Medical Billing and Coding Pediatrics

Medical Billing and Coding Pediatrics

Pediatrics Medical Billing

Pediatrics is the branch of medicine that identifies & treats diseases in newborns, children & adolescents. Per the American Academy of Pediatrics, Medical Billing and Coding Pediatrics care refer to the care delivered for people up to 21. Pediatricians deal with different illnesses, procedures, treatments, and preventive healthcare.

Pediatric billing & coding is different from other disciplines as it requires the billers & coders to be mindful of elements such as immunizations. Careful coding must be undertaken for immunization data so that the practice is reimbursed accordingly. Pediatrics might be challenging due to its many modifiers & bundling needs.

Methodology regarding Handling Issues in Pediatrics Medical Billing

Medical billing in pediatrics involves a number of particular issues. Pediatricians must manage a wide variety of disorders, procedures, treatments, well-child care, and preventative health care using a diversified array of diagnostic and treatment methods. Additionally, the healthcare coverage landscape for children is highly complicated. Without correct coding and claim submission systems, managing your revenue cycle and guaranteeing maximum reimbursement is impossible. Outsource Strategies International (OSI) possesses the specific knowledge and resources necessary to provide doctors and pediatric practices with accurate and fast medical billing services. Our HIPAA-compliant services assist you in obtaining maximum compensation by ensuring that your claims are clean and require fewer re-files and/or appeals.

Individual physicians, multispecialty groups, clinics, free-standing diagnostic facilities, long-term care institutions, acute care facilities, hospitals, and ambulatory surgical centers all benefit from our medical billing company’s bespoke solutions.

The in-house personnel in pediatrics practices have more on their plates than other specialties, as dealing with youngsters can be hard. The front-office crew should ensure a reduced waiting period since children are susceptible to contagious infections and can be highly restless. They also keep vaccination records, age change documentation, and government compliance standards. Specialized coding and billing experts are essential to prevent compromising patient care and assuring accuracy in processing.

Whatever be the size of your pediatrics practice, outsourcing your billing & coding obligations to seasoned pediatrics billing service providers like Medical Billing Wholesalers will help you reduce money and pump new vigor into your revenue cycle. We offer prior authorizations, claim submission, accounts receivable, denials management, and credentialing services. Our team of pediatrics billing specialists can help construct a leakage-free revenue cycle for your practice.

The Advantages of Our Pediatric Coding and Billing Services

We provide competence, knowledge, and precision in pediatric billing and coding services while also ensuring that your practice’s revenue cycle is error-free. Our team works to ensure that the billing, coding, claim submission, and payment posting processes are as painless as possible. We follow up on accounts receivables persistently and obtain prior authorization to avoid claim denials. Our denials team is dedicated to refocusing your efforts away from denial management and toward denial prevention. Medical Billing Wholesalers assists pediatricians in concentrating their efforts on providing exceptional care to their small patients by focusing on administrative and financial excellence. We provide you with a team of specialists that includes the following:

  • Successfully collaborate with Medicare and have a thorough understanding of state-specific Medicaid policies
  • Cost-cutting experts dedicated to assisting you in achieving greater clinical and operational efficiency
  • Our clients often notice an increase in revenue of over 20% and a decrease in denials of at least 15%. This is accomplished through the application of our expertise and process rigorous.


  • Serves all specialized fields, including cardiology, dentistry, orthopedics, and infectious diseases.
  • Understands how to bill for infants, well-child and sick child visits, nebulizer treatment, and other pediatric procedures.
  • Appropriate knowledge of ICD-9, ICD-10, CPT, and HCPCS codes
  • Maintains current knowledge of new regulations governing major insurance companies, including Medicare, Medicaid, and Workers’ Compensation.
  • Suggestions for pending or refused claims
  • Audits of charts to ensure the correctness of claims
  • Can bill claims use any advanced software suite?

