Pediatrics medical coding and billing in healthcare isn’t as simple as they might sound. Medical coding and billing in healthcare are two separate processes. Medical coding is when the medical coder translates the encounter between patient and physician from diagnosis or treatment into a digital or alphabetical code. Every medical condition, diagnosis, treatment procedure or medical service provided has a specific code. Medical billers create medical claims based on the codes. This is the point where medical billing and medical coding intersect. Medical billers take these medical claims and submit them to the insurance payers. The medical claim is submitted so that the healthcare provider or physician is reimbursed for the medical services they rendered.
Introduction to Pediatrics:
What is pediatrics? Pediatrics is a branch of medicine dealing with disease diagnosis and their treatment related to children, infants, or adolescents. According to the American Academy of Pediatrics, it includes healthcare for people up to the age of 21 (according to the American Academy of Pediatrics).
Why do pediatricians require medical billing services?
Pediatricians deal with kids, which is why compared to other healthcare fields and practices, they tend to spend more time (at least 25% more) with the patient. Another factor includes that as the patients are infants, they cannot properly communicate their problems. This is why it is hard for the physician (pediatrician) to come up with a diagnosis and treatment procedure hence more time. Now all this time spent communicating and understanding the problem has an impact on medical billing and coding. Medical billing and coding help ensure that the physician or the healthcare provider is being reimbursed fairly according to the time spent. This is why pediatricians need medical billing services.
When it comes to Pediatrics medical coding and billing, the medical biller should not overlook a couple of requirements. This involves billing or coding for vaccines. Overlooking to bill for vaccines results in the healthcare provider losing a heavy chunk of their revenue. Except this, there are various other errors regarding pediatrics medical billing.
Why are pediatricians facing issues with medical billing?
The medical billing codes for pediatric billing are changing and being updated by the concerned parties and using the wrong codes or missing the latest updates causes various issues. For instance, (if the right ICD – 10 codes are used correctly), various vaccinations for newborns are also approved by the insurance payers. And if the wrong codes are used, it can result in claim denials.
One of the biggest challenges pediatricians faces is the communication factor, which makes the complete diagnosis process complicated. Normal medical coding and pediatric medical coding are not the same, and there are a number of different chronic diseases that occur in children, some congenital disabilities or congenital deformities. The medical billers must have a vast understanding of these conditions. For Pediatrics medical coding and billing, diagnosing these conditions include unique codes, coding rules, and age factor. Following are some of the common areas where coders get confused when it comes to pediatric medical coding:
- Cardiac Surgery
- Congenital deformities
- Syndromes or chronic illness
- Vaccine billing
Using the right codes has a huge impact on the overall reimbursement rate and revenue cycle. If the patient went through multiple medical procedures, the coder must determine which one of those is the principal.
Common issues with Pediatrics medical coding and billing:
The two most commonly used codes a medical coder must be familiar with include ICD – International Classification of Diseases – codes and CPT codes – Current Procedural Terminology. ICD codes are for a patient’s sickness and CPT codes are for services provided or performed by the physician on the patient.
Pediatric medical claims often get rejected or denied due to various errors and reasons, including the use of wrong codes. Errors are very common when it comes to medical billing, but they are also the sole reason behind low reimbursement rates, lost payments, denials, and possible audits. Following are some of the common reasons behind errors in pediatric coding and billing include:
– Incomplete or incorrect patient and coding information:
The incorrect or missing information of the patient like patient name, address, gender, or the treatment date, hence, resulting in claim denials.
In some cases, the healthcare provider fails to provide adequate, detailed, or pertinent patient information regarding the procedures performed, resulting in incorrect or missing information in the medical claim.
– Use of incorrect codes:
Every diagnosis or treatment has its own corresponding code and they go through changes every year. This is why the medical billers should be up-to-date regarding the latest procedural codes and their rules. Using old codes results in the medical claim being denied or rejected.
– Use of wrong modifiers:
There are a number of modifiers used in medical billing, including Modifier 22, 24, 25, 26 59 and 91, etc. There are specific guidelines for using each modifier and they also keep changing constantly. The medical billers and coders need to be updated about the changes and use the right modifier.
Using the wrong modifier in medical billing results in a loss in payments, reduced revenue, lower reimbursement rate, and claim denials.
– Unbundling and Upcoding:
Upcoding in a medical claim involves codes for the procedure that were never performed or, for instance, if a patient has spent 15 to 20 minutes with the physician but is billed for 40 minutes, this is called upcoding.
Unbundling is when a procedure is divided into several small parts, each coded separately.
– Professional services and Vaccine billing:
Pediatricians often meet with the patient’s parents regarding the diagnosis and treatment. In this case, even if the patient is not present with the parent, the healthcare professional services provided by the physician or pediatrician should be billed under the insurance claim. Vaccine billing is overlooked.
Outsourcing Pediatrics medical coding and billing Services:
You worry about providing safe patient care and let us worry about the records!
But why outsource Pediatrics medical coding and billing services? This field comes with a number of challenges and worrying about the paperwork, record keeping, medical claims, submission, and denials is time-consuming, to be the least. A pediatric medical biller’s entire job is to take all this off of your plate and let you take care of the patient.
Following are some of the responsibilities of a medical billing specialist:
– Using the proper information and codes for diagnosis, treatment, or the services provided by the healthcare provider
– Preparing a clean claim
– Submitting the claim using a medical billing software
– Follow-up with the insurance company regarding the medical claim.
– In case of denial or rejection, correct and resubmit the claim so that the physician is compensated.
– Ensure that they are compliant with the HIPAA for record-keeping.
– Requesting patient payment
Medical billers and coders have a vital role in any healthcare facility and without a specialist, the revenue cycle of the facility struggles. Maintaining a proper revenue cycle and income is a necessity for running a healthcare organization or any other business.
Benefits of Outsourