Pediatrics Medical Billing


california medical claims billing Billing for general pediatric services presents many challenges for billers due to the numerous and varied issues of the young patient. The staff at MEDX has many years of experience in responding to these sometime varied and complicated issues that can affect cash flow for the single or multi-office pediatric practice.

Below are just a few examples:

  1. Is the child’s insurance coverage subject to the “birthday rule” of the parents?
  2. Are the parents divorced but the non caregiver has financial responsibility?
  3. Was the visit for a well check, with different yearly deductible, vs. a sick visit?
  4. Are certain immunizations/procedures billed to a different insurance due to “carve outs” within an HMO plan?
  5. Are there special state or county plans that supply free medications to the Pediatrician but require special billing forms to pay for administration services? In California there is the CHDP (Child Health and Disability Prevention) with county variances.
  6. Is part of the patient volume covered under a capitated contract the physician has with the local IPA thus requiring special tracking and reporting of this data?
  7. Are computer generated reminder messages to parents (either by home phone, cell phone, or text message) needed to fill your appointment schedule for annual physicals, flu vaccines, or appointment reminder?
  8. Does the practice offer “urgent care” or “after hours” services and bill accordingly?
  9. Adding lab work to the visit is both convenient and beneficial to the practice. We have experience in billing lab panels to the health plans and explaining to parents any amounts not covered by the plan.
  10. How are “no shows” or short notice “cancellations” being addressed by the practice?

Pediatric practices must consistently verify patient eligibility prior to rendering service. It is not uncommon for young parents to change jobs thus insurance coverage for the child may also change. Dual coverage may also exist if both parents are working and providing benefits.

Ensuring charge capture is another issue for discussion especially if staff turnover presents a problem for the pediatric practice.

In addition to all the billing components that are provided by Medx we can review the appointment lists and provide the practice with the detail of any prior balance owed thus allowing the front office staff to collect visit copays and older balances at time of service.