Welcome To PedSource
Physician's Computer Company (PCC), developer of Partner pediatric practice management software, is a valuable business resource for pediatricians. PCC created PedSource to share these resources with the larger pediatric community.
Benefits
When you join PedSource you'll enjoy...- Invitations to Pediatric Conferences and Audio-Seminars
- A library of tips and tricks to help you save time and money
- Benchmarks and Calculators featuring Pediatric data
- Opportunities to assist with the design of a Pediatric EHR
- Peer-to-peer networking
Jul
23
PCC is pleased to announce that this summer's Pediatric Coding & Practice Management Conference will take place at Walt Disney World® Resort, Florida from July 23-24 2009.
We are planning an exciting conference packed with pediatric practice management education in a fun-filled learning environment. Mark your calendars or begin to plan your trip to Walt Disney World® Resort now.
Register Now! Or, Read More about this event.
New! Earn 5.5 CEUs!
This program has prior approval of the American Academy of Professional Coders for 5.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the program content or the program sponsor. CEU credit must be awarded before April 30, 2010.
Do Retail-Based Clinics Pose a Threat to Your Practice?
June 24, 2009 by katy
Retail-based medical clinics (RBCs) have taken the ideas of convenience and one-stop shopping to a new level, and have cropped up throughout the country at a rapidly growing rate. With numbers expected to reach into the thousands in 2009, these clinics are located in drug stores and shopping centers like WalMart and Target, and bear names that reflect their philosophy of service, such as "MinuteClinic" and "QuickHealth." These clinics advertise themselves as both convenient and affordable, and have an added appeal for those who fall into the categories of under or uninsured.
New at PedSource
Interested in these items recently posted at PedSource? After two weeks, new articles may be protected for exclusive use by PedSource members. Membership is free so Login or Join Today to access these items and other pediatric specific content.
- Concierge Pediatrics is it Within your Reach?
- The Red Flags Rule and Your Practice
- The Red Flags Rule - Are You In Compliance?
- Red Flag Rule ID Theft Progam Template
- How to Write a Financial Policy
- Your Practice and the Economy - May Update
- Stimulus EHR Incentives for Pediatricians
- Virus Protection Frequently Asked Questions
- Cleanup Time: Springtime System Administration
- The Pediatic Center Goes Live with PCC EHR
- Revere Winthrop Pediatrics Prepares for PCC EHR
- VPG Will Become and Early Adopter fo PCC EHR
- Launch of PCC EHR Version 1.1 Coming Soon
New Online Resource for Developing Early Literacy Skills
June 23, 2009 by katy
As pediatric professionals, you are acutely aware of the importance of developing pre-literacy skills to childhood development and helping children reach their full potential. The Stern Center for Language and Learning recently launched a free online program to help prepare children for reading by teaching parents and child care providers how to get children ready for literacy success.
Jun
23
Plans for PCC EHR Version 2.0
June 23, 2009 by katy
Our goal in creating PCC EHR Version 1.1 was to replace the paper chart and allow pediatricians who want PCC EHR right away to implement it in their office. Now that PCC EHR Version 1.1 is complete and up and running in a handful of pediatric offices, work has begun on PCC EHR Version 2.0.
Blog: Confessions of a Pediatric Practice Consultant
Jun
30
A few weeks ago, Dr. Stoller sent me this (and I have just been too swamped to keep up):
"OXFORD: ALERT! Recoupment Requests Based on Extrapolation
Some members have received letters from Oxford requesting that they pay large alleged overpayments based on extrapolation. Members are urged to alert their office staff to be aware of the process. A letter from Oxford notifies the physician of an audit that will cover medical billing and coding for e&m claims. The letter may seek information from physicians who are no longer Oxford providers. It will include a list of patients whose records have been selected for review. The
letter may include instructions from CODeXACT, Powered by PARSES (PARSES), which sets forth instructions on how to provide the requested documents. After the physician provides documents Oxford may send a letter from a Provider Compl iance Analyst seeking a repayment for alleged overpayments based on the “random sample.” This letter indicates that the overpayment is based on a “statistical methodology” and extrapolates to assert an alleged overpayment amount.MSNJ believes that Oxford’s use of extrapolation to derive an overpayment amount is in violation of state laws and regulations. We have forwarded examples of this business practice to the New Jersey Department of Banking & Insurance (DOBI’s). We want to ensure that all such overpayment requests have been discovered. Members are urged not to pay the alleged overpayment amount. Given that the PARSES analysis will be used to extrapolate an alleged overpayment amount physicians may want to consider objecting to the request rather than providing the requested documentation.
Please respond to this article by writing to info@msnj.org if you have received one of the notice letters or one of the overpayment request letters. Please indicate whether you have paid any such overpayment request.
We will keep members apprised of developments concerning DOBI’s investigation of this business practice."
At about the same time, some of our clients in TN were being harassed by a "recovery contractor" in an effort to recover money supposedly overpaid by TN BCBS (read about the TN Medical Society's response).
Now, a few weeks later, Dr. Stoller has updated me:
OXFORD: Cease & Desist Order Issued on Recoupment
The New Jersey Department of Banking & Insurance (DOBI) issued a
cease and desist order against Oxford Health Insurance, Inc. on June
23, 2009, asserting that it has violated New Jersey law by seeking
overpayments from physicians based on extrapolation. DOBI asserts that
the Health Claims Authorization, Processing & Payment Act (HCAPPA)
restricts the situations in which a carrier may seek reimbursement for
overpayments based upon extrapolation. In particular, DOBI was
concerned about the use of extrapolation based on fraud.
The papers filed by DOBI indicate that Oxford justified its recoupment
attempts based on fraud. However, the statute only allows extrapolation
where there is “clear evidence of fraud” and the payer has both
investigated in accordance with its fraud prevention plan and has
referred the claim to the Office of the Insurance Fraud Prosecutor
(OIFP). According to DOBI, Oxford did not make such a referral. In
fact, DOBI’s papers cite numerous circumstances that suggest that
Oxford did not consider the physicians’ conduct to be fraudulent,
including the fact that Oxford allowed the targeted practices to remain
in its network. Moreover, the papers indicate that Oxford’s referral to
the OIFP was only made after DOBI’s inquiry into Oxford’s recoupment
practice, suggesting back-tracking on the part of the company.The cease and desist order requires that Oxford: discontinue its
recoupment activity based on extrapolation; reimburse physicians for
overpayment recovery that violated the HCAPPA, together with 12%
interest; and file a report with DOBI detailing its efforts in this
regard.DOBI’s action may take away some of the anxiety physicians feel when
insurers intimate that they have acted fraudulently when, in fact, they
are billing services and collecting payments in good faith.
Susanne Madden predicted this very behavior a few months ago, but I don't think she was going out on a limb there, either. It's going to get worse before it gets better, I think. And - brief applause for the NJ and TN Medical Societies.

