Bi-County Pediatrics switches to OP RCM™ and recognizes a 30 percent increase in payments
Located in Douglasville, Georgia, Bi-County Pediatrics serves a suburban community of more than 4,000 patients with a 40 percent capped Medicaid population. A mainstay in their community, the practice’s two physicians and six staff members care for 25-45 patients per day and are now seeing the grandchildren of their very first patients. Although their patient mix has changed over time, the practice remains dedicated to providing superior, comprehensive healthcare to its patients.
Seasoned Billers Retire
For the majority of the practice’s impressive history, two billers have been responsible for managing the revenue cycle. When both retired within months of each other, Pat Flowers, Bi-County Pediatrics’ Practice Administrator, had an important decision to make: rebuild the billing staff or outsource billing to a third party. For several reasons, Pat ultimately decided to outsource her billing to OP’s pediatric billing services, OP RCM.
In-depth Knowledge of a Complex Payer System
Between the Managed Care Organization (MCO) guidelines and complicated Medicaid rules, Georgia is one of the toughest states to bill for. If billers don’t stay up-to-date on changes to payer rules, they run the risk of leaving countless dollars on the table.
Immediately upon transitioning to OP RCM, Pat and her staff began collaborating with their OP counterparts. Bi-County Pediatrics’ front office staff continues to communicate with the OP team via email, phone, and chat several times a day. While the practice’s front office staff does check coding internally to make sure all charges are correct, they know the OP team reviews the finer points of the bills to make sure every penny is accounted for.
Pat says, “The OP team is quick to respond to any questions we have, and we have seen a dramatic increase in payments from the appeals they process for us. They have our best interests at heart and will go after every last penny that is due from our payers.”
The Future Looks Bright
Less than a year after OP RCM began billing for Bi-County Pediatrics, charges have increased by roughly 23 percent, payments have increased by 30 percent, and Gross Collections Rate (GCR) increased from 52 percent to 55.2 percent. GCR measures on a percentage basis, which is the average collected on a dollar billed out. Pat attributes these impressive gains directly to the work that OP RCM has done on behalf of her practice. “Our OP billing specialist bills for the entire state of Georgia, so she sees what other practices are doing. She sees a better way to bill, and she is an expert on the rules. OP is much better equipped to handle this than having our own practice do it,” says Pat.
Bi-County Pediatrics is thrilled with the revenue cycle enhancements they’ve achieved thus far as a result of partnering with OP’s billing services. They are extremely excited about the improvements they expect to see as the teams continue to collaborate in the future.
For Pat, it was critical that the individuals responsible for managing the practice’s billing not only understand Georgia’s current billing idiosyncrasies but also be able to discover and address future changes. According to Pat, “OP RCM billers know the ins and outs of Georgia’s Medicaid rules and are proactive in their efforts to understand changes coming down the pike.”
A True Partnership
In addition to the state-specific knowledge Bi-County Pediatrics expected of its billers, the practice also required full transparency and collaboration with any third-party vendor they selected. The practice didn’t want to throw their billing “over the fence” to a vendor but instead preferred to work with a partner.