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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.
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