Pediatric medical billing services are specifically designed to handle the billing needs of pediatric practices. These practices treat infants, children, and sometimes young adults. This includes services like vaccinations, well-child visits, and childhood illnesses. By using specialized coders and handling the entire revenue cycle, these services ensure pediatric practices get paid accurately for the care they deliver.

Billing Care Solutions Services

Accurate Medical Billing & Coding:

Billing Care Solutions comprises certified coders with in-depth knowledge of the latest ICD-10 and CPT coding specific to pediatrics. This translates to accurate coding for vaccinations, well-child visits, complex childhood illnesses, and emerging treatments, minimizing claim denials and maximizing reimbursements. Billing Care Solutions leverage advanced editing software to ensure pristine coding accuracy, a critical factor often overlooked by other services.

Streamlined Revenue Cycle Management (RCM):

Billing Care Solutions handle the entire revenue cycle, from eligibility and benefit verification before each visit to claim submission, follow-up, and collections. Billing Care Solutions secure electronic health record (EHR) integration ensures seamless data flow and minimizes manual errors. This frees your valuable staff to focus on what matters most – providing excellent care to your young patients.

Efficient Account Receivable Management:

Billing Care Solutions prioritize timely collections through automated reminders and clear communication with patients and guarantors. Billing Care Solutions utilize advanced analytics to identify past-due accounts and develop targeted collection strategies, ensuring a healthy cash flow for your practice.

Seamless Provider Enrollment & Credentialing:

Billing Care Solutions navigate the ever-changing complexities of provider enrollment and credentialing with various insurance companies can be time-consuming and frustrating. Billing Care Solutions takes the burden off your shoulders, ensuring timely enrollment and credentialing so you can start seeing patients quickly.

In-depth Eligibility & Benefit Verification:

Billing Care Solutions leverage real-time eligibility and benefit verification tools to ensure accurate patient information upfront. This proactive approach prevents claim rejections, delays in care, and surprise billing for your patients.

Comprehensive Authorization & Referral Services:

Billing Care Solutions streamline the often-complex authorization and referral process by working directly with insurance companies. This reduces administrative burdens on your staff and ensures timely approvals for necessary services, minimizing disruptions in patient care.

Actionable Business Intelligence Reporting:

Billing Care Solutions provide customized reports that go beyond basic financial statements. These reports offer insights into key metrics like coding accuracy, denial rates, collection trends, and patient demographics. This actionable intelligence allows you to identify areas for improvement, optimize staffing, and make data-driven decisions to boost your practice’s financial performance.

Dedicated Patient Support:

Billing Care Solutions patient support team is dedicated to providing exceptional service to your patients. Billing Care Solutions offer clear communication and explanation of billing processes, ensuring a positive billing experience that fosters patient satisfaction and loyalty.

Coding System

Current Procedural Terminology (CPT) codes:

These codes describe specific medical services and procedures performed by the physician. In pediatrics, common CPT codes include:

• 99201-99215: E/M codes for new and established patient office visits, categorized by complexity (level 1-5).
• 99381-99395: Well-child visit codes for different age groups (newborn to 17+ years).
• Specific procedure codes: These codes represent procedures performed during a visit, like vaccinations (90471) or ear examinations (92555).

Healthcare Common Procedure Coding System (HCPCS Level II) codes:

These codes supplement CPT codes and may represent specific supplies, services, or procedures not covered by CPT. Some examples in pediatrics include:

• V00 series: Vaccination administration codes.
• J codes: Codes for immunizing agents.
• A codes: Codes for specific durable medical equipment used by children.

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes:

These codes diagnose the patient’s condition(s) and are crucial for insurance reimbursement. Pediatric ICD-10 codes cover a wide range, including:

• Infectious and parasitic diseases (e.g., A99.1 – Measles)
• Respiratory diseases (e.g., J18.9 – Bronchitis, unspecified)
• Congenital malformations and chromosomal abnormalities (e.g., Q00-Q99)
• Injuries, poisonings, and certain other consequences of external causes (e.g., S00-T88)

Modifiers

Modifier 25: Significant, Separately Identifiable E/M service by the same physician

This is used when a significant evaluation and management service (E/M) is performed on the same day as another procedure or service. For example, a child comes in for a well-child visit (preventive service) and also has an ear infection that needs to be addressed (separate E/M service).

Modifier 59: Distinct Procedure Service

This indicates that a separate and distinct procedure was performed on the same day as another service. It’s less commonly used in pediatrics compared to modifier 25.

Modifier 24: Unrelated E/M service by the same physician

This applies to an unrelated E/M service provided within the global period (typically 90 days) following a major surgery performed by the same physician. This wouldn’t be used for billing procedures in pediatrics.

Modifier 33: Preventive Service

This identifies a service billed as preventive care. It’s often used with well-child visit codes.

In conclusion, Billing Care Solutions provides a comprehensive solution that simplifies your billing processes, maximizes reimbursements, and allows you to focus on what matters most – delivering exceptional care to your young patients and building a thriving pediatric practice.

We specialize in Medical Billing and Coding and provide comprehensive support for your practice. For more information visit

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