The Secret to Better Pediatric Billing

Do you lie awake at night worrying about your pediatric practice’s billing processes? Are you concerned about what will happen when your reliable, long-standing staff biller decides to retire? For example, who’s going to ensure you’re billing for all services you perform such as every strep test has an accompanying visit billed. And who’s going to keep track of the constant, ever-changing payer rules that can result in significant financial hardships, if you’re relying on inadequate, inexperienced or unmotivated billing staff?

If these are your thoughts, there are steps you can take to address these problems and achieve better pediatric billing practices — both now and in the future.

Pros and Cons of In-House Billing

There are some advantages that in-house billing offers, such as a feeling of control, flexibility in how the work gets done, and perceived cost savings, but these depend largely on having the right person to manage the process. Without that proviso, the benefits could rapidly be overshadowed by disadvantages such as:

  • Complexity of the revenue cycle
  • Distraction of managing billing staff which results in difficulty maintaining a focus on patient care
  • Slower or inconsistent payments that cause cash flow problems, particularly for smaller practices
  • Challenge of keeping up to date with constant and rapidly changing industry factors

Finding the right solution is an individual process that requires careful, in-depth analysis to determine what will work for your practice.

The Outsourcing Option

Outsourcing your pediatric billing is an option worth consideration, if and when you identify the right billing partner. Because make no mistake, it is a partnership, with both parties responsible for certain aspects of the process. Your vendor might take over certain tasks, such as transmitting claims to the clearinghouse, sending out patient statements, applying payments, following up denials and open account receivable and making sure denials are being captured. The practice will still retain ownership of others, however, including functions like negotiating payer contracts, dealing with patient queries, and capturing correct patient insurance and demographic information. The outsourcing option has serious benefits, though, including:

1: Better Revenue Cycle Management

Imagine the advantages of having an expert focused on managing your revenue cycle, undistracted by other priorities in the healthcare business. You’ll improve your cash flow, reduce receivables and maximize the benefits of prompt payment of your own bills.

2: Expertise in Your Specialty

Deploying a vendor who understands the uniqueness of pediatrics (and who isn’t juggling multiple balls in the air) brings to the table a singular focus that ensures fewer oversights.

3: Strong Networking Value

Using a specialist vendor enables you to give every reimbursement claim equal attention and resources. In addition, by managing the billing for multiple practices, vendors have insights into industry-wide events that could impact you. The networking value means you can act faster and make changes necessary instead of being the last to find out about significant changes.

4: Improved Accuracy and Attention

Enhance your billing accuracy by ensuring the addition of necessary information such as modifiers, billing codes that match relevant office visits. Ensuring your team’s work is all captured and processed provides tremendous value for the practice.

5: Heightened Understanding of Denials

With expertise and commitment, an outsource vendor will be able to track and monitor denials of reimbursement. Having detailed data available in the form of vendor reports will enable you to understand the reasons for the denials and avoid these obstacles in the future.

6: Counting the Cost

In every decision a practice makes, cost is a factor. While outsourcing your pediatric billing might sound like an expensive choice. Our analysis shows, when you take into account the savings in billing department personnel, hardware and software, and the higher percentage typically collected by a focused vendor, there’s an excellent chance you’ll find yourself on the scoring side.

The Bottom Line

Outsourcing isn’t without disadvantages, one of which is the lack of direct control over the billing process. And given the amount of work involved in making the switch, it’s not a decision you can reverse on a whim, so it’s important to find the appropriate billing partner for your circumstances. With revenue cycle management and medical billing becoming more challenging daily, however, outsourcing could turn out to be the best option for your practice.

For more information, please view our complimentary webinar The Secret to Better Billing.

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