Pediatric billing and RCM

Why Pediatric Practices Outsource Their Billing and Why You Should Too

Very few things about medical billing are straightforward, but it’s especially true in pediatrics. Proper coding, modifiers, and changes in Medicaid rules and payer guidelines can turn a simple office visit into a minefield of dependencies. Add staffing shortages and the challenge of finding qualified medical billers to the mix, and it further exacerbates the stress of billing for pediatric practices.

When it comes to running a pediatric practice, the days of “one size fits all” are over. You can no longer thrive and work efficiently using a generic, non-specialty-specific EHR, and the same is true for billing and revenue cycle management. You can not entrust the financial viability of your practice with billing companies that don’t have a deep understanding of pediatrics and the complexity of the patient visits your office sees.

Why You Need to Use a Pediatric-Specialty RCM Service

Outsourcing your billing and revenue cycle management to a pediatric-specialty RCM team can increase the efficiency and accuracy of your billing operations, leading to better financial outcomes.

If you’re looking for a reliable and experienced RCM team to outsource your billing, consider a pediatric-specialty RCM team. They can provide the expert support you need to run a successful pediatric practice because they understand the nuances of coding, claims submittals, and finding missed billable charges.

There are many other benefits of outsourcing your billing to a pediatric-specialty RCM team. Some of these benefits include:

  • Increased efficiency and accuracy in billing
  • Improved cash flow
  • Reduced billing and coding mistakes
  • Increased practice revenues
  • Improved practice management

A specialized pediatric-specific RCM team can provide an elevated level of support for the unique needs of your practice. This is important because they will be able to quickly identify issues and maximize reimbursements for your practice. In addition, a specialized team will be familiar with the ever-changing regulations and requirements for pediatric billing, including changes in Medicaid regulations and P4P measures. Having this expertise will help ensure that your claims are processed accurately and in a timely manner.

Why Pediatric Practices Choose to Outsource their Billing

The reasons that pediatric practices decide to outsource their billing and revenue cycle management are as different as the patients they see. In our latest RCM case study, we did a deep dive with our clients to learn “why” they chose OP RCM for their billing needs and how it has impacted their financial outcomes. We offer proven results that show how OP RCM works to increase cash flow, decrease days in A/R, and fill in those unexpected staffing gaps to help practices stay financially healthy.

Staffing Challenges

As populations shift, and people are leaving healthcare in a mass exodus, OP RCM filled a niche that many areas throughout the country are starting to experience – a lack of skilled pediatric billers. Dedicating time and resources toward recruitment without the guarantee of finding even one good biller was a very real concern for one customer in Teton County, Wyoming, so they decided to turn their billing over to OP RCM.

After a successful transition, the practice started seeing the efficiencies that come with economies of scale. Charges increased by 4% and payments increased by 14%. Better billing practices also allowed OP RCM to get more money out of each claim, and those claims are getting paid faster. The average days in A/R were reduced by a whopping 22%. 

Financial Growth

One OP practice in Broward County, Florida had set an objective of increasing the number of patients who got up-to-date and stayed up-to-date with their vaccines. Then, without notice, a nearby pediatric practice closed leading to an influx of patients they weren’t expecting. The office manager quickly realized she needed outside assistance in order to achieve this ambitious goal and turned to OP RCM for a solution. 

OP’s recommendations were twofold. On the clinical side, the practice began using OP’s recall and messaging functionality to identify and schedule patients overdue for immunizations. To manage the financial side of the business, the practice began working with OP RCM to ensure their claims were processed faster and more efficiently and were being paid at a higher rate.

In the two years since they started working with the OP RCM team, the practice has seen a staggering 220% increase in their overall vaccine payments, while charges have increased 113% and total payments increased 151%.

Help During an Emergency

Employee shortages and untrained staff since the start of the pandemic have had a significant negative impact on the finances of many pediatric practices. Losing a biller unexpectedly to Covid left one pediatric practice in South Carolina reeling. Soon after, the practice discovered the front desk had been checking in patients without asking for insurance cards, leading the system to flag them as self-pay and not capturing insurance information for billable claims. Patient statements were being generated in error, creating confusion among parents, and frustrating staff who tried to identify what went wrong. 

Over the span of several months, the practice had submitted almost no claims. Without an immediate solution, the owner of the practice called OP RCM and began outsourcing their billing that same month. 

What wasn’t immediately obvious to the practice at the time was the trickle-down effect that comes with having a singular billing expert within a healthcare organization. After a steep learning curve, the practice took the lessons taught by the OP RCM team and started to see some real improvements. Average days in A/R were reduced by 31% and total payments increased by 21%. Back on track, the practice is once again thriving as OP RCM continues to manage its billing and revenue cycle management.

The Key to Pediatric Billing Success

Good billing practices are critical to the financial success of your practice. And while outsourcing your billing can have a profound impact on your bottom line, you must do your homework and choose a partner who understands pediatric billing and all of the nuances that come with it.

Outsourcing your billing to a pediatric-specialty RCM team can provide many benefits for your pediatric practice. If you’re looking for expert support to improve your practice’s efficiency and bottom line, consider outsourcing your billing to a pediatric-specialty RCM team like OP. The results will leave you wondering why you didn’t do it sooner.

To learn more about each practice and the results they achieved using OP RCM, click here to read their stories in full. 

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.

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