Pediatricians play a crucial role in keeping your little ones healthy and safe as possible. Generally, pediatricians spend more time with the little ones to understand their sickness. It is because pediatric patients get nervous and are also not mature enough to clearly communicate their medical issues. So, keeping the parents in the conversation is important. The triadic nature of pediatric patient interactions makes it difficult for the pediatrician to come up with a diagnosis and treatment and hence requires more time. We know that accurate and thorough documentation of the pediatric patient encounter is crucial for medical coding. And accurate coding in turn ensures that the pediatrician is reimbursed in full and on time.
Let us in this blog discuss the billing challenges faced by pediatricians and how professional pediatric billing services can be beneficial for them.
Complex ICD-10 requirements
The ICD-10 new code set contains a large number of codes, particularly for pediatric practices. This sheer volume of codes poses a major challenge for pediatricians. Using the right codes is crucial to ensuring accurate reimbursements for a pediatric practice. A study conducted by the University of Illinois reports that pediatric practices are at the potential risk of financial disruption and administrative errors if proper attention is not paid to diagnostic coding. The study also found that 26% of the codes were convoluted, meaning they involve complex mapping and may lead to adverse consequences, like financial loss from billing errors.
Billing for time spent
Generally, a pediatric appointment can last somewhere between half an hour to one hour. If time is a determining factor for evaluation and management services, then proper documentation is a must. The appropriate time should be mentioned in the medical record as it helps determine the level of coding. If more than half of the visit is spent providing counseling or care coordination you can get through many of the coding requirements by adding a statement at the end of the note summarizing the time spent and what was discussed. A well-documented patient’s medical record goes a long way in ensuring appropriate reimbursements.
New born health insurance transition
In the case of new born babies it is important to add the new born to the mother’s insurance plan within 30 days. Transitioning from the mother’s insurance plan to a separate one for the new born could be challenging for pediatricians. The insurance transition process should be smooth and all the coding should be done with utmost care in order to ensure accurate and timely reimbursements. A medical billing company can help you save the time and effort in ensuring a smooth insurance transition and billing it the perfect way.
Doctor/parent visit without the child
When a child has been diagnosed with an illness or condition, many a time the parent may visit the pediatrician without the child for a follow-up. Even though the pediatric patient has not accompanied the parent, the services should be coded and billed properly to be sent out to the insurance company. For e.g., if the pediatrician has a counseling session with parents who think their kids might have ADHD, an EM code is driven by time as the session lasts anywhere from half an hour to one hour. Hence, all the key components of the visit must be included in order to determine the appropriate code (level of service) to be assigned.
Vaccine services are a costly affair
Vaccine administration is a critical component of a successful pediatric practice. Even though vaccines are provided by the VFC Program free of cost, the pediatric practice has to meet costs related to the storage, handling, inventory management, and vaccine spoilage and wastage. Coding for vaccine administration should be done correctly to avoid any revenue loss. Pediatricians vaccinate children and bill Medicaid for an administration fee. Here the pediatrician is reimbursed for the administration fee alone. However, for vaccines purchased outside of the VFC program the pediatrician is reimbursed for both the cost of the vaccine as well as for the shot administration. Paying attention to coding avoids errors and ensures the right reimbursements.
Failing to bill for services
Pediatric practices are not aware of the fact that they can be billed for services which they regard as specialty (orthopedic) services. Take for example Nursemaid’s elbow, a common injury that takes place among toddlers and preschoolers. This is an elbow dislocation and all that it needs is to put the bone back in its position. Many pediatric specialists do not know that they can bill for this service thinking that it is technically an orthopedic surgery code. Similarly, removal of foreign bodies in children is also billable by pediatricians. Take for example the pediatrician removes a bead from the child’s ear without administering anesthesia, it should be billed.
Are you a pediatrician facing challenges while handling your practice’s billing requirements? Well, as a Pediatrician you deal with a wide range of conditions, procedures, treatments and preventive healthcare on a day-to-day basis. And even the smallest error in coding can lead to claim denials and delays in payments. Late payments stemming from claim denials can touch almost everything - strain cash flow, damage patient relationships, disrupt your revenue cycle workflow, and ultimately your bottom line. Hence, using the appropriate codes and performing the right billing is crucial as it has a huge impact on the overall reimbursement and revenue cycle of the practice.
Why worry about the formidable challenges that go with pediatric medical billing instead of focusing on treating the little ones? Outsource your pediatric medical billing needs to Scribe4Me and focus on providing safe patient care. Soon, you will start noticing a significant drop in denials, faster payments, improved cash flow and an overall healthy revenue cycle. Our team of AAPC-certified coders review pediatric medical records to assign the right codes, ensure billing compliance, and also stay up-to-date with the changes in the CMS and payer-specific rules and regulations. Rest assured.
For more information on our pediatric medical billing services reach us at (908)760-8935.
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