Pediatric Billing – When You Need to Optimize Now

Pediatric Revenue, The American Academy of Pediatrics (AAP)/Bright Futures recommends well-child visits as a strategy for pediatricians and parents to support the needs of children. ebix, Inc. can help ensure accurate capture of services provided to maximize reimbursement opportunities. In addition to being up-to-date with the latest codes, coders with pediatric clinical experience are familiar with the different clinical indicators present in children. They also know about the payor’s reporting requirements, essential to prevent denials.

Pediatric billing has specific billing requirements that other specialties may not have. One great example is vaccines. Vaccines not billed and followed up on properly a practice can lose a lot of money.

A single vaccine may cost the practice up to $170. So making sure the correct NDC number and diagnosis code are used and the insurance company submission rules are followed to the letter is vital. Not getting paid for even a few vaccines will hurt the practice. Over time this could lead to tens of thousands of dollars lost. You don’t want that!

Experienced Pediatric Billing Services get you more.

It is essential to realize that the key to successful Revenue Cycle Management is understanding all your practice’s revenue sources. Hence, our team will help improve profitability by monitoring, measuring, and managing all aspects of your revenue cycle.

Indeed, the ebix team has excellent tools and experience. Hence, our Revenue Cycle Management solutions are in place to capture revenue from claims remittances, patients, and evidence-based data. Collecting from all these sources will help secure your practice’s healthcare payments and make it more profitable.

Pediatric Billing Services for Your Practice

Initial Credentialing is Free. Our expert staff reaches out to the carriers of your choice to obtain network status. Namely, accessible at a startup and a very reasonable fee per provider afterward.
Fee Schedule Analysis. We enter the allowed amounts from the network contracts obtained to track and uncover any improper reimbursements. We will help research appropriate change levels.
Workflow Consulting. Our management staff has over 100 years of combined experience. Therefore, we can advise you on the best practices to build a team and processes that ensure results.
Carrier Contract Advice. Consequently, there are pitfalls to avoid in contracts and situations that may cause you to choose non-network status with challenging carriers. We have additional expert resources to bring help when necessary.
Coding Expertise. The ebix team offers certified coding staff to “abstract” codes from provider documentation or review your code for accuracy and completeness. We offer Chart auditing services and provider/staff education. Our efforts result from additional revenue opportunities, compliance, and audit survival.
Fees based on Results. We don’t get paid until we’ve obtained reimbursement for you.
No Surprises. No additional charges for postage, claims, statements, or custom report/data analytics needs.
Fast Claim Submission. Your billing will be submitted promptly after receipt. Don’t suffer from delays or write-offs from inappropriate submissions.
Up to 10% Better Reimbursements.

Medical Coding Compliance

The ebix Pediatric Billing Services team has a strong reputation as an expert in medical coding services. By and large, medical billing begins with accurate and complete documentation in the medical record. Hence, coding is how your intellectual services and labor translate into a code used to bill insurance and document the value of your service.

Perhaps most noteworthy are the ICD-10 codes. The ICD-10 codes are currently the cornerstone of classifying diseases, injuries, health encounters, and inpatient procedures in morbidity settings. Because of this, the ebix, Inc. team has honed medical coding skills and business processes to meet the needs of independent physicians.

Therefore, transforming a provider’s narrative or description of the disease, injury, and procedures into universal medical code numbers for the insurance claim is the fundamental purpose of medical coding. For this reason, our team of professional certified medical coders ensures higher reimbursement by properly aligning services with a medical diagnosis. Consequently, this doesn’t just assure proper payment. It will also minimize denials resulting from the incorrect association of diagnosis and procedure codes.

Data Analytics

Our financial reporting gives you the insight you need to address the root causes of charge issues, resolve process inefficiencies, improve coding compliance, and ensure the integrity of all claims. Office Managers and Administrators can quickly review performance and trends, drill down into the data to analyze root causes by reason, evaluate payer performance, and the financial impact of claim denials.

Examples of some of the financial reports we provide (above and beyond the regular month-end reporting that gives details about charges, collections, and your AR) include:

Charge & Revenue Analysis – evaluate financial ratios versus MGMA benchmarks
Coding analysis – identify potential under, over, and incorrect coding scenarios
Procedure Analysis – analyze top CPT codes for cost-benefit analysis
Payer Reimbursement Analysis – assess which payers consistently slow up payments through unnecessary denials and “lost” claims.
Provider & Staff Productivity Analysis – evaluate provider and staff productivity based on the specific place of service, revenue, and RVUs
AR Aging Analysis – velocity of payments per payor and CPT, respectively

Minimize Medical Claim Denials

Based on our experience working with physicians and healthcare organizations, we understand that the revenue cycle success starts at patient registration and continues throughout the claims cycle. Accuracy of patient demographics and financial information upfront results in reduced denials, fewer rejected claims and more occasional returned statements. Claim cleanliness is the critical component that stops the denial from origination, and the following parameters impact it:

Patient registration data quality
Prior-authorizations
Non-covered services and medical necessity management
Eligibility and benefits coverage
Clinical documentation quality
Coding
Claim editing
Payor rules & mandates