Pediatric Critical Care Professional Billing -- The Medx Specialties


Pediatric critical care services are an array of services provided by physicians directing the inpatient care of critically ill children. Critical care billing is time based and we know the physician may spend billable time with a patient at bedside or elsewhere on the floor/unit reviewing test results, discussing the patient’s care with other medical staff or documenting the medical record. We have the experience to bill for the physician’s total time engaged in work directly related to the individual patient’s care.

Critical care and other E/M services are reimbursable for care provided to the same patient on the same date by the same physician or another physician in the same group or another group. We have the coding experience including use of modifiers to help the physician successfully report to the insurance carrier repeat critical care time.

We specialize in Pediatric Intensive Care billing and have experience in several facilities in Southern California. Currently, we also bill for several medical groups covering a very large PICU in Los Angeles County.

Our office has expertise in helping the physician select the appropriate CPT code to insure maximum reimbursement for physician transport and payer specific codes (for example Medi-Cal/CCS “Z” codes) for continuous hospital care at various critical care levels.

For fast, efficient billing, Hospital Based Practices need to have electronic connectivity with hospitals to retrieve medical records and face sheet information. We make all the arrangements with the hospital for electronic retrieval of patient information by preparing HIPAA Business Associate Agreement and having our IT staff meet with the hospital’s IT department.

We review the CPT charge code assigned by the doctor and cross reference to the appropriate code for maximum reimbursement (example, global codes) within the insurance carriers guidelines (HMO, PPO, Medi-Cal, CCS, etc.). We eliminate any bundled codes which will cause a denial or reduced payment.

We determine new patient’s insurance by using the hospital’s information and then re-verify for insurance accuracy and eligibility prior to billing claims electronically.

A vigorous insurance follow-up system is utilized to collect on outstanding claims and we also leverage the reporting of unfair payment practices to the Department of Managed Health Care and Department of Insurance for slow payers.

We can also assist the physician group with insurance contract negotiations and credentialing.