The ability to survive as an independent pediatric practice is contingent on being able to find new sources of revenue, even as reimbursements continue to shrink. But with a tight labor market and the challenges that come with finding skilled staff, it can be a tall order to fill. When hiring staff isn’t feasible, finding the right partner to help you with your growth goals is the best solution.

Congetta Coleman, a long-time Billing and Coding Specialist at Metro Pediatrics was faced with this dilemma in 2015. The practice was experiencing explosive growth, but their EHR was unable to meet their clinical and financial needs. Metro’s overworked billing team was stretched thin, and the complex billing requirements for Medicaid – which comprised 70%+ of their patients’ insurance plans – were keeping them from maximizing their revenue. Missed charges and coding challenges were all too common, and it was time to make a change.

After doing extensive research, Congetta and her team decided to “go all in” with OP’s pediatric-specific EHR, and also outsourced the majority of their billing to OP RCM. Here’s what happened as a result.

A Strong Partnership

One of the most significant benefits of working with an outsourced billing partner like OP is the benefit you get from the expertise of an entire financial team. Because the OP RCM team specializes in pediatric billing, it was easy for them to find specific services the providers were performing, but not billing for. The team prides itself on keeping up-to-date on all state-specific payer rules, and the nuances of billing for them. When they find discrepancies or changes in payer rules, the information is relayed back to the practice, allowing them to capture charges and maximize their payments based on the feedback from the RCM team. 

This new partnership brought about changes the practice never could have imagined. In addition to increased billing and coding knowledge, it freed up the team’s time to focus on patient care and allowed them the opportunity to look for new sources of revenue. The results from moving their billing to OP RCM were immediate.

Increased Revenue and Better Patient Care

When you have the right technology to manage the clinical side of your practice, it can make all the difference on the financial side as well. You can run recall reports for overdue well visits and vaccines. You can recall kids on asthma action plans to decrease gaps in care. You can even recall patients who are at-risk during flu season to make sure they are getting immunized in a timely manner. As an added benefit, all of this good data hygiene allows you to receive hard-earned pay-for-performance dollars.

The clinical tools that are integrated within OP led to a new initiative that allowed Metro to find additional revenue using recall reports. Because the pandemic had thrown well visit schedules into flux, Metro was able to easily run a report and recall all overdue patients for these critically important appointments. In just one month, the practice saw an increase in charges and payments that were 24% above their average. The added benefit: patients were receiving much-needed care. 

But that was just the beginning.

With additional time to focus on other initiatives, the staff was able to focus on NCQA certification. Using the tools within OP, the staff was able to pull the reports they needed, and as a result, Metro was recently awarded Patient-Centered Medical Home certification. 

Why was the PCMH certification so important to Metro? Earning NCQA PCMH Recognition means you are providing patient-centered care that is associated with higher quality, better patient satisfaction, and a reduction in avoidable, costly visits to places like an emergency room. An added bonus: many payers acknowledge PCMH Recognition as a standard of high-quality care and provide incentives to NCQA-recognized practices.

It’s Not Just about Billing

Sometimes people only think about outsourcing as a way to offload internal billing. Maybe you’re short-staffed. Maybe a biller takes an extended leave. Using an outsourced billing service is an ideal solution to fit those scenarios. But…there are so many other advantages that come with a strong RCM partner.

From a revenue perspective, Metro Pediatrics’ partnership with OP RCM led to a 24% increase in charges and visits, and a 14% increase in average payment per visit. But it also allowed them to get their patients up-to-date on their well visits, created better internal billing practices, and gave them the freedom to explore and obtain PCMH certification. 

With the right RCM partner, anything is possible. As Congetta Coleman says, “OP always has our best interests in mind. Anything they find to bring in more revenue, they let us know, and that means a lot! I can’t sing their praises enough.”

To learn more about Metro Pediatrics’ success using OP’s RCM services, you can read their client success story here.

EHRs are the key to streamlining operations, identifying efficiencies, and freeing up valuable time for clients. Our EHR and Revenue Cycle Management solutions offer features designed to help keep your practice’s financial and clinical operations running smoothly, so you can focus on what you do best – taking care of your patients. To learn how Office Practicum can help your pediatric practice operate at its best, contact us today.