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Pediatric RCM Services

When you think about pediatric RCM (Revenue Cycle Management), you might think of the daily tasks of billing. However, pediatric RCM isn’t limited to posting charges, sending claims, posting payments, and working A/R; it’s a combination of both good pediatric billing practices and active monitoring of claim activity performed by the OP RCM team.

Pediatric RCM is all we do

Unlike generic billing services, OP RCM is focused solely on pediatric billing and financial performance. Our pediatric RCM team takes pride in having a seasoned skillset, making it easy for them to track discrepancies or changes in payer rules. Relaying this information back to your practice team ensures there is never a delay in cash flow.

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


The OP RCM team specializes in...

Nuanced and state-specific payer rules

With more than a third of US children on Medicaid, it’s critical that your RCM partner understands the nuances that come with billing state payers. Whether your patients have Medicaid or Commercial insurance, the OP RCM team understands what’s required for accurate claim payment. They’ve even developed their own playbook that details how to bill for Medicaid for every state where there is an OP RCM practice.

Vaccine billing

Whether you’re located in a universal vaccine billing state like Washington or Connecticut or a state that provides VFC (Vaccines for Children Program) and/or privately purchased vaccines, the OP RCM team ensures that vaccinations and the associated administration codes are billed properly. More than 50 percent of vaccine product for U.S. children is supplied by the VFC program, and the expertise of OP RCM’s billers ensures you receive maximum and appropriate reimbursement.

Reimbursements

While the average total dollar amount of a pediatric office visit claim is far less than that of another specialty like orthopedics or cardiology, your claims will get the full attention they require. The goal of the OP RCM team is to get you paid as much as possible for the services you provide as quickly as possible.

Credentialing and Enrollment

Credentialing and payer enrollments are notoriously time-consuming, and oftentimes, not very straightforward. A single application error could result in reduced or denied payments. OP Credentialing and Enrollment services are tailored to reduce the time-intensive burden of keeping up with credentialing and payer enrollments, so you can focus on what truly matters – patient care. Learn more about OP Credentialing and Enrollment Services.

As of June 30, 2023, OP RCM managed over $225M
in annual charges.

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.

What a partnership with OP’s pediatric RCM service means

With OP RCM, you’re gaining a partner in profitability. Your financial results, backed by our understanding of KPIs, benchmarks, and performance improvement are our top priority. To this end, you’ll experience what we believe to be two of the most foundational components of a successful partnership— visibility and transparency.

With all claim activity occurring directly in your system and not a separate proprietary software that you can’t access, you’ll have complete visibility into your practice’s total performance. OP RCM’s billing experts take advantage of OP’s Advanced Workflow and Rules Engine (OP AWARE) and our fully integrated Claim Scrubber, a combination of technologies that ensures claims go out right the first time. And, using advanced reporting and dashboard tools within OP, you’ll be able to drill down into your practice’s billing data any time you want.

Our commitment to you

We’re not interested in just getting claims out the door. We’re committed to the financial success of your pediatric practice. By partnering with OP RCM, you’ll benefit from our Practice Optimization analysis to assess where you may be leaving money on the table. Our findings often lead to significant revenue increases. A recent analysis performed by the OP RCM team uncovered missed revenue in one 2-location practice that exceeded $17,000 over a two-month period, in part due to:

  • Unbilled depression screenings totaling $6,000
  • Value-add services conducted during well visits totaling more than $4,000
  • Missed CPT codes totaling nearly $1,500

Are you confident that you’re optimizing billing for all of your services?