key performance indicator to monitor. Today, there was an interesting article in the Wall Street Journal that discusses the importance of monitoring the amount of Accounts Receivable in a business and that large businesses use a metric known…
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