Every provider knows that practice volume is one of the keys to financial success. But when Village Pediatrics grew so much that owner and certified pediatric nurse practitioner Staci Scott and another clinician had to use two hours of personal time weekly performing medical coding, they needed help. Their initial agreement with a third-party billing company required at least an hour a week troubleshooting and back-and-forth communications. But this service wasn’t integrated with Village Pediatrics’ EHR, so it was challenging to view claims. There were also regulatory issues with information sharing.

How athenaOne® Medical Coding transformed practice operations

About a year into working with the third-party billing company, Scott said Village Pediatrics still found the process “confounding and exhausting.” The service was not integrated with athenaOne, so there was no HIPAA-compliant way to communicate. Switching to Medical Coding changed that and has made day-to-day operations easier and more efficient. The streamlined service means that there are no additional signons to access a third-party system, nor a reason to keep separate spreadsheets comparing data from athenahealth with the third-party service. “I can see all the notes in one spot. I can communicate things when I send the claim—send notes for extensive visits, for instance,” said Scott. “And if the coders have questions, communication is so much easier and more streamlined now.” Instead of two hours of personal time previously spent on these administrative tasks, Scott now spends a maximum of 30 to 45 minutes on coding weekly.

Instead of inputting codes and submitting electronically — a process Scott was still performing, even with the third-party agency — now she simply confirms insurance is correct with a short note. She doesn’t need to keep up with changing payer rules, and there’s less pressure to know which modifier to use with different payers. “There are some really odd rules,” Scott explained, “so the quality of (athenahealth) coders’ knowledge has been really helpful.”

In many instances, this supplementary insight from HIPAA-compliant professionals has enhanced profitability. Identifying more codes Village Pediatrics didn’t realize they could bill for — hemoglobin pricks can often be coded for multiple charges, for instance — has been an added benefit. Scott also says there’s been less claim rework since transitioning to Medical Coding.

Village Pediatrics can now process its claims faster due to a lower backlog of work. Besides this efficiency, Scott says she is also “reassured” thanks to automatically performed quality assurance and auditing services. She no longer has to worry about the quarterly audit that she performed herself, which meant additional after-hours work performed a few times a year.