I-Med Claims - Medical Billing Company
Pediatric Billing Services

Best Practices To Improve Pediatric Billing Services

Pediatric billing services has become increasingly complex in today’s constantly evolving healthcare landscape. Coders and billers must continuously update their skills and concepts to ensure accurate billing and timely collection of claims. Optimizing billing processes is crucial for pediatric practices to ensure cost efficiency and maximize revenue cycle management. By implementing effective billing strategies, pediatric practices can minimize claim rejections and denials, resulting in faster payments and reduced administrative costs. Therefore, pediatric practices must prioritize billing process optimization to stay competitive in the healthcare industry.

Why Do Pediatricians Need Medical Billing Services?

Pediatricians require medical billing services due to the unique challenges they face in their field. Since they spend more time with each patient (at least 25% more), accurate medical billing and coding are essential to ensure fair reimbursement for their time. Additionally, communicating with young patients and diagnosing them can be challenging, making it vital to have a streamlined billing process. Failure to bill for vaccines can result in a significant loss of revenue, highlighting the importance of proper coding and billing procedures in pediatrics. As such, medical billers must pay close attention to the requirements specific to pediatrics to avoid errors and ensure fair reimbursement.

Evaluate Your Current Billing Process

Evaluating your current billing processes is essential to identify inefficiency and improve revenue cycle management. Assessing your billing processes can help you identify common errors, such as inaccurate coding or incomplete documentation, that lead to claim denials and delayed payments. By measuring key metrics such as claim denial rates and time to payment, you can gain valuable insights into your billing processes’ effectiveness and identify improvement areas.

When conducting an assessment, involving all stakeholders, including physicians, billing staff, and administrators, is crucial. 

  • Start by documenting your current billing processes, including workflows, software and technology used, and roles and responsibilities of staff members. 
  • Identify areas that may be causing delays or errors in your billing cycle, such as long wait times for insurance verification or insufficient documentation for claims.
  • You can use tools such as revenue cycle management software or manual data tracking to measure critical metrics. 
  • Track the time it takes to process claims from submission to payment and measure your claim denial rates to identify patterns and standard errors. 
  • Additionally, monitor your accounts receivable to ensure timely payment and identify any trends in payment delays.

Consider working with a billing consultant or revenue cycle management specialist to identify areas of improvement and develop an implementation plan.

Implement The Best Practices To Improve Pediatric Billing Services 

To create an efficient pediatric billing and coding system and increase revenue potential, implement the following best practices:

Before The Visit 

Have the front desk staff verify eligibility, obtain authorizations, and collect co-pays and co-insurance before the visit.

Check verification eligibility 

Verifying eligibility beforehand can help identify any potential issues with insurance coverage and prevent claim denials later on. To improve your pediatric billing services processes, checking patient eligibility is crucial. Doing so lets you identify the patient’s coverage status before the scheduled visit and be proactive about collections. Use the electronic eligibility feature in your EHR at least two days before the visit to capture any necessary insurance information. Keep an up-to-date and legible copy of the patient’s insurance card on file, and check for any updates before the appointment to avoid delays and denials. This helps to improve clean claim metrics and ensure efficient billing processes.

Review Patient Responsibility 

Reviewing patient responsibility to optimize your pediatric billing and coding system is crucial. Ensure authorizations and referrals are approved and associated with the correct visit to avoid denials. Ask patients about any changes in their policy or coverage at every visit, and check for primary, secondary, and tertiary insurance. Inquire about benefit coordination to avoid any errors in range. Remember that Medicaid should only be used as a last resort payer and not as your primary insurance. By following these best practices, you can ensure that your billing processes are efficient and effective.

