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Very few things about medical billing are straightforward, but it’s especially true in pediatrics. Proper coding, modifiers, and changes in Medicaid rules and payer guidelines can turn a simple office visit into a minefield of dependencies. Add staffing shortages and the challenge of finding qualified medical billers to the mix, and it further exacerbates the stress of billing for pediatric practices. When it comes to running a pediatric practice, the days of “one size fits all” are over. You can no longer thrive and work efficiently using a generic, non-specialty-specific EHR, and the same is true for billing and revenue cycle...

If a pediatric practice has some extra down time, pause and remember the financial health of your practice starts with having an appropriate fee schedule. While contractually the payers determine how much they are going to pay you for each service you provide, it starts with how much you charge.  Scheduled Processes and Procedures At a minimum, at the beginning of the year, your practice should have a scheduled process and procedure for updating your fee schedule so you can be sure you are not leaving money on the table (and in the insurance company’s pocket.) The AAP has resources for pediatricians...

If your payment data is currently dispersed across multiple systems, you might hit a roadblock in your plan for payment assurance. What does your roadmap for payment assurance look like? Use these three checkpoints to analyze where your data might be failing you and how you can improve collection processes by pulling payment data from one reliable source. Checkpoint #1: Talk to Your Staff About Their Processes to Collect Collecting patient payments is time-consuming. Do you know how much time your staff spends to collect a single payment? Ask your staff to walk you through their daily process to collect, reconcile and post...

Do you lie awake at night worrying about your pediatric practice’s billing processes? Are you concerned about what will happen when your reliable, long-standing staff biller decides to retire? For example, who’s going to ensure you’re billing for all services you perform such as every strep test has an accompanying visit billed. And who’s going to keep track of the constant, ever-changing payer rules that can result in significant financial hardships, if you’re relying on inadequate, inexperienced or unmotivated billing staff? If these are your thoughts, there are steps you can take to address these problems and achieve better pediatric billing...

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