Case Study: Bi-County Pediatrics

Bi-County Pediatrics switches to OP Pediatric Billing Services and recognizes a 30% increase in payments

Located in Douglasville, Georgia, Bi-County Pediatrics serves a suburban community of more than 4,000 patients with a 40% 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. The practice’s founder, Dr. Raymond Flowers, is also a founder of Kids Health First Pediatric Alliance, a collaborative, professional alliance of more than 200 pediatricians in the Atlanta metropolitan area.

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 Pediatric Billing Services.

In-depth Knowledge of a Complex Payer System

Between 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. 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 Pediatric Billing Service’s 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.

Immediately upon transitioning to OP Pediatric Billing Services, 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 Pediatric Billing Services began billing for Bi-County Pediatrics, charges have increased by roughly 23%, payments have increased by 30%, and Gross Collections Rate (GCR) increased from 52% to 55.2%. GCR measures on a percentage basis, the average collected on a dollar billed out. Pat attributes these impressive gains directly to the work that OP Pediatric Billing Services 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.

Challenge

Replace recently retired, practice-based billers in a state with complex billing rules that often lead to missed charges and payments

Solution

Partner with OP Pediatric Billing Services

Results with OP

  • 23% increase in charges
  • 30% increase in payments
  • GCR increase from 52% to 55.2
I highly recommend OP Pediatric Billing Services. It has been great for my bottom line and the OP billing team is great to work with. I know they work hard to make sure we get paid every penny of every charge that’s billed.

Pat Flowers Practice Administrator at Bi-County Pediatrics