During and After the visit 

It’s important to conduct thorough checks during and after the patient’s visit to ensure accurate pediatric billing services. This involves implementing comprehensive billing processes throughout the patient’s visit and beyond. These processes include:

Charge Rules 

Use charge rules when bundling commonly used code sets to avoid National Correct Coding Initiative (CCI) edits. Search for covered diagnosis codes by the procedure and standard CPT codes that require pre-authorization. The ultimate aim is to pay the pediatric claim in full on the first attempt. Pediatric billers should set a rule to prompt them to send medical records when a specific payer or CPT code always requires them. 

Enter Charges 

To prevent revenue delays and denials, ensure that charges are entered within two days of the visit date. The claim must go through multiple stages, including submission, acceptance by the clearinghouse, acceptance by the payer, and adjudication. By entering charges promptly, you can avoid timely filing denials and receive payment more quickly.

Reconcile Claim Batches Daily

Pediatric billing workflow demands a daily review of clearinghouse status reports to reconcile claim batches. This ensures that the payer has appropriately submitted and received all claims. If a claim is missing from the report, it should be reviewed for any errors and resubmitted promptly to avoid further delays. Daily claim batch reconciliation is essential in preventing denials and maximizing revenue.

Stay Updated 

it’s essential to stay informed about the latest changes and updates. Keeping abreast of healthcare reform changes, including ICD-10 and CPT codes. Studying how other pediatricians are billing for their services to gain insights and ideas. Utilizing coding guides, educational seminars, and webinars as helpful resources. Hiring certified billing and coding professionals to manage billing needs and ensure accuracy. Staying up-to-date on changes and trends is crucial for pediatricians to optimize reimbursement opportunities and succeed in their practice.

Use EMR software 

Investing in an electronic medical record (EMR) system is a highly effective strategy for pediatric billing services. This system can simplify and streamline billing by tracking reimbursement information and ensuring accurate data entry. EMRs also automate processes, increasing efficiency.

Moreover, EMRs provide a centralized repository for all patient documents, enabling billing personnel to access required documents quickly. By adopting EMRs, pediatricians can save time and energy while maximizing their reimbursement opportunities.

Leverage Professional Help

To optimize reimbursement opportunities, consider seeking the assistance of a professional billing specialist with expertise in pediatric billing. Billing specialists possess coding, claim submission, appeals process, and collections knowledge, which can lead to successful billing. They understand the nuances of each insurance carrier and can help submit claims accurately to ensure maximum reimbursement for pediatric services.

Benefits Of Outsourcing Pediatric Billing Services

Outsourcing pediatric medical billing can bring several benefits, including a greater focus on safe patient care and a reduction in billing errors and claim denials. This, in turn, can impact the revenue cycle, resulting in faster payments, fewer denials, and increased revenue. Other benefits include:

  • Outsourcing pediatric billing improves cash flow and revenue cycle and saves administrative expenses, such as staff salaries, training, and software maintenance. Moreover, it eliminates issues like staff absence, resulting in delayed claim submissions. With outsourced medical billing, these concerns are no longer a problem, allowing pediatricians to focus on providing quality patient care.
  • By outsourcing medical billing and coding, you can ensure compliance with the latest rules and regulations of CMS and insurance payers and code changes. Staying up-to-date with these changes is a full-time job and requires a lot of effort.
  • A medical billing company can help prepare and submit claims on time without any errors, which can help increase revenue and reimbursement rates while following Pediatrics medical coding and billing guidelines.
  • A medical billing company can offer user-friendly implementation of billing software.
  • Outsourcing medical billing and coding to a third-party service provider eliminates the need for healthcare providers to deal directly with multiple insurance payers. Instead, the medical billing company acts as a single point of contact for claim submission and handling.

Final thoughts 

It’s crucial to stay up-to-date with the latest developments and adapt your strategies accordingly. By being proactive and taking advantage of new approaches, pediatricians can ensure they are fairly compensated for their services. Physicians can combine their attention to detail and ingenuity to maximize billing returns while delivering high-quality patient care. It’s time to explore new possibilities and utilize all available opportunities for optimal reimbursement.

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