Implementing a Successful Pediatric Billing Program
Taos Clinic for Children & Youth Experiences Significant Increase in Revenue with OP
Taos Clinic for Children and Youth (TCCY) is a five-provider practice located in Taos County, New Mexico. They have been in business since 1978 and an OP client since 2008. Nearly 33,000 people reside in Taos County, and of those, 12,000 are seen annually at TCCY – the only full-time pediatric clinic in the county. Thirty percent of the patients are classified as chronic, and seventy percent of their patients have Medicaid as their primary insurance plan.
Struggling to Survive
TCCY found it challenging to recruit and retain skilled healthcare professionals for a child population that requires a high degree of varying medical treatment challenges. In addition to finding skilled labor, Taos was struggling to find a billing system that worked well for pediatrics, and superbills weren’t getting submitted in a timely manner. They had tried in-house and off-site billing before ultimately deciding to partner with OP.
Partnering with OP
After several meetings with the doctors and staff, OP RCM assumed billing responsibilities for Taos. At first, Taos billers were given a one-week time frame to submit superbills. Because the billing burden had been taken off their shoulders, they were able to focus on completing charts in a more timely manner, and are now processing claims the same day as the patient visit.
“We took care of the billing so the doctors could focus on what matters most – seeing patients,” said OP Billing Expert for TCCY. Payments are now received within thirty days from the time of the office visit to the time of the ERA post. This is just one area where the practice has experienced significant improvement since contracting with OP RCM.
Focusing on What Matters
OP RCM was able to focus on the intricacies of the individual payer rules so the staff at TCCY could spend more time working the patient account, which led to a direct increase in practice revenue. Since Medicaid rules tend to vary by state, and requirements are in constant flux, it’s critical to stay on top of these changes to make sure the practice is meeting all payer requirements.
The OP team was also able to conduct research on insurance coding requirements, which made it easier to recoup lost revenue. When the billers saw certain complex diagnoses, they contacted the doctors to see if in-house tests were performed and included in the superbill to ensure the providers were getting paid for all of their work.
“No two practices adhere to identical metrics for measuring their operational performance, and no two practices have the same patient challenges,” said Dick Schlarbaum, Office Manager at Taos Clinic for Children & Youth. “Therefore, it becomes the responsibility of the practice to partner with a vendor that seeks to assist them in achieving their operational objectives.” Using OP RCM has allowed Taos to focus on these objectives.