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 performance for a Pediatric practice as well.  Due to this impact, Pediatric practices with more consistent approaches with pediatric providers and front desk team members achieve higher performance on revenue cycle management benchmarks.    This consistency is due to a practice leader or owner oversight and feedback to both front desk team members and pediatric providers.       A successful Pediatric practice leader is able to hire, coach and retain team members in various roles while providing balanced feedback to team members to enhance performance.

 

A healthy practice maintains a core team for years while achieving continuous improvements in practice operations.    A consistent core team at a pediatric practice often is a core component for training new team members.  Additionally, this core team at the practice learns and understands parent’s scheduling needs, financial needs and needs of the community the practice is located.   Whether a team is new or experienced, creating a simple checklist for core activities is a resource that can further enhance consistency of the team. 

 

Checklists to help Front Desk Team Impact on the Revenue Cycle 

A front desk team member is the person who answers the phone, schedules appointments, verifies demographic information and insurance eligibility.     Some suggested checklists items to consider for front desk team members include:

• Reviewing with each family the current demographic information including address, phone number(s), e-mail and care team members associated with the child.
• Reviewing the insurance (name of insurance, policy number) that is in the system and confirming that this insurance remains the current insurance for 2022.
• Confirming the guarantor on the insurance and if the patient has a secondary insurance (e.g. Managed Medicaid is the secondary and the parent’s insurance is the primary insurance).
• Confirming eligibility of the insurance by leveraging the tools in the system.   Additionally, the front desk person should verify the insurance via either Navinet or the insurance website as needed.
• Review any financial flags placed on the account and if a balance is due per the flag, collect the balance when the patient checks in.  
• Collect the copay and record this in EHR/practice management system.
• Confirm the VFC eligibility of the patient and record this information as appropriate.

 

Checklist for Providers on Each Visit

A Pediatric provider is critical for not only the clinical management of the patient but also for selecting the appropriate level of services completed during the visit.   As Pediatric providers gain more experience and knowledge of families, they understand the needs of the patient and families.    While Pediatric providers are highly skilled and knowledgeable, a non-clinical checklist can further help in their effectiveness.    Some suggested checklist items to consider for providers related to each visit:

• Well visit – 
  • Confirm that the appropriate vaccines associated with the visit are sent to the MA/Nurse for fulfillment.    
  • The provider should also verify and document all the current diagnosis codes for the patient.   
  • Order other appropriate tests for the well visit including hearing screens and vision screens.  
  • During many well visits, patients and parents identify an issue to address (e.g. Rash) that the pediatric provider should document and add on the appropriate E/M code (99212, 99213, 99214 or 99215).   When providers are busy, they can miss this opportunity to appropriately select the extra E/M service provided. 
  • Recommend that Pediatric providers close all charts within 72 hours of the visit.
• Sick visits – 
  • Confirm the diagnosis and select the appropriate tests or other procedures completed during the visit (e.g. ordering a strep test, COVID19 test and/or Flu test).  
  • The pediatric provider should include all the relevant diagnosis codes for the visit.  Based on the E/M guidelines, the provider should select the appropriate E/M either based on time or Medical Decision Making.  A pediatric provider that invests an extra 30 seconds to select the appropriate code based on the visit is usually time well spent.   
  • We recommend closing all charts within 48 hours of the visit.
• Vaccine Visits –   Leverage the vaccine template, select the appropriate vaccines, review the visit and close the chart the day of the visit.

 

Checklists for MA/Nurses:

The MA/Nurses fulfill orders such as hearing tests, strep tests as well as vaccinations.     Some suggested checklist items to consider for MAs/nurses related to each visit:

• Double check that the procedure is ordered in the procedure given.  For example, if a provider orders a Strep test in the system, verifies this is the correct order, completes the test (strep test) and documentation of any notes related to the test in the chart.
• For vaccines, ensure that the vaccine recorded aligns with the vaccines given to the patient.    Good system design should have checks and balances that help to reduce errors in recording vaccines given.   Great system design connects the vaccine inventory process to the administration to the billing and practice management.  Unfortunately, many systems have gaps in the vaccine revenue cycle that require manual processes by the Pediatric office Management team.

While experienced team members maintain much knowledge and skill for their role in Pediatric care, checklists can further enhance performance.   This article provides some framework to consider for checklists, the checklist should be developed and agreed upon by skilled members of the Pediatric group that understand the practice approach and needs.