ORLANDO — Pediatricians have a reputation for being generous in caring for—and about—their patients. But that doesn't mean they should cut corners on coding, said Charles Scott, M.D., a pediatrician in private practice in Medford, N.J.
Pediatricians should be coding for every service that is done, Dr. Scott said at a meeting sponsored by the American Academy of Pediatrics. “Don't apologize for the care you have rendered on the child's behalf.”
Shrinking third-party payments, along with increasing expenses, more paperwork, and less patient appreciation, all eat into a pediatrician's pockets at the end of the day, and it's important to find legitimate ways to generate revenue, preferably without adding office personnel, Dr. Scott said.
“Those nickels and dimes add up,” he said. “Insurers won't allow us to pass our costs on to consumers, so accurate and thorough billing is essential to help your practice survive and thrive.”
Principles that can help manage costs and maximize payments in pediatric practice include avoiding freebies—such as “just taking a peek” at the second child—and avoiding professional courtesy with respect to copays. Physicians should also use additional codes when appropriate, such as those for visits after hours and on Sundays.
In addition, collecting copayments; charging for emergency visits; splinting and strapping supplies; and charging to complete forms for school, camp, or day care can make a significant difference in the bottom line.
“The small charges that some people forget can really add to your bottom line,” Dr. Scott said.
The insurance companies, unlike physicians, aren't concerned about the costs of operating a practice, so the challenge for doctors is to find innovative, ethical ways to generate revenue, Dr. Scott said. By being diligent about coding, as well as adding a few procedures, a physician can keep work exciting and generate extra revenue without increasing overhead costs, Dr. Scott added. He noted some small charges that can add up to big money:
▸ Don't leave any copayments on the table. Every patient has to pay, including those who are fellow physicians. Collect the copayments prior to the visit.
▸ Charge for second-child tagalongs. If a parent asks you to take a look at a second child, register the patient, collect the copay, conduct a thorough and appropriate evaluation, and bill for the visit.
▸ Don't offer professional courtesies. Most colleagues will take their kids to a pediatrician. But it's illegal to charge only the amount that the insurance will pay. You can't write off copays as a professional courtesy—that's considered fraud.
▸ Remember the copayment usually is higher for the emergency department than for the office visit. Tell patients that. And if the insurance won't pay for the relatively lower office charge plus the emergency code, remind the insurer that you saved them money by preventing an ED visit—something you won't do in the future should one of their plan's patients call again. Further, let the patient know that the insurer doesn't want you to see them if there should be an emergency in the future. Let the patient yell at the insurer for lack of recognition of a code that benefits all parties.
Events that constitute office emergencies include lacerations, respiratory distress, seizures, trauma, parents rushing in to demand an appointment, and a child who needs an immediate evaluation before a specialist's office closes. These deserve an additional premium for your immediate availability for that emergency.
▸ Consider simultaneous sick and well exams. There's no question that you can find some additional diagnosis at every well-child visit. It is rare that a child comes in who is 100% healthy. To code for a sick visit at the same time, the other diagnosis has to have taken more of your time than the well visit alone would have taken. Simultaneous sick and well exams don't always take much more time than a simple checkup, and you can code for the extra work. However, it has to be reasonable to spend time this way, and sometimes a separate second visit is the better bet when an insurer is intransigent.
For example, if a child comes in for a well visit and you identify an illness such as otitis media, writing a prescription takes time. You can use codes for both sick and well exams simultaneously. You can use the -25 modifier to identify that the “sick visit” part of the examination was separate.
In another example, if a child comes in for a well visit, and you want to talk in depth about an issue that arises, spend the time to do so if you prefer—but also code for that time. Alternatively, reschedule a separate visit to discuss the specific problem—such as school issues, bed-wetting, or attention-deficit hyperactivity disorder—and use a higher-level E/M (evaluation and management) code for that second visit.