5 Tips for Deciding How to Handle Billing at Your Startup Pediatric Practice

You’ve decided you’re ready to spread your entrepreneurial wings. You’re going to open your own pediatric practice.

While it’s an exciting time, it’s also busy with planning. You’ve got a checklist full of items like credentialing providers with payers, securing financing, choosing a location, purchasing technology, hiring staff, ordering supplies and furniture, and preparing forms and processes.

Another important area to tackle before officially launching your new practice? Billing. It’s one of the most critical elements of your business. Without a good billing system, you won’t get paid appropriately. And a practice that’s not profitable will quickly fold in the ever-changing world of healthcare.

So how do you decide how to handle billing for your pediatric startup? Here are five tips to help you make the best choice for your new business.

1. Know your options

One choice is to hire an employee or a team who does billing internally. If you are onboarding billers you worked with at a previous practice, the benefit is that they already know the processes.

However, having an in-house billing staff can present challenges. In addition to paying salaries and benefits, you have to make sure billers are always up to date on the latest rules and policies. This is no easy task when dealing with large health insurance companies.

The second option is to outsource your billing to a third-party company. This can be a wise choice because it allows your new team to focus on other efforts that affect revenue, including collecting patient balances and overseeing vaccine management. Before selecting a third-party billing company, be sure to interview some so you can make an informed decision.

2. Keep pediatrics at the forefront

This might seem obvious, but pediatric practices, especially startups, need the support of people and companies who know the specialty. When setting up in-house billing for your fledgling pediatric practice, ask yourself if the person you’re hiring has experience in pediatric billing.

The same goes for a third-party company. Pick one that knows the nuances of pediatric billing — Medicaid regulations and reporting, combination well and sick charges during the same visit, and vaccine management. Companies that offer more general healthcare billing may not understand the unique needs of pediatric practices.

3. Consider your peace of mind

Whether you’re hiring internally or partnering with a billing company, you want to have trust in that relationship.

Unfortunately, there are dishonest people out there. The last thing you want is a billing team member who steals from your practice, taking five or ten dollars from every claim. In that case, you wouldn’t even know there’s a problem until checks start bouncing.

When you partner with a billing service, think about visibility and transparency. A credible company will bill on your system, not proprietary software that you can’t access. You should be able to see each step that’s occurred on every claim and check your practice’s overall performance.

4. Protect your bottom line

In order to have a profitable business, whoever is handling your billing needs to understand insurance claims. Payer rules are constantly changing, and keeping up with them can be challenging, especially for an in-house billing team.

Billing companies, particularly ones that specialize in pediatrics, will likely know how to get the highest reimbursements for your practice. This is important because, although pediatrics is one of the most important specialties in medicine, it is also one of the lowest paying. Partnering with a billing company that fights for every single penny will increase your bottom line.

5. Examine bundling of services

Healthcare billing is complex. It requires knowledge of health records and medical coding. Given that overlap, it might benefit your pediatric practice to streamline similar services.

Connecting your electronic health record (EHR) system with your billing can be a smart choice, especially considering all you’re undertaking at the start of your new pediatric practice. When exploring billing options, give some extra attention to third-party companies that offer EHR. Partnering with an organization that provides both systems can save you many headaches as you launch your practice.

For more information about pediatric billing, watch this video.

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