Pediatrics Billing Services
Are your pediatric billing duties spilling over to your frontline caregivers? Inefficient handling of billing causes claims denials and delays. You need expert help to minimize your billing administrative burden. Our specialized HIPAA-compliant pediatric billing services offer the solution to navigate pediatric billing requirements while focusing on your core tasks.
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How We Streamline Pediatric Billing for Your Practice
Our CPEDC-certified coders understand the complex nature of pediatric codes and their correct usage. They have acquired this mastery by meeting the billing and coding needs of general pediatric clinics, specialty pediatric centers (e.g., pediatric cardiology, oncology), urgent care pediatric hospitals, and school-based health clinics, among others. You can bank on them to leverage their expertise to reduce claims denials, enhance cash flow, and revamp your pediatric billing process end-to-end. Here is how we help you with our pediatric billing and coding services:
- Integrate digital tools like electronic medical records (EMRs), electronic health records (EHRs), electronic data interchange (EDI), and other capabilities into the new or existing pediatric billing software to facilitate electronic claims processing and handle electronic payments.
- Gather all patient information, including demographics, medical history, and physician referrals, and verify comprehensive insurance details such as insurance coverage, prior authorization status, effective dates, expiration dates, and claims address to generate accurate claims documentation.
- Check if pre-authorization is required for any rendered services and apply for approval if needed.
- Expertise in handling diverse pediatric billing models, including value-based billing, capitation billing, telehealth billing, and school-based billing.
- Assign accurate codes for age-specific and new/established patient codes (e.g., 99204/99205), ICD-10-CM, and HCPCS codes (like E1229-E1239 for pediatric wheelchairs) for rendered pediatric services.
- Adhere to the latest coding parameters while billing for pediatric services, including neonatology, behavioral psychology, gastroenterology, pulmonology, diabetes, oncology, neurology, vaccinations, and others.
- Align with any revisions in fee schedules or payment guidelines for diverse insurance payers such as Medicare Medicaid, the Children's Health Insurance Program (CHIP), FEHBP, etc., as well as private insurers like UnitedHealth, Cigna, and Humana, among others.
- Examine the Explanation of Benefits (EOBs) from the payers to identify any payment discrepancies, resolve them, and proceed with the appeals process accordingly.
- Follow up with insurance payers to verify patient benefits and obtain a comprehensive understanding of deductibles, copayments, and coinsurance for each patient. Inform patients about their payment responsibilities to reduce unpaid claims for patients.
Our Comprehensive Pediatrics Billing Outsourcing Services
- Patient registration
- Insurance verification
- Medical coding and billing
- Claims submission and follow-up
- Accounts receivable (A/R) management
- Payment posting and reconciliation
- Patient billing and collections
- Compliance monitoring
- Reporting and analysis
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During the consultation, some of the issues we can discuss are:
- Your current pediatric billing workflow, challenges, and inefficiencies.
- How we ensure coding and billing accuracy to gain maximum reimbursement
- How we stay updated on changes in pediatric billing regulations and requirements such as HIPAA, CMS, and more.
- Our success stories in billing and claims submissions for various critical pediatric services.
Why Choose Invensis as your Pediatric Billing Company?
As a seasoned pediatrics medical billing services provider with over 25 years of experience, we have tailored our billing services to meet the requirements of a diverse clientele. The list includes general pediatric hospitals, children's hospitals, specialty pediatric centers, pediatric ICUs, emergency pediatric centers, and more. Our team of certified billers (CPB) and coders (CPC), supported by credentialing experts, claims processors, accounts receivable (AR) specialists, and compliance officers, help our clients streamline their billing process effectively. We have a successful track record of assisting our clients to achieve a clean claims rate of 98% and an improvement in net collection rate of 95%. Additionally, we have made a denial benchmark below 8% and an average days in AR of about 35-40 days.
Benefits of Outsourcing Pediatric Billing
- Access to Expertise:
Managing billing for pediatrics is a complicated task in-house, considering the expertise and experience, and cost associated with it. Errors and non-compliance can result in denied claims and revenue loss. To mitigate these risks, pediatricians outsource billing services to specialized billing firms. It helps them focus better on what they do best - taking care of patients.
Outsourcing pediatrics billing services to Invensis ensures that your practice receives timely and accurate financial reports. Our billing experts increases your revenue and reduce denials. They do this by submitting clean claims and following up on outstanding accounts receivable. - Improved Patient Experience:
Pediatrics billing can be complex and time-consuming for healthcare providers, which can negatively impact patient experience. Delays in billing and coding errors can lead to frustrated patients and staff. It leads to decreased revenue and increased administrative burdens.
Outsourcing pediatrics billing services to Invensis can help healthcare providers with streamlined billing processes, fewer errors, and timely reimbursements. Our team of expert billers prioritize accuracy and compliance to ensure that claims are processed quickly and efficiently. This in turn boosts overall patient experience. - Better Revenue:
Revenue is the lifeblood of any healthcare organization. However, managing pediatrics billing can be complex, tedious, and time-consuming, especially when dealing with insurance companies and government payers. Outsourcing your pediatrics billing services to Invensis can help improve your revenue cycle and maximize your financial returns.
Invensis offers specialized expertise in pediatrics billing, allowing you to focus on your core competencies of providing quality patient care. We ensure that claims are submitted in a timely and accurate manner. It results in faster reimbursements and minimizes the risk of revenue. - Enhanced Compliance:
Healthcare providers who offer pediatric services face a multitude of challenges in managing their billing operations. Noncompliance with billing regulations can lead to hefty penalties, loss of reputation, and even legal issues. By opting for outsourced pediatrics billing services to Invensis, healthcare providers can ensure that they stay compliant with billing regulations.
At Invensis, our team of expert billers and coders are well-versed in the latest billing regulations and can help healthcare providers stay compliant. Our team conducts regular audits to identify and correct errors, ensuring that our clients receive accurate and timely reimbursements.
Trends in Pediatric Billing
- Increased Use of Electronic Health Records (EHRs):
Many pediatric practices are adopting EHRs to manage patient data, streamline billing processes and ensure compliance with regulations. EHRs facilitates enhanced communication between pediatrics and patients. At Invensis, we have implemented EHR systems to send appointment reminders, provide lab test results, and more. - Shift Towards Value-based Care:
Another trend in billing for pediatrics services is the focus on providing value-based care to patients. It emphasizes on the quality of patient care, the outcomes, and patient satisfaction rather than the number of treatments performed. At Invensis, we adopted this care model to ensure high-quality care for your pediatric practices. - Increased Scrutiny of Billing Practices:
Healthcare providers are under heavy scrutiny because of many instances of fraudulent activities related to billing. Regulatory bodies, payers, and auditors are keeping a close attention to the billing procedures of pediatric practices. Invensis’ services are fully-compliant with industry standards. We also leverage data analytics to identify billing errors and monitor billing practices for better compliance.
What Our Customers Say
Invensis has been a great partner providing quality medical coding and billing services. The team is extremely responsive to every query we pose, and the turn-around time for deliverables is always as committed.
Invensis has been our revenue cycle management healthcare outsourcing partner for the past 5 years. They have always delivered on their commitments, whether it is meeting our Service Level Agreement (SLA) or improving our billing process.
We have been working with Invensis for the past two years, and they have helped us overcome many revenue cycle management challenges. The team often walks the extra mile to ensure that our needs are met.
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