Our pediatric billing services company includes everything required to optimize your revenue. From managing complex vaccination schedules to handling age-specific coding, we help your practice achieve maximum reimbursements.
Running a pediatric office means your staff needs to stay focused on young patients who need extra care and attention. Between managing siblings in the waiting room, preventing the spread of contagious illnesses, and keeping wait times short, your team already has its hands full.
That’s where pediatric RCM services make a real difference. Your front desk and medical staff shouldn’t have to worry about complicated coding changes, pediatric insurance verification, or claim denials on top of everything else. When you partner with our specialists who handle medical billing for pediatrics, your team can do what they do best: take care of kids, while we handle getting you paid correctly and on time.
Whether you run an independent pediatric practice or work within a larger healthcare institution, several factors make pediatric billing and coding uniquely complex and demanding.
No other specialty deals with as many vaccinations as pediatrics. That means your billing staff needs to know the right pediatric CPT codes for dozens of different vaccines, plus all the combination options. Some vaccines are required for school entry, others are just recommended, and parents need help keeping track of which is which.
Then there’s flu season, back-to-school time, and other periods when vaccine appointments stack up. Your team has to code everything correctly using the right pediatric CPT codes while managing the rush. Getting these claims right the first time matters because even small mistakes lead to denials.
Government programs like VFC, CHIP, and EPSDT help kids get the care they need. But each one has its own rules about what you can bill, how to document it, and what reports you need to file. Your practice might give a vaccine through VFC to one patient and bill private insurance for the same vaccine given to another patient.
Missing paperwork or billing something the wrong way can mean audits or losing money you’ve earned. Most practices don’t have time to stay on top of all these programs while seeing patients. That’s where working with a pediatrics billing services company like MedCare helps; they know these programs inside and out and make sure you get paid correctly.
Here’s something that trips up a lot of practices: when a patient turns 18, everything changes for billing purposes. Insurance companies immediately treat them as adults, even if they’re still in high school, seeing the same pediatrician. The codes you’ve been using for years suddenly don’t work anymore.
A well-child visit now needs an adult code. Vaccines need adult administration codes. Even though you’re doing the same exam, pediatric ICD 10 codes won’t fly anymore. With so many patients at different ages, it’s easy to miss birthdays and submit claims with the wrong codes. Specialized pediatric medical billing services of MedCare track these changes so you don’t end up with denials over something this simple.
Kids’ families move around more than you’d think. Parents change jobs and insurance plans, families relocate, and divorced parents often have different coverage for the same child. All of that creates headaches when patient information doesn’t match what’s in the insurance company’s system.
Even small mismatches, a slightly wrong address, an old policy number, get claims rejected immediately. Your clinical staff shouldn’t spend their time tracking down correct information and resubmitting claims. That’s not what they trained for. When you choose professional pediatric billing solutions, our billing experts catch these issues upfront and handle rejections fast so your revenue keeps flowing.
When you outsource pediatric billing services to MedCare MSO, you’re working with certified specialists who handle billing for over 50+ specializations. Our team knows pediatric medicine inside and out, where errors happen, what gets bundled, and how to catch problems before claims go out. We scrub every claim to make sure it’s clean before submission.
Our billers know which procedures get bundled, what’s covered under different plans, and how to code everything correctly the first time. We scrub every claim before it goes out, catching mistakes that would cause denials. That means cleaner claims, faster payments, and less back-and-forth with insurance companies. When issues do come up, we handle them right away so your revenue doesn’t get stuck in limbo. Additionally, our AR recovery services ensure that your outstanding claims are diligently followed up on, reducing Days in A/R and improving cash flow.
Yes, MedCare MSO provides dedicated account managers who work closely with your practice. They ensure personalized attention, oversee billing operations, and handle any specific issues your practice may encounter. This ensures smooth communication and optimal results in managing your billing needs.
Yes, additional services like developmental screenings, immunizations, and diagnostic tests can be billed during routine visits. MedCare MSO ensures proper documentation and coding using pediatric-specific CPT and ICD-10 codes, maximizing reimbursement while adhering to insurance guidelines.
The cost of outsourcing varies depending on your practice’s size and billing volume. MedCare MSO offers a customized pricing structure designed to deliver value by improving cash flow and reducing administrative costs. Outsourcing can lead to better reimbursement rates and fewer claim denials.
Pediatric medical billing services handle all billing tasks for pediatric practices, including coding, submitting claims, and ensuring timely payments.
The most challenging aspect of pediatric medical billing is managing age-specific coding, particularly when transitioning patients from pediatric to adult care at age 18. This requires accurate documentation and the use of the correct CPT and ICD-10 codes to avoid claim denials and ensure proper reimbursement.
Our revenue cycle management services include everything required to optimize your revenue, including compliance reviews, annual payer adjustments, payer credentialing, and more. Get a free demo today to see how we can save your work while making you money.
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