Pediatric Billing Services

Well-child visits, immunizations and VFC, developmental screening and Medicaid or CHIP claims.

Paediatric claims are small and there are a lot of them. That means one systematic error repeats hundreds of times before anyone notices. Vaccine administration billed without the counselling code. A developmental screen bundled into the well-child visit. A sick visit the same day without modifier 25. Each is worth little on its own and a great deal added up. Our pediatric billing services audit the patterns, not the single claim.

Practices weighing up pediatric medical billing services should ask about Vaccines for Children. VFC supplies vaccine free for eligible children. A practice that is not enrolled is buying stock it could have had free, and billing only for giving it.

Our Services

Small Patients, Long Code List

Paediatrics covers infants, children and adolescents, with a wide range of conditions and a long list of billing codes to match. That range invites errors.

We do not just catch those errors, we design them out. Our team has spent over a decade on paediatric coding and billing, and that is where the advantage comes from.

What benefits are provided by our Pediatric Billing and Coding Services?

  • Optimally Bundled and Coded

    While maintaining HIPAA compliance, we adhere to ethical practices that prohibit over or up-bundling and up-coding. Our commitment lies in accurate bundling and coding aligned with the services provided. This principled approach stands as a cornerstone of our success as a recognized pediatric coding and billing service.

    No deviations allowed

  • No deviations allowed

    Exceptionally, we refer to vaccine billing, a crucial aspect that is sometimes overlooked during claim preparation, leading to substantial revenue losses. In contrast, our meticulous process leaves no claim unchecked, ensuring timely collections and maximum reimbursement.

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Our pediatric billing covers every specialty, supported by the expertise of a specialized coder and, indispensably, a skilled biller:

  • Child Life Program
  • Pediatric Neurology
  • Pediatric Oncology
  • Clinical Genetics
  • Behavioral Psychology
  • General Pediatrics
  • Pediatric Diabetes
  • Pediatric Gastroenterology
  • Pediatric Nephrology
  • Pediatric Pulmonology
  • Pediatric Cardiology
  • Nutrition Services
  • Pediatric Endocrinology
  • Pediatric Infectious Diseases

Vaccines and well child visits carry the revenue

A paediatric practice runs on high volume and small margins, so the routine claims have to be right. Most of the loss is in vaccines.

Every vaccine is two charges

There is a code for the vaccine product and a separate code for giving it. Practices bill the product and drop the administration more often than any other error we find in paediatrics, and across a full immunisation schedule that is thousands of dollars a year per provider.

For patients under nineteen where the vaccine and its risks are counselled, a different administration code set applies. It is billed per component of the vaccine rather than per injection, so a combination vaccine covering three diseases is not one unit.

State supplied vaccine still pays you

Where vaccine comes free through the federal childhood programme, the product is billed at no charge, in the way your state requires, and the administration is still payable. Practices that simply do not bill those encounters are giving away the only part they were entitled to.

Well child and sick visits together

A child comes in for a check up and has an ear infection. Both are billable, with modifier 25 on the problem visit, when the note carries a separate history, assessment and plan for the ear. This is the same rule as in family medicine and it is missed for the same reason: one visit gets written up and one gets billed.

Screening is billable and usually is not billed

Developmental screening, autism screening, maternal depression screening and adolescent depression screening all have their own codes and are separately payable alongside the well child visit. Most practices perform them because guidelines call for them and bill none of them.

The requirement is a standardised instrument, scored, with the result and the action in the record. Practices already using the forms usually need only the billing step added.

Pediatric Credentialing, Medicaid, CHIP and VFC Enrollment

Paediatrics lives on public payers, so Medicaid and CHIP enrollment comes first, not last. It is two steps. You enrol with the state program, then with each managed care plan on its own. Most practices finish the first step and assume they are done. Paediatricians should also ask for PCP panel assignment, so children are attributed to the practice instead of arriving by chance.

One enrollment is unique to paediatrics: the Vaccines for Children program. VFC supplies vaccine free for eligible children. It also carries real duties, including fridge temperature logs, separate stock, yearly re-enrollment and site visits. Without VFC you buy vaccine you could have had free, and you bill only for giving it.

We handle Medicaid, CHIP, managed care and VFC enrollment together. See our medical credentialing services.