Did you know that 83% of healthcare practices lose around $48,000 due to pediatric billing mistakes? That’s a huge sum that could have been avoided with efficient billing practices. Simply put, pediatric billing is one of the most crucial, yet complex, aspects of running a pediatric practice. The mistakes that occur can lead to denied claims, delayed payments, and ultimately, lost revenue. In this blog, we’ll dive into the common mistakes pediatrics billing services make and offer actionable tips to avoid them, helping your practice stay financially healthy.
Incorrect Patient or Guarantor Information
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One of the most frequent mistakes in pediatric billing services is incorrect patient or guarantor information. This includes misspelled names, wrong birthdates, or outdated insurance details. Such mistakes often lead to delayed claims or outright denials, disrupting your pediatric practice’s cash flow.
How to Avoid It
- Ensure patient and guarantor details are verified and correct at the time of service.
- Always verify insurance details before the patient’s visit, especially for pediatric patients with changing policies.
Misapplied Vaccine Codes
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Vaccines are a routine part of pediatric care, but incorrect CPT codes or misapplied vaccine codes can lead to claim denials. It’s essential to correctly apply pediatric billing services guidelines to ensure accurate reimbursement for vaccinations.
How to Avoid It
- Double-check the vaccine CPT codes to ensure the right ones are applied for each patient.
- Keep up-to-date with the latest pediatric billing and coding standards to avoid errors in your claims.
Missing Modifiers
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Let me tell you an interesting fact: modifiers play an important role in pediatric billing and coding. These small additions help to clarify the specifics of a service provided. Missing or misused modifiers can result in underpaid or denied claims, so they must be used correctly for accurate billing.
How to Avoid It
- Be sure to apply the right modifiers to each service.
- Train your house staff on the importance of using appropriate modifiers to avoid denials.
Failure to Coordinate Benefits for Newborns
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Newborns often require separate insurance coordination. Failure to properly coordinate the benefits between the mother’s insurance and the newborn’s insurance can lead to delays in payments.
How to Avoid It
- Verify both parents’ insurance details before submitting claims for newborns.
- File newborn claims as secondary if the mother’s insurance is primary to ensure proper reimbursement.
Incorrect Coding and Lack of Documentation
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The most common of all issues is incorrect coding or inadequate documentation to support a claim. Without detailed and accurate information, your claims will likely be denied or delayed.
How to Avoid It
- Ensure all pediatric billing processes are followed, and the correct codes are used for each procedure.
- Keep detailed records of all treatments and services provided to support claims and meet pediatric billing guidelines.
Not Following Up on Denied Claims
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It’s easy to let denied claims sit there, but doing so can lead to significant revenue loss. Pediatric medical billing requires careful tracking and follow-up on all claims, particularly those that are denied.
How to Avoid It
- Set up a system to track denied claims and ensure prompt follow-up.
- Use an outsourced pediatric medical billing service to handle follow-ups if your in-house team is too busy.
Not Using a Pediatric Billing Specialist
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Outsourced pediatric medical billing or hiring a dedicated pediatric billing company can help your practice avoid common mistakes. Pediatric billing is unique, and using a general billing service may lead to costly errors.
How to Avoid It
- Consider working with a billing company or an expert who specializes in pediatric billing services.
- This will help streamline your pediatric billing processes and improve cash flow.
Now that we have gone through the pediatric billing mistakes, you can also check this guide on medical billing mistakes to avoid those errors in the future and ensure compliance.
How These Mistakes Impact Your Practice’s Revenue
When billing errors happen, the impact on your practice’s financial management can be significant. Not only do mistakes cause delays in payments, but they also increase your staff’s workload, as they spend time correcting errors instead of focusing on patient care. Over time, this can add up to a serious loss in revenue. Many pediatric practices lose over $48,000 annually because of these errors.
By avoiding these common mistakes and streamlining your revenue cycle management, your practice can improve cash flow and ensure that you’re getting paid for the services you provide.
Ending Remarks
I think we have learned that by following pediatric billing guidelines, you can avoid the common mistakes that cost your practice thousands of dollars each year. Take the time to get it right, and you’ll see improved revenue and fewer claim denials.
If you’re finding the billing process overwhelming or making too many mistakes, consider working with a trusted pediatric billing company or specialist. A little attention to detail can go a long way in keeping your practice’s finances on track.
Frequently Asked Questions
Have questions about pediatric billing? We’ve got you covered with answers to the most frequently asked questions.
What are the most common mistakes in pediatric billing?
Incorrect patient information, misapplied vaccine codes, missing modifiers, and failure to coordinate newborn benefits.
How can I reduce errors in pediatric billing?
Verify insurance details, double-check codes, keep accurate records, and follow up on denied claims.
Why is pediatric billing more complicated than general billing?
Pediatrics requires specific codes, coordination between multiple insurance providers, and a deeper understanding of pediatric billing processes.
How often should I follow up on denied claims?
Immediately after receiving a denial. Prompt follow-up ensures timely payment and reduces revenue loss.
Should I hire a pediatric billing service?
Yes. A specialist can reduce errors, save time, and help improve your practice’s revenue cycle management.
