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Running a pediatric practice is a team effort. At the heart of the operation is a partnership between the Physician Owner and the Practice Administrator — the duo responsible for both the clinical mission and the business engine. Note that in a small practice the Physician Owner might function as both the Practice Administrator and practice owner. Equally important to the practice are the relationships that support your systems: the PediatricXpress Electronic Health Record (EHR) system and the Physician Xpress Medical Billing team.
While the Physician Xpress team is committed to optimal Pediatric Practice performance, there are certain functions and roles that are within the front desk team and/or Pediatric provider. A Pediatric practice owner/lead should consider the roles/functions that are core to the Physician Xpress team and what roles/functions remain the responsibility of a practice leader and their staff.
The Physician Owner: Vision, Clinical Standards, Strategic Oversight
As the clinical and business leader, the Pediatric practice owner is responsible for:
Setting the clinical direction of the practice
Overseeing provider quality and care standards
Making key financial and strategic decision
Ensuring the practice operates in alignment with its mission and values
While the Pediatric Practice owner may not be in the weeds of daily operations (note: most are), staying informed and asking the right questions is essential — especially when it comes to financial and compliance performance.
The Practice Administrator (often part of all of this role is aspect of the Pediatric practice owner’s role): Execution, Operations, Staff Management and overall practice Management
The administrator translates the owner’s vision into daily workflows. Responsibilities include:
Managing staffing, schedules, patient flow, and compliance
Acting as the point of contact for EHR and Revenue Cycle team members.
Monitoring reporting, payer contracts, and service levels by the practice team
Ensuring problems are escalated and resolved efficiently
EHR and Billing Team: Tools and Tactical Partners
The physician Xpress team has a role related to the PediatricXpress EHR system and the Physician Xpress Medical Billing Team.
🔹 Expectations of the Physician Xpress team related to the PediatricXpress system
The PediatricXpress system by Physician Xpress can be leveraged to become the digital backbone of your Pediatric practice. Expect:
Reliable system performance, data security, and uptime. We maintain the PediatricXpress system on a true cloud system with enterprise level security, backups and redundancies. The system is monitored and managed by a team of Network engineers. Our team continuously identifies system performance improvements and enhancements that occur on a routine basis.
Regulatory compliance, including HIPAA, and interoperability requirements. Interoperability includes the ability to send Electronic prescriptions, interface with Immunization registries and maintain bi-directional connections with both LabCorp and Quest. Additionally, the PediatricXpress system is connected to multiple clinical integrated networks for which practice data is sent on a weekly basis.
User-friendly tools for scheduling, charting, messaging, patient portal, and reporting. The appointment book is an integrated design that links many aspects of the practice in a simple interface. Users can click on patient names to view their clinical charts quickly.
Training and onboarding tools for staff on how to use the system. There are over 85 video tutorials within the PediatricXpress system that provides training on most of the aspects of the system. This can be accessed by all users.
Access to support for resolution of issues/concerns and system customization options. We recommend that support requests be sent via the task system to the account manager currently. In the near future, all support and billing related requests will be required to be sent via the PediatricXpress task system.
Areas/role of the Pediatric practice leadership in leveraging the PediatricXpress EHR system:
Managing the Pediatric practice staff’s workflow or ensuring they’re using the system correctly. After the initial on-boarding process, practice leaders need to identify and implement a process for their practice related to new employee training. Many practices leverage an experienced employee to train the new employee on the PediatricXpress system while others use this approach as well as leverage the training videos in the PediatricXpress system.
Coding of visits, documenting clinical notes and ensuring consistency across the provider team. Each practice should manage and monitor the providers related to selection of appropriate CPT codes and ICD10 diagnosis codes as well as closing charts timely. There are tools in the system to monitor various aspects of performance including charts that are open per provider.
Monitoring your practice’s productivity or performance — While the physician Xpress team provides a monthly report that provides most of the Key Performance Indicators (KPIs) related to monitoring a Pediatric practice, practices might have other business analysis needs that are the responsibility of the practice.
🔹 Expectations of the Physician Xpress Medical Billing Team
The Physician Xpress billing team plays a crucial role in turning your services into revenue. You can expect:
Clean and timely claim submissions based on your documentation and coding. While selection of the proper CPT code and ICD10 diagnosis code is the provider’s role, the medical billing team reviews these codes, makes adjustments related to modifiers and ICD10 linkages to CPT codes based on Pediatric medical billing standards.
Denial and rejection management, including re-submissions and appeals. Denials can occur due to ICD10 linkages to select CPT codes that a payer might reject or for other payer related issues.
Payment posting, adjustments, and patient balance follow-up. After processing claims, the medical billing team manages ERAs related to the status and payment of claims including adjustments that occur. Certain insurances have co-insurance or deductibles for sick visits that result in a patient statement to the family.
Monthly reports on collections, denials, A/R, and payer trends. Monthly reporting provides the pediatric practice a view of the practice performance and Revenue Cycle Management overall performance as of the end of the month.
Role/Areas for the Pediatric Practice leader related enhancing Revenue Cycle Management:
Front Desk Check-in including eligibility verification and collecting copays and balances. The front desk team should be following the practice guidelines and processes for check in including verification of each insurance via the payor websites and collecting copays and balances. The PediatricXpress system provides an automatic eligibility tool that reduces this workload dramatically. While the system has auto eligibility tools, the front desk team still needs to call some payers for verification that might not have linkages to the automated systems.
Ensuring that your providers are documenting and coding correctly based on the care provided.. The practice leader/owner should routinely view a sample of charts from the other providers to ensure the documentation aligns with the coding selected by the provider.
Creating and implementing a financial policy or managing patient financial conversations at the front desk. The PediatricXpress system has the ability to send out a ‘templated’ financial policy if configured for the practice. In addition to this approach, Pediatric Practices should have a copy of their financial policies and obtain signatures from each family that is part of the practice.
Management of the practice staff to complete missing charts or documentation including timely closing of charts.
Final Thought: Tools Don’t Replace Leadership
The Physician Xpress team amplifies a well-run pediatric practice. While we greatly improve a low performing practice Revenue cycle management performance, we are unable to fix certain aspects of a Pediatric practice that are the responsibility of the Pediatric Practice owner or leader. Systems, staff, and partnership with the physician Xpress team should work in harmony and can optimize the revenue cycle for the pediatric practice. When leadership sets the vision, administration builds the structure, and the Physician Xpress team supports the execution, the result is a pediatric practice that thrives clinically and financially.
