RCM24Billing Free A/R Audit

Specialties

Medical billing for pediatrics

Pediatric revenue sits in many small, routine services: vaccines, screenings and well visits. Each one is easy to miss, and across a full schedule the missed ones add up.

Doctor listening to a young child’s back with a stethoscope

What makes pediatric billing different

  • Vaccines. Each vaccine has a product code and an administration code, and the administration codes depend on counselling and the number of components. Vaccines for Children stock is free to the practice, so only the administration is billed.
  • Well-child visits follow an age-based schedule, and screenings done in the same visit, such as developmental, vision, hearing or depression screens, are often separately billable.
  • Sick and well on one day. A well visit that also treats an ear infection can support both services, when documented separately and billed with the correct modifier.
  • Medicaid and CHIP. A large share of pediatric patients are covered by state programs with their own rules, managed care plans and enrollment requirements.
  • Newborn care in the hospital and the first office visits, often before the baby’s own insurance is active.

How we work it

We match vaccine administrations to the vaccine record so none go unbilled, separate state-supplied stock from private stock, and check that screenings done in a visit are captured. Newborn claims are held until coverage is confirmed, rather than submitted and denied.

Common questions

Do you bill for Vaccines for Children stock?

Only the administration is billed for state-supplied vaccines, because the vaccine itself costs the practice nothing. We keep that separate from privately purchased stock, where both the product and the administration are billed.

Can screenings be billed during a well-child visit?

Many can, including developmental, vision, hearing and depression screens, when they’re performed with a standardised tool and documented. They’re often missed because the visit itself is billed and the screening is assumed to be included.

Other specialties we bill for

Start with the free audit

Send us ninety days of claims data and we’ll show you what was left uncollected. No charge, no obligation, and the findings are yours either way.

Request my free audit