A Closer Look at Your Pediatric Billing Team’s Performance

medical billing assessment test

Navigating the complexities of pediatric billing can often feel like solving a puzzle without all the pieces. One of the most frequent questions we get is, “How can I easily assess how my billing team is performing?”. While traditional pediatric medical billing performance metrics provide some insight, they don’t always paint the full picture. Here’s a focused approach to evaluating your biller’s effectiveness and performing a medical billing assessment test.

Claim Payment and Management

Before diving into the weeds of days in Accounts Receivable (AR) or percentages of claims over 90 days, we recommend starting with the basics:

  • Claim Payment Success: The foundational goal of any billing operation is to get claims paid. Evaluating the number of claims paid versus those submitted gives you a direct look at your biller’s efficiency and effectiveness.
  • Attention to Unpaid Claims: It’s crucial to ensure that not only are claims being submitted, but those that aren’t paid immediately are receiving ongoing attention. This proactive management is key to maintaining a healthy cash flow.

Write-Offs and Aging Claims

  • Zero-Paid Claims: Begin by reviewing any claims that have been written off entirely, with $0 paid and $0 owed. This number should ideally be minimal. Exceptions should be rare and well-explained, providing clear billing insights into why specific services weren’t reimbursed.
  • Aging Claims Review: Next, turn your attention to older claims. While it’s normal to have some aged claims due to legitimate reasons, the crucial factor is what actions are being taken to address them. Effective pediatric medical billing requires regular, proactive review and resolution efforts to ensure these claims move toward payment.

KPIs for Pediatric Medical Billing

While the pediatric medical billing performance metrics discussed above provide a solid foundation for evaluating your billing team’s performance, there are additional key performance indicators for medical billing that can offer a more comprehensive view of your practice’s financial health.

Patient Satisfaction:

  • Patient Feedback: Regularly gather feedback from patients regarding their billing experience. This can help identify areas where the billing process may be causing frustration or confusion.
  • Timely Statements: Ensure patients receive their statements promptly after services are rendered. Delayed statements can lead to increased patient inquiries and potential payment delays.

Staff Efficiency:

  • Billing Cycle Time: Measure the average time it takes to process and submit a claim from the time of service. A shorter billing cycle time indicates efficient staff processes and reduced revenue leakage.
  • Error Rates: Track the number and types of billing errors that occur. This can help identify areas where staff training or process improvements may be needed.

Technology Utilization:

  • Electronic Health Records (EHR) Integration: Assess how effectively your pediatric EHR system is integrated with your billing software. A seamless integration can streamline data entry and reduce errors.
  • Denial Management Tools: Evaluate the use of denial management software or tools. These can help identify common denial reasons and develop strategies to prevent future denials.

By incorporating these additional KPIs into your medical billing assessment, you can gain a more nuanced understanding of your billing team’s performance and identify areas for improvement. This will ultimately help you optimize your billing processes and ensure the financial success of your pediatric practice.

Active Pediatric Financial Management

This targeted approach to reviewing your billing operations offers a clear, straightforward method to gauge whether your billing team is actively managing your financial health or if urgent issues require immediate attention. It’s a lens through which you can view not just problems, but also the efforts and strategies employed to solve them.

Ensuring Financial Health

The end goal of pediatric billing isn’t merely to submit claims—it’s to secure payment for the vital care you provide. By concentrating on claim payment success and the management of unpaid claims, you create a foundation for assessing the performance of your billing team.

This method ensures that your billing operations are not just about numbers but about meaningful actions that contribute to the financial success of your pediatric practice. Start with these focus areas to conduct a medical billing assessment test of your team’s performance against the key areas outlined. Get a real-time snapshot of your billing team’s performance and its impact on your practice’s overall financial health. 

Partner with Altus for Expert Pediatric Billing

Altus is your trusted partner in optimizing pediatric billing operations. Our team of experienced professionals are dedicated to providing tailored pediatric billing services that address the unique challenges faced by healthcare providers.

Don’t let billing complexities hinder your practice’s success. Contact us today to schedule a consultation and explore how our expert-driven approach can make a difference.