Pediatric RCM Made Easy

Pediatric billing can be complex. From state-specific Medicaid rules to accurately coding a sick visit during a well visit, it’s a constant juggling act. Add in the nuances of vaccine billing and telehealth, and it’s easy to see how claims get missed, payments are delayed, and your valuable time is wasted chasing down reimbursements. Failing to navigate these challenges can lead to lost revenue, claims denials, and a backlog of A/R that can seriously impact your practice’s financial health. That’s where we come in.

Cleaner Claims. Faster Payments.

Imagine a world where your billing runs smoothly, payments arrive promptly, and you have more time to focus on what matters most – your patients. With OP RCM, it’s achievable! Our team of pediatric billing experts takes the stress out of the revenue cycle, so you can benefit from:

Streamlined workflows – We handle everything from claim submission to payment posting, eliminating manual errors and freeing up your staff for more meaningful tasks.
Maximized reimbursements – Our in-depth knowledge of pediatric coding and payer requirements ensures you get paid for every service you provide.
Financial clarity – Our interactive analytics tool gives you real-time insights into your practice’s financial health, empowering you to make data-driven decisions.
Peace of mind – Our proactive approach to claim management and denial prevention ensures that your billing is in expert hands, getting the same attention it would if you were doing it yourself.

Your Practice, Your Way: RCM Solutions Tailored for You

Complete RCM Services

Your comprehensive billing solution, covering everything from eligibility verification to payment posting.

Short-Term RCM Services

Get expert billing support during staff absences, summer vacations, and other employee transitions.

Coding Review Services

Our expert team will audit your visit notes, summarize findings and trends and offer recommendations and guidance.

Outstanding A/R Recovery

Short-term projects with a dedicated focus on reclaiming lost revenue from denied or unpaid claims.

Credentialing + Enrollment Services

Let us simplify provider credentialing and enrollment to ensure accurate claims and faster payments. Our services save you time and hassle, so you can focus on what's important.

Learn more.

Patient Account Center

Let our team handle your inbound patient billing calls. We'll handle statement questions, update insurance info, and process patient payments, all through a dedicated phone line.

OP RCM is Your Partner is Making Your Practice More Profitable

With proactive claim management and smart tools to catch errors before they happen, we ensure accuracy and maximize your reimbursements. Our interactive, easy-to-use financial dashboards give you complete transparency into your practice’s finances, including key metrics like first-pass resolve rate, days in A/R, and payment aging. This clear picture empowers you to make informed decisions and optimize your financial performance. We handle your billing with the same care and attention to detail you give your patients, so you can focus on what matters most – providing excellent care.

After partnering with OP RCM, my practice collections increased significantly. The RCM team is extremely knowledgeable and responsive, and provides exceptional support. We highly recommend them.

Keysville Pediatrics, Keysville, VA

Let us take the burden off of you!

Our team specializes in billing for pediatric offices. We know the ins and outs of coding, payment rules, vaccine billing, sick and well visit combo visits, state-specific Medicaid policies, and commercial payer requirements. Let our experts help you get the most out of your billing, submit accurate claims, and get paid what you deserve so you have a path to financial stability and growth.

See how we do it in this 2-minute video.

Let’s connect!

Your financial results are our #1 priority

Our team’s pediatric-specific billing expertise — combined with proactive claim management — is the reason our pediatric RCM clients see:

Uninterrupted cash flow
We get your claims to payers without interruption for quicker payment turnaround.

Increased payment per visit
On average, our clients see a 7% increase in payment per visit.

Reduced write-offs
Our denial follow-up process ensures that you get paid for the services you provide.

OP RCM customers have averaged 26% growth supported by a 99% Net Collection Rate and Average Days in A/R < 30.

Frequently Asked Questions

Q: What is RCM and why do pediatric practices need specialized services?

A: RCM (Revenue Cycle Management) encompasses all the financial processes involved in managing patient care episodes from registration through final payment. Pediatric practices need specialized RCM services because pediatric billing is uniquely complex, involving state-specific Medicaid rules, combination sick and well visits, vaccine billing nuances, and family-based billing structures that general RCM providers often struggle to handle efficiently.

Q: How much does OP's Pediatric RCM service cost?

A: Our RCM pricing is customized based on your practice’s size, patient volume, and specific needs. We offer flexible solutions including Complete RCM Services with optional Patient Account Services, Outstanding A/R Recovery, Short-Term RCM Services, and Coding Review Services. Contact us for a personalized quote and ROI analysis that demonstrates how our services can increase your revenue while reducing administrative burden.

Q: What results can I expect from OP RCM Services?

A: Our pediatric RCM clients typically experience significant financial improvements: an average 7% increase in payment per visit, 26% revenue growth supported by a 99% Net Collection Rate, and Average Days in A/R under 30 days. We also help practices achieve uninterrupted cash flow, reduced write-offs through proactive denial follow-up, and faster payment turnaround from claims submitted without delays.

Q: How quickly can OP RCM Services start helping my practice?

A: Implementation timelines vary by service type. For Complete RCM Services, we typically complete onboarding within 2-4 weeks, ensuring a smooth transition with minimal disruption to your practice. Outstanding A/R Recovery projects can begin immediately and often show results within 30-60 days. Short-term RCM support for staff absences can be arranged quickly to prevent revenue gaps.

Q: Will I lose control of my billing if I outsource to OP RCM?

A: Absolutely not. You maintain full visibility and control through our interactive financial dashboards that provide real-time insights into key metrics like first-pass resolve rate, days in A/R, and payment aging. You’ll receive regular reports, have access to your dedicated RCM team, and can track every claim. We work as your partner, handling the complexity while keeping you informed and in control of strategic decisions.

Q: Does OP RCM work with practices not using Office Practicum EHR?

A: While our RCM services integrate seamlessly with the Office Practicum EHR platform for maximum efficiency, we do work with practices using other systems. However, practices using OP’s dual-certified pediatric EHR benefit from streamlined workflows, integrated claim scrubbing, and optimized billing processes that can significantly enhance RCM results.

Q: What makes pediatric billing different from general medical billing?

A: Pediatric billing has unique complexities including: accurately coding combination sick and well visits, managing state-specific Medicaid programs (like EPSDT requirements), properly billing for vaccines with detailed administration and product codes, handling family-based accounts where multiple children may be seen on the same day, managing adolescent confidentiality requirements, and navigating the nuances of preventive care guidelines that vary by age. Our team specializes exclusively in these pediatric-specific challenges.

Q: How does OP RCM handle claim denials?

A: We take a proactive approach to denial management. Our OP Claim Scrubber technology catches and fixes errors in real-time before claims are submitted, preventing denials before they happen. When denials do occur, our experienced team immediately investigates root causes, appeals when appropriate, and implements process improvements to prevent future denials. This comprehensive approach ensures you get paid for the services you provide and minimizes lost revenue.

Don’t just take our word for it…

Check out our Client Success Stories to learn more about how a supportive pediatric RCM partnership with OP RCM can increase your practice revenue.