Helping Medical Practices Increase Revenue

Big isn’t necessarily better, especially when it comes to delivering quality patient care. Researchers have found that smaller practices delivering more personalized patient care, had lower rates of preventable hospital admissions, possibly due to the fact that patients often have an easier time booking an appointment with a smaller practice, as well as better physician-patient relationships. These in turn may lead to keeping patients healthier by detecting potential conditions before they result in a hospital admission.

Approximately 19 percent of the U.S. population is covered by Medicaid, or roughly 70 million people.  Among the rural poor, especially, with children and elderly are at risk in underserved and lower socioeconomic regions of the country.

One of the most important steps for onboarding a new provider for your practice is credentialing. Failing to get a new provider credentialed by payers could result in no payment for services unless a patient’s plan allows for out-of-network benefits. Credentialing involves verifying the facts such as the state licensure, medical school certificate, malpractice carriers, and also includes a background investigation of the physician’s financial and criminal history. 

Preventive medicine is one of the most critical components of providing care for infants and children by pediatricians.  Due to recent changes in CPT vaccination codes as well as billing requirements by payers, reimbursement for even the most routine vaccinations, as well as preventive exams, can become a billing challenge. Another loss of revenue for many pediatric providers is failure to maximize reimbursements by undercoding and omitting modifiers as well as submitting claims without supporting documentation.

Every practice and health organization, regardless of size or specialty, needs to step back from time to time and evaluate their patients’ experiences and satisfaction levels. With more patients flexing their consumer muscles and taking on more financial responsibility for their health care expenses, providers no longer can afford to do “business as usual.”