The headline of a recent Huffington Post article reflects the concerns of many consumers who interact with the healthcare system in either a hospital or physician’s office. It opines: “There’s a Strong Chance That You are Paying for Expensive Medical Billing Mistakes.”
This scathing analysis of medical billing errors featured an interview with a company that reviews bills on behalf patients – Medical Billing Advocates of America. The company estimated the error rate is 80 to 90 percent on hospital stays and physician office visits. If this is true, consumers would be justified in following the ancient warning of caveat emptor (buyer beware).
As the managers of busy pediatric practices can attest, the consternation about medical billing errors cuts both ways. Because of the high patient volume and the razor-thin profit margins in the pediatric specialty, the revenue lost due to inaccurate patient billings can have an exponentially negative effect on the viability of a practice. That’s the bad news. The good news is that these errors can be minimized with better practice management technology.
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One of the best tools for helping pediatricians eliminate or at least minimize billing errors is a robust electronic health records (EHR) platform that is specifically designed for pediatrics. Since 1983, pediatricians have trusted the PCC EHR platform to ensure billing accuracy.
Jan Blanchard is an expert on medical billing. She is a pediatrics solutions consultant for PCC and her team assists pediatric practice managers and clinicians in maximizing their business management tools.
“We help practice managers transform their business into what we believe it can be: a profitable, high-functioning clinical organization,” she said.
Blanchard sheds some light on the nature of the problem.
“Defining the meaning of the term ‘error’ is the primary challenge for pediatric practices,” she said. “It is in the insurance carrier’s best interest to change the rules often, and they do.
“Keeping up with the myriad and often unannounced changes that insurance carriers make in their billing requirements is critical to the financial health of a practice. While we believe that coding standards should be consistent, my experience has been that carriers feel that standards are ‘nice’ but they often don’t abide by these rules. Thus, the challenge is more complicated than merely finding billing errors. It is a process of keeping up with the moving target of what sometimes seem to be capricious carrier requirements!”
“Pediatrics is a specialty of volume,” Blanchard said. “During flu season, for example, a clinician might see 30 or 40 kids a day all of whom have the same symptoms and, as such, have the same recommendations for follow-up care. With the PCC platform, we automate as much of this charting as possible and we tie this to automated billing.
“If a child is very sick and an antibiotic is administered, our system will ensure that the one ‘click’ that ordered this action will include all supplies and medications for which the practice can be paid, as well as understanding the total number of units that can be billed. We try to remove the guesswork about the application of codes, and we ensure the clinician has a complete set of all of the codes that could possibly be needed. Our system is designed to enable the clinical work to seamlessly flow into the billing process, capturing everything for which the practice can be compensated.”
There are many billing challenges that are specific to a pediatric practice, and it is in this area that the PCC platform consistently receives accolades from clients.
“On the preventative side of pediatrics, specifically the immunizations, there are many billing challenges that are specific to pediatrics,” Blanchard said, “When managed correctly, the coding for immunizations can capitalize on multiple units that can be billed for a single vaccine. For example, if the clinician has a combination vaccine such as Pentacel, she can bill multiples of the vaccine’s administration, depending on the number of components in the vaccine. Since there are five different diseases covered by that vaccine, the pediatrician can bill for five units of this administration.
“Too many pediatricians mis-bill their immunizations and it can make a big difference in the financial health of a practice. This is an example of a procedure that is much different from ‘adult’ medicine and a more generalized EHR would likely not catch this nuance.”
The pediatric solutions team at PCC also offers training and support in several areas of practice management, including billing and accounting.
“We offer free web labs every month that are focused on billing and coding discussions,” she said. “Just yesterday in a webinar, I walked about 25 practices through the process of setting their prices at a rate that is fair. We help our clients develop pricing policies that are predictable, logical and defensible and that properly reflect the value of the services offered. Because of our national customer base, we can build pricing data among pediatric practices nationwide that is fair and consistent.”
In a busy practice, procedures can be overlooked, supplies forgotten and revenue lost.
“Many practices are unaware that they can bill for many of the services that they believe are ‘specialty’ services,” she said. “In fact, a service is a service as long as the clinician is qualified to render it and it is within the scope of the practice.
“There is a common childhood injury known as ‘Nursemaid’s Elbow’ that occurs frequently in little ones who experience elbow dislocations. When the doctor puts these bones back in their correct position, it results in immediate relief for the child, the parents are greatly relieved and it’s great care. Unfortunately, many pediatricians don’t realize that they can bill for this because it is technically an orthopedic surgery code. In fact, this procedure is not invasive but rather an orthopedic manipulation and therefore billable by the pediatrician.
“Another example of this type of service that is sometimes confusing involves foreign body extractions. This type of procedure occurs every day in a pediatrician’s office. A child shows up with a splinter but the skin has grown over it. This requires a small incision in order to remove the foreign body, and this also is billable.
“Many of our clients view themselves as general pediatric practitioners, but when we study their practice and their style of care, we find that they do a fair amount of ‘specialty care.’ In many cases they fail to recognize that they can bill patients for this service. Plus, because this type of specialty care can be charged at a higher rate, when we bridge these gaps, it helps the practice increase profitability.”
Just as the Huffington Post “billing mistakes” article suggests, healthcare expenses are top of mind for most families and individuals. Because of this, there is increased attention paid to the value of this care. In helping to reduce or eliminate billing errors, the PCC platform helps a pediatric practice build loyalty and confidence among the parents of these young patients.
“Because of the automation of many of our clinical tools, we make it easier for doctors to deliver additional programs that are over and above the clinical experience,” Blanchard noted. “The time saved on clerical work allows the practice to offer other benefits such as patient education and community building programs among parents.
“The PCC patient portal also makes outreach much more efficient. This automated system easily manages patient recall for wellness visits and dramatically improves the overall patient experience. With fewer errors, both sides of the healthcare delivery system win.”