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Ken Dominy
Independent pediatricians that are practice owners have many roles. While a practice owner might have the skills to do all the roles in their practice, many of the roles are lower revenue roles, some that distract the practice owner from growing the practice. A Key Performance Indicator for pediatric groups is the number of new patient additions per month. Practice owners need to free up time to focus on high revenue roles to optimize the number of new patient adds per month in addition to the number of patient visits per month. Optimal focus in this area helps grow the practice and reduce administrative burden for the providers.
There is much administrative work and process engineering to optimize a pediatric practice medical billing operation. Some of these tasks/items include:
-Review and send claims each day in a consistent matter
-Review and resubmission of rejected claims
-Posting payments and determining patient responsibility
-Staying up on trends in the market and training updates
-Review of all data and information to develop/create monthly reports
-Reviewing data yearly to create a strategic business review
-Development of Yearly Profit/loss review by vaccine per payer
While the revenue cycle management related tasks and reporting are important to the practice, optimizing the revenue cycle takes much time, skill, and in many cases pulls the physician or practice owner away from areas that generate more revenue. Optimal revenue generating roles include seeing patients or networking with other physicians/groups for referrals. Some of the tasks might seem simple, like sending a few claims to the insurance company. Others are more complex and require team knowledge or benchmarking data. These processes and systems can take 8-10 years to optimize (practices should avoid new billing companies or software companies that do not perform billing for the majority of their clients). Over time most practice owners are unable to dedicate enough time to optimize their revenue cycle due to other priorities. The physician owner(s) of the pediatric group might know a change is needed to improve performance of the revenue cycle but are too busy to complete the task. Large companies that try to serve hundreds or thousands of physician practices have a hard time executing consistently due to the variation of staff performance and turn over. Smaller, high-performing pediatric medical billing companies are harder to find for a number of reasons. Pediatric practice owners that use a top-performing pediatric billing company can use the enhanced revenue and reduced admin burden to expand the practice either in the same location or add another office. Outsourcing the medical billing should reduce the amount of office space needed as well as the total number of employees at the practice. This reduction in people and space frees up time for the providers and staff to optimize patient care. Optimal pediatric patient care increases patient satisfaction, and increased patient satisfaction usually increases the ‘word of mouth’ referrals to the practice. A call to the right pediatric medical billing company with an integrated pediatric EHR and practice management system should improve the overall financial health of the pediatric practice.
