Do you think there’s a strong chance for expensive errors in pediatric billing? Scorching analysis of billing errors is estimated to be 80 to 90 percent which includes hospital stays and healthcare professional’s office visits. Pediatric billing deals with vast number of unique challenges of multiple procedures, conditions as well as treatments. It’s admitted that insurance coverage for children is quite complicated.

Pediatric billing and coding errors leads to loss of maximum reimbursements and is also not possible without correct coding and claim process. While most of the other specialties focus on Medicare programs, Pediatric specialty is one of a kind which actually does not concentrate on Medicare much.

In Pediatric billing, healthcare professionals rarely consider and realize the advantages when it comes to E/M codes. According to CPT, a scheduled appointment can actually last very long time. Sometimes the time spent in counseling can generally result in high level E/M services.

EHR is the main tool for Pediatric billing:

  • To eliminate errors and mistakes involved in pediatric billing, the best solution would be implementation of robust EHR tool especially designed for pediatric billing.
  • Ensuring billing accuracy can increase healthcare professionals’ revenue to the peaks depending on the trusted EHR platform.
  • Healthcare professionals must determine to transform their business into a profitable and highly functioning clinical organization.
  • Billing errors are the primary challenges for pediatric billing practices. Often insurance companies show interest in changing rules and policies.
  • Going along with the untold changes and immediate billing requirements becomes very critical for the financial status of the healthcare professionals’ practice.
  • Pediatric coding standards should be consistent and even if those standards are accepted by insurance companies, most of them don’t abide by those rules and standards.
  • It was more complicated as well as challenging to find billing errors earlier. Pediatric billing errors are to be avoided with perfect EHR by keeping a target to meet the insurance companies’ requirements.
  • Pediatric ICD-10 is more complex compared to ICD-9 but has been set up in a logical and understandable sequence.

A separate system designed for Pediatric billing:

  • Pediatric specialty is considered as “specialty of volume”, and especially in the season of flu, healthcare professionals need to render services for at least 20 to 40 children those will have similar symptoms. They will be recommended for follow up care too.
  • EHR helps by automating most of the charting process and makes pediatric billing error free to the maximum.
  • When a child is sick and antibiotic is recommended and administered, EHR will be ready to make sure if the ordered action includes all the supplies and medications for the practice that can be paid as well as understanding the number of units to be billed.
  • EHR tries to eliminate the confusion by guessing on code application and ensures if healthcare professionals have set of all codes which is required for further billing processes.
  • It also enables seamless flow of revenue, trouble free clinical work and also captures everything which the pediatric practice is compensated or repaid.

Advantages of EHR platform in Pediatric billing:

  • There are many billing challenges involved when it comes to pediatric billing practices. On the preservative side and especially the immunizations for that matter.
  • In fact, the challenges of pediatric billing practices are more but if managed with accurate coding for immunizations that can be capitalized for multiple units and be billed for single vaccine, the loss could be very less.
  • For instance, if the healthcare professional has a combination vaccine, then he/she can bill multiple vaccines’ administration that depends on the component’s number in the vaccine.
  • As there are five diseases covered by the same combination vaccine, it’s allowed and makes it possible for pediatricians or healthcare professionals to bill for five units.
  • Many healthcare professionals make errors in their immunizations which can create vast difference in revenue reimbursements of pediatric practice.
  • Of course, it can also be considered as an example of procedures those are entirely different from adult vaccines and moreover advanced EHR system can easily capture it.
  • It’s also in the hands of pediatric billing team that has to be widely connected and open to training and support programs in many areas of practice including pediatric billing and accounting.

Expensive errors in Pediatric billing:

  • Healthcare professionals are busy with patient care. There can be much confusion when it comes to overlooked and forgotten procedures. As a result, revenue is lost.
  • Most of the medical practices are unaware of concept that they are allowed to bill for multiple services as long as healthcare professionals are qualified to render them.
  • For “Nursemaid’s Elbow”, a common childhood injury which occurs in children frequently with elbow dislocations, the healthcare professional sets back the bone to its position. It gives a big relief for the little child and parents as well.
  • But most of the pediatricians doesn’t know that they can bill for this particular service as it’s considered to be technically orthopedic surgery code.
  • Foreign body extractions are another example that occurs every day in pediatrician’s office. Incision is required to remove the foreign body from child’s skin using splinter. This procedure can also be billed.
  • In most of the cases healthcare professionals are unaware of their billing opportunities and fail to recognize the services that can be billed.
  • The errors in the pediatric billing practices increase especially due to unknown and unaware procedures those are billable with accurate coding guidelines.

Hope you got the information on Pediatric billing services. For more suggestions, please comment below, we will definitely consider them if relevant. For more queries and updates on healthcare, please subscribe to our blog.

How do EHR eliminate expensive errors in Pediatric Billing?