OP’s Pediatric Success Series
by Lance Castle
Outsourced Billing for Pediatric Practices: How to Boost Revenue and Efficiency
Traditionally, pediatric practices have relied on in-house billing experts to manage all aspects of invoicing, billing, and collections. These employees are no doubt skilled, but times have changed.
Modern pediatric practices don’t have room for human errors and oversight in today’s competitive world. That’s where outsourced billing comes in. A reputable, well-established billing service manages the billing cycle efficiently and expertly so that you don’t have to. It also helps you see what’s impacting your revenue cycle so you can make quick, targeted changes.
Gil Kochman, VP of Pediatric Billing Services at Office Practicum, explains how outsourcing can work for you.
Challenges of In-House Billing
Many practices continue to rely on in-house billing, but it presents many challenges for pediatric practices.
For one, the pediatric revenue cycle is complex. It’s difficult, if not next to impossible, to keep up with the constant regulatory changes and payer-specific adjudication rules and payment processing requirements.
In addition, “practices that rely on in-house billing staff may lack a well-defined protocol,” Kochman explains. Specifically, there may be fewer documented guidelines around proper billing procedures, especially if billing is managed by a sole employee.
This is problematic for a variety of reasons. Having minimal guidelines for something as important as billing can cause major disruption during workforce changes. Let’s say your sole biller goes on vacation or leaves the practice, for example. How will you train another employee to take the reins if there simply aren’t any established rules?
In-house billing may also lead to inconsistencies in the processing of claims. This means that some payments may be processed more quickly than others. And, other payments may take much longer to process (especially if they had an error). These inconsistencies could negatively impact the practices cash flow, days in A/R, and timely filing deadlines. Practices may also have trouble ensuring that services were billed and collected properly.
Slow reimbursement is another side effect of inconsistent billing. This might not seem like a big deal in the long run. Better late than never, right? Kochman doesn’t think so. “Slow reimbursement results in unstable cash flow.”
Practices want a predictable, stable cash flow so they can feel confident that the money flowing into the practice is greater than the amount flowing out in the form of expenses. A healthy cash flow enables practices to pay their staff, purchase vaccines, and, literally, keep the lights on.
Since pediatric practices already have such thin margins, risking cash flow stability simply isn’t worth it.
Advantages of Outsourced Billing
Outsourced billing alleviates many of the headaches associated with in-house billing.
Still, some people fear that they’ll lose control over the billing cycle because it’s not being managed in-house. While others may feel that the billing service team members will not work as hard to collect the practice’s money as practice employees would.
These concerns are valid, but as Kochman explains, the right billing partner will provide the transparency, tracking, and motivated employees to allay any of these fears.
Singularly Focused Experts
One of the greatest benefits of outsourcing your billing to a pediatric-specific billing service is access to experts who are singularly focused on pediatric revenue cycle management. They know the intricacies of pediatric billing – including the ever-changing regulations, adjudication rules, and payment models – because their sole responsibility is ensuring that their clients get paid for the services they provide.
The Network Effect
Because pediatric-specific billing services manage the revenue cycle for hundreds of pediatric clients, they are better able to detect and respond to changes that are taking place. For example, if the billing service sees that Medicaid claims from a particular state are being rejected at a higher rate than usual, they can determine why and fix the problem for the affected clients and put protocols in place to prevent this from happening in the future.
A billing company can see what is and isn’t working across their entire client base, enabling them to establish best practices that benefit all their clients. This network effect cannot be replicated in-house.
More Revenue for Your Practice
Another benefit of outsourcing your billing is that it enables you to focus your staff on more revenue-generating activities like patient collections, recalls, flu clinics, etc. Leave the detailed monthly reporting, trend analysis, and benchmarking to the billing service. They can also keep you updated on the latest industry news and trends and show you how you stack up against competitors and practices similar to yours. Practices who manage everything in-house simply don’t have access to such valuable information.
What to Look for in a Billing Service
Choosing the right billing service for your practice is important. You don’t want to simply hand off all your billing responsibilities to a faceless entity. Instead, you want to partner with a company who will work with your practice to achieve your financial goals. Below is a simple list of what you should expect from your billing service:
Collection Performance Improvements
- Timely conversion of superbills to claims
- More accurate initial submission of claims
- Proper setup of all payer rules
- Ongoing monitoring of payer rule changes
- Work exceptions and denials immediately to ensure timely correction for adjudication
- Ensure proper modifiers are in place
- Make sure missing codes are added (e.g., admin codes for vaccines)
- Notify the practice about rejections related to procedure and/or diagnosis errors
Fee Schedule Optimization
- Review and maintain fee schedule to ensure reimbursement optimization
Eliminate Missing Charges
- Ensure superbills are completed and converted to claims in a timely manner
- Run reports to ensure all appointments have corresponding superbills
- Ensure missing codes are added (e.g., admin codes for vaccines, strep test without an office visit)
A well-established pediatric billing company sees both the big and small picture. In addition, they understand your specific challenges and goals — and provide ideas for improvement.
Finding the right pediatric-specific billing partner is the best way to ensure that outsourcing earns your practice both time and revenue.
About the Sponsor
Office Practicum is a leading provider of pediatric-specific solutions. Our EHR, PM system, and billing services help pediatric practices improve clinical and financial outcomes. Contact us today to learn more.