Case Study: Forever Kids Pediatrics
Lacy Burkes, APN with Forever Kids Pediatrics Clinic in the rural area of Canton, Texas, opened the freestanding private practice in 2016 after spending 4 years as a pediatric nurse practitioner. Forever Kids Pediatrics has 4 staff employees and recently added a second provider. The practice serves approximately 30 to 45 patients per day in the summer, primarily for preventive care immunizations. In the winter, visits increase to 45 to 55 patients per day with more acute care visits. The practice has a large Medicaid population of approximately 85% of patients, with about 10% commercial and 5% self-pay.
Forever Kids Pediatrics experienced success using Quanum Practice Management and (PM) Electronic Health Record (EHR) an integrated solution to manage their practice and efficiently document patient encounters and associated coding and billing. The practice also used a billing service to help manage billing activities, with a focus on minimizing denials and pursuing patient collections.
In February 2018, issues arose with the billing service provider the practice was using, which resulted in a 70% decrease in collections. Although the number of patients seen was not in decline, the practice was struggling financially and Burkes was concerned about having to close the doors.
Burkes reached out to her Quanum team to review options to improve billing. At the same time, she also researched the option of hiring an in-house biller.
The Quest team recommended an alternative Revenue Cycle Management (RCM) provider to help meet the needs of Burkes and Forever Kids Pediatrics. Within a few months, Quanum RCM was in place to help elevate and manage their billing performance, from code verification to superbill creation, and from claims submission to collection from payers and patients. And to provide full transparency, the practice has access to a dashboard that tracks the number of new patients, claims pending, claims denied, claims refiled, and current accounts receivable so that the practice has a complete picture of their financials at any time.
The system enables Forever Kids Pediatrics to maintain the same front office workflow, which includes a thorough process of verifying insurance when scheduling appointments and investigating issues when they arise. The practice management system sends appointment reminders, minimizing the need for staff to perform outreach to confirm appointments. This helps reduce cancellations and no shows, while increasing the on-time arrival of patients to the office. Additionally, patients are checked in for appointments only after their insurance is verified and copays and payments are collected. Burkes added an additional feature for scanning the patient’s insurance card into the system to help the practice track and manage insurance coverage.
Staff received training in the weeks leading up to the transition in June 2018. The team also worked together to ensure clear communication and processes regarding how statements are generated, when reports are run, and how collections are handled. This improves the collection process, but also helps increase patient satisfaction by eliminating patient frustration with insurance coverage or receiving bills they don’t understand.
Implementing the RCM service was a smooth transition, and the results are consistently exceeding expectations. The practice notes that collections have almost tripled since changing billing service providers. The Quanum Practice Solutions suite continues to meet the needs of the growing practice, while driving efficiencies. This allows the practice to focus less on administrative tasks, and more on their patients.
In the third quarter of 2019, gross revenue increased by 53% compared to the second quarter, and the practice experienced a 3% reduction in their accounts receivables (AR) over 120 days respectively. Most AR is closing in less than 20 days, which is less than half of the benchmark standard of 40 days, and it continues to improve.
Staff can verify insurance in one simple step, enabling tasks to process much faster. Insurance can be verified approximately 90% of time. Denials have reduced dramatically since staff enter the information needed for claims processing before the claim is sent, saving time with revising or resubmitting the claim. The system is confirming approximately 70% of appointments, significantly decreasing the amount of time.