Our Services

We offer comprehensive services ranging from patient enrollment to claim filing, patient billing, and receivables management

  • Enrollment and scheduling of patients
  • Verification of insurance
  • Authorizations for insurance
  • Coding
  • Payment posting and account reconciliation
  • Management of receivables
  • Management of denials of claims

The Fundamental Benefits

  • Reduce the number of days in A/R
  • Regular quality assurance checks
  • Status reports on a daily, weekly, and monthly basis
  • Meetings held on a weekly basis to discuss progress and review reports
  • TAT tailored to your specifications
  • There are no long-term annual contracts.

Medical and Coding Billing Errors Statistics

In this article, we will try to cover some of the common Medical and Coding Billing Errors Statistics that lead to rejected claims. If your biller lacks the finesse to get the maximum return for you, you may find a lot of this information very useful. A biller for any practice, lab, or hospital must realize the importance of their role in the business model. They must be diligent, thorough, and meticulous with their job or the brunt of tiny mistakes falls on to the medical service provider, leading to funds stuck in AR and the revenue cycle not coughing out decent profits.

Medical and Coding Billing Errors Statistics

Claims card in hands of Medical Doctor

So, these are some very common errors that lead to rejections.

Missing information:

Every missing information may cause denials or rejections. The most common missing items are listed below:

Missing or incorrect member ID

Missing or incorrect patient DOB or gender

incorrect or Missing zip code or patient’s address

Missing date of accident or date of a medical emergency

Missing hospice information or modifier (GW, GV)

Incomplete or Missing documentation

Lack of other insurance information or COB (coordination of benefits) issue

Timely filing

If a claim is submitted outside the time frame set by insurance it may result in a denial. So providers should be aware of timely filing limits as different payers will have different timely filing limits which are listed below.

Medicare – 12 months from DOS

Aetna – 90 days from DOS

Anthem – 180 days from DOS

Cigna – 90 days from DOS

UHC – 90 days from DOS

Coding errors:

Failing to provide information to payers to support claims results in denials or delays.

The problem can occur if billing department members don’t link a diagnosis code with the CPT code or they do not add the 4th or 5th digit to the diagnosis code.

The upcoding error can occur if billing department employee makes a mistake when entering diagnosis and treatment codes or if the employee is confused by the information provided by the physician or if patients are billed for the more complex procedures than they actually received or bills are submitted for services that were never performed.

Telemedicine coding errors:

Incorrect use of modifiers for telehealth services results in denials or rejections. For example, the GT modifier applies to the real-time telehealth services provided by audio or video system, while the GQ modifier covers services provided through asynchronous telecommunication systems such as an emailed x-ray.

Telehealth modifiers are listed below:

  • GQ

    – Modifier GQ is used to code for services delivered via an asynchronous telecommunications system. Asynchronous telecommunication is when a physician collects & stores medical history, images & pathology reports and forwards them to senior or specialist physicians to get an opinion on the diagnoses & treatment. It can be used by providers participating in federal telemedicine demonstration programs

  • GT or 95

    – Modifier 95 can be used to code all of the diagnosis, evaluation, or treatment of symptoms via Telemedicine. 95 can be attached to any CPT codes. Modifier 95 can be used only when the service is offered via an interactive audio & video telecommunication system. Modifier GT is being appended in place of modifier 95 only when directed by the insurance payer

Duplicate billing:

This is a human error wherein the same medical procedure is billed more than once. This can result in resubmitting a claim or delay in payments. These claims are usually categorized into two groups exact duplicate claim and suspect duplicate claim.

If you submit the initial claim to insurance it is counted as the original submission. Later if you need to recheck or go back to make changes such as insurance carrier, subscriber ID, etc. and you resubmit it without mentioning it as a corrected claim with the original ICN number it will be rejected as a duplicate claim.

Inactive or terminated insurance:

This is one of the most common Medical and Coding Billing Errors Statistics reasons for claim rejections or denials. It is advised to check the insurance availability of the service while treating the patient. Changes and modifications can happen with a patient’s insurance at any point. For example at the time of submission or treatment patient’s policy end date was not given but later it was updated in insurance records.

I hope this article helped you in understanding the reasons behind high rejection rates. Feel free to interact with us over our socials and let us know what you think.