Pediatric Coding Alert

Hint: Keep a backup list of appointments to help quell cancellation woes.

Every pediatric practice is looking for ways to ensure that they don’t lose income, and it can be challenging to try and generate new revenue sources. Consider these three quick tips to ensure that you aren’t missing out on your best income opportunities.

1.  Use Automated Eligibility Checks

Many practices report that they’ll get an insurance card, take it at face value, and assume that the patient has coverage -- only to find out down the line sometimes that coverage was expired. Then they begin to traverse the maze of collections with the patient, which can be time-consuming and frustrating. However, you can prevent this problem with a quick review on the front end, says Sandy Coffta, vice president of client services with Healthcare Administrative Partners.

“The best and most efficient way to ensure your patients’ insurance information is up to date is to run an automated eligibility check,” Coffta says. “Doing so means taking advantage of electronic data interfaces to perform such validations proactively.  Submitting the patient’s insurance data as an eligibility inquiry as far upstream in the revenue cycle as possible helps prevent payer denials and the cost of staff time to handle the appeals.”

This is especially true as patients’ insurance plans evolve toward a higher patient-payment model. “With patients now paying more out-of-pocket for their care, it is more important than ever for providers to communicate with them early in the process about potential costs and verification of insurance coverage,” Coffta advises.

In addition, you can get helpful information from the insurer during real-time eligibility checks, says Mary Beth Haugen, MS, RHIA, president and CEO of Haugen Consulting Group, Inc. in Denver, Colo. “Payers may also include copay, deductibles and co-insurance amounts in their response, though it is not required,” she says.

2. Fill in Those Scheduling Holes

When a patient calls and cancels a scheduled appointment, you usually face two options: charge the patient for the missed visit, or simply accept the fact that you are going to lose the income you would have made during that session. The reality, however, is that there is a third option.

If a practice has the resources, it’s smart to keep an on-call list of patients willing to fill canceled appointments immediately. Often, you’ll get calls from worried parents who want to bring in their kids the same day, but in cases when you don’t have any room in the schedule, you can keep a “wait list” of patients you’ll call if someone else should cancel, which will help you fill those scheduling holes. You may also want to consider keeping a “waiting list” for those wanting physicals and need them “now.” Although physical time usually is longer than a “sick” visit, many can be “worked into” that time frame. Filling a cancellation with a physical actually will generate a higher reimbursement. 

3. Weight and Color Checks May Warrant 99211

Sometimes, your pediatrician will discharge a newborn from the hospital but ask the parent to bring the baby into the office within the next few days to check on weight gain, color, or breastfeeding success. Although some practices may write off these visits if the doctor doesn’t see the baby, keep in mind that 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional…) can be your friend in these situations.

You can report 99211 if the nurse has a medically necessary reason to see the baby for the weight or color check. However, if the parents just bring the baby into the office and ask you to weigh her for their own records, then you cannot report 99211 because there is no medically necessary reason to do so.