Pediatric Billing Services

Grow a healthy and profitable pediatric practice

Increase total payments by 9% by partnering with OP RCMTM

OP understands the unique billing challenges pediatricians face — complex revenue cycle, differing state Medicaid requirements, vaccine administration coding, and combined well and sick charges during the same visit. Our billing specialists manage the ever-changing rules for payer requirements so you can focus on the things that matter most. With OP RCM as your pediatric billing partner, you can keep your focus on patient care, not insurance collections.

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Pediatric billing is what we do

Unlike most other billing services, OP RCM is singularly focused on pediatric billing. As a result, our team has expertise in areas that matter most to pediatric practices:

  • Medicaid – we understand the ins and outs of Medicaid and have written a playbook that details how to bill for Medicaid in each state that we service.
  • Vaccine billing – whether or not your practice is in a state like Washington or Connecticut with universal vaccine billing, your team of OP billing experts will ensure that your vaccinations are billed properly.
  • Reimbursements – With other billing companies your claims may not get the full attention they deserve because the dollar amount they represent is far less compared to other clients in specialties like orthopedics and cardiology. Pediatrics is the only specialty we serve. Our goal is to get you paid as much as possible for the services you provide. As a result, your claims will get the full attention they need.

Partners in profitability

When you partner with OP RCM, you work with an entire team of billing, posting, and A/R specialists who know the intricacies of pediatric billing in your state, including the ever-changing regulations, complex commercial payer and Medicaid adjudication rules, and evolving payment models. They will also:

  • Transmit your claims to the clearinghouse
  • Process clearinghouse and payer responses
  • Post payer and patient payments
  • Partner with you to work through denials
  • Send out your patient statements

In addition to this team of pediatric billing experts, you’ll also be assigned a dedicated account manager. All members of the OP RCM team will work with your in-house billing team to achieve your financial goals. In particular, your account manager will:

  • Provide detailed monthly reporting, trend analysis, and benchmarking
  • Uncover any inefficiencies in your billing workflow and provide suggestions for improvement
  • Offer recommendations on how to optimize the use of our software

By taking these responsibilities off your plate, you and your staff are free to focus on more revenue-generating activities like patient collections, recalls, and flu clinics.

Reach your financial goals

Our team’s expertise — combined with our adherence to billing best practices — is the reason our clients see:

  • Increased total payments – Our clients see an average 9% increase in total payments.
  • Increased cash flow – We get your claims to payers without interruption so the payers can get their reimbursements to you.
  • Increased payment per visit – Our clients see a 4.6% increase in payment per visit.
  • Decreased days in A/R – We work payment denials as we receive them, ensuring that they do not sit in your receivables.
  • Reduced write-offs – Our experts perform denial follow up so that you get paid for the services you provide vs. having to write them off.

Click here to see how Taos Clinic for Children & Youth increased their revenue by switching to OP RCM.

Additional benefits

  • High-touch, easy implementation process: Our implementation specialists will be with you every step of the way as you transition to OP RCM to ensure that there are no disruptions to your operations.
  • Complete visibility and transparency: Our team bills on your system — not some proprietary software that you do not have access to — because we believe that transparency is the key to any successful partnership. As a result, you’ll be able to see everything that we’ve done on every claim and have visibility into your practice’s total performance.
  • US-based billing experts: Your team of billing, posting, and A/R specialists are based in our corporate office and work schedules that accommodate our clients.
  • Clearinghouse and other connections: We manage the relationship with the clearinghouse as well as assist with your clearinghouse EDI enrollment and electronic remittances set up.
No two practices adhere to identical metrics for measuring their performance, and no two practices have the same patient challenges. Therefore, it becomes the responsibility of the practice to partner with a vendor that seeks to assist them in achieving their objectives.
- Dick Schlarbaum with Taos Clinic for Children and Youth