Get Your Free RCM Assessment
Specialty — Pediatrics

Medical billing and RCM for pediatrics practices

Pediatric billing is low-dollar, high-volume and rule-dense, with vaccine administration and well-child schedules that payers apply inconsistently.

Get Your Free RCM Assessment Talk to a specialist
A pediatrician examining a young girl during a check-up
Denial drivers
Eligibility, well-child frequency
Coding pressure
Vaccine administration
Where A/R ages
Patient balances
Underpayment risk
Moderate
The challenges

What actually costs pediatrics practices money

Vaccine administration coding

Product and administration codes must match, counted per component.

Well-child frequency rules

Visit timing rules differ by payer and by plan year.

Split and changing family coverage

Custody and dual-coverage situations produce eligibility failures.

Medicaid plan variation

Managed Medicaid plans behave differently from one another.

How we work a pediatrics account
  1. 1 Vaccine coding checked component by component
  2. 2 Well-child schedules maintained per payer
  3. 3 Eligibility verified against the correct guarantor
  4. 4 Managed Medicaid handled plan by plan

Other specialties

View all
A primary care physician talking with a patient in a bright exam room Primary Care A physician listening to a patient’s heart with a stethoscope Cardiology An orthopedic physician explaining an X-ray to a patient Orthopedics A therapist in a counseling session with a client in a bright office Behavioral Health A physical therapist working on a patient’s shoulder in a sunlit clinic Physical Therapy A dermatologist examining a patient’s skin with a dermatoscope Dermatology

How healthy is your pediatrics revenue cycle?

We will review your denials, A/R and payer performance and tell you what we find.

Get Your Free RCM Assessment Talk to an RCM Specialist
  • No obligation, and you keep the findings either way
  • Under two minutes to request
  • No patient information needed to start
Get Your Free RCM Assessment