The pediatric department is one of the most important segments of the healthcare industry. You could be a part of a large hospital chain or run an independent practice. Either way, pediatric medical billing and coding are challenging and need to be approached right.
The pediatric department treats infants from the second they are born until they turn 21. This means that patients will come with multiple conditions, each of which may need an array of diagnostic procedures and treatment options.
Pediatric care involves treating physical, developmental, and behavioral issues, increasing the complexity of billing and reimbursements at the backend.
Here are reasons why pediatric medical billing services end up being very challenging.
1. Pediatric care is complex by itself – Since kids can be cranky, uncooperative, or tired, doctors may have to make multiple visits to diagnose or treat. Also, since younger patients cannot clearly explain their condition, there will be a need for more diagnostic tests and procedures. The medical coders need to capture all these extra efforts and try to reimburse them.
2. Patients don’t have to be present for checkups for claims to be made – Sometimes, parents may visit the doctor without the children for a follow-up or for changes in medications. In other departments, you cannot make an insurance claim without the patient being physically present for a checkup. Here, the rules change, and the medical billing and coding experts need to be on their feet.
3. Newborn insurance transition issues – When an infant is born, the mother’s insurance covers the baby. However, the baby needs to be moved to a separate insurance policy soon, and some bills have to be charged to the mother’s payer while others to the infant’s new payers. You get the drift. This transition can only be handled by experts.
4. Missing out on billable services – Often, a child may come with minor discomforts or physical issues that the doctor can treat right away in the clinic setting and send the child back. Many billers don’t realize these services come under the specialty of the pediatrician and can be billed. Examples could be manually fixing a dislocated elbow or removing a foreign object from the baby’s body without the need for serious invasive procedures.
5. Immunization billing errors – All children visit a pediatrician’s office for immunization. While most services know that these can be billed, they sometimes miss out on pooled immunization. Let’s say a particular vaccine is administered to keep the child away from three different diseases. This means the practice can actually bill for three units instead of just one. If your medical billing and coding service has been billing these pooled immunizations just once, then you have been losing precious revenues.
Pediatricians are extremely invested in their profession, given the age and nature of patients they deal with. Also, an average pediatrician sees 20-25 patients a day. Imagine the number of patients a pediatric department will handle on a daily basis then!
Such large patient volumes cannot be handled manually by a small team of internal billers and coders. Pediatricians can increase their revenues without increasing their consultation hours by just working together with a good medical billing and coding company.
How can a third party medical billing and coding company help pediatric services?
1. Automation
While we talk about extended consultation hours and high patient footfalls in pediatric departments, there is an advantage you cannot miss. Many of the patients come with similar problems. Come the winter season, pediatricians will see multiple kids with the common cold or the flu. Similarly, the summer season will bring infants and toddlers to the doctor for heat rashes or dehydration.
Therefore, a smart medical billing and coding company can automate billing processes so that similar care can be billed and coded instantly without wasting time. Think of how quickly you can move from claims to reimbursements this way!
2. Reduced manual errors
An RCM company like Quintessence has invested significantly in technology like AI to ensure we stay away from preventable manual errors that bring down the reimbursement rate. Together, our coding and reimbursement tools make smart and right decisions every time and nudge the biller and coder to correct errors in the initial stages.
These ML tools that we have are trained to learn with every claim submitted, every denial faced, and every successful reimbursement claimed. As a result, the tool can predict the success rate of any claim beforehand, helping us make the right move.
3. The strength of experience
You may hire the best billers and coders internally for your practice. However, they get to work only with your practice, and that’s a slight disadvantage. For a company that handles multiple clients, the billers and coders are forced to learn every single day, and they have working experience to back them up.
For instance, Quintessence is backed by more than 100 years of combined working knowledge, and this helps us give you the competitive edge that you have always been looking for.
4. End-to-end support
While pediatricians are already struggling with burnout and insane work hours, the last thing they want to do is constantly be troubled with backend tasks. A third-party medical billing and coding company will be able to take over the complete RCM process, starting from prior authorizations and patient data management to denials and receivables management. When you work with a third-party service provider, you don’t have to worry about staffing issues, workloads, and other backend issues.
You just need to focus on your core competency – treating pediatric patients while the company will handle your revenue generation.
Quintessence makes things easier for clients by offering RCM for a single fee. The prices are transparent, and SLAs are met every single time.
Takeaways
Any pediatric setup has amazing opportunities to help little ones stay healthy, build revenues, and expand and grow. All it needs is the right backend support. Getting the help of the right medical billing and coding companies will automatically reduce the A/R cycle, improve good touches, and increase reimbursement rates.
Quintessence makes outcome-linked assurances, and we have a 94% end-customer retention rate, which tells a lot about us. If you think your pediatric practice needs a strategic partner to help you grow, then do get in touch with Quintessence Business Solutions and Services right away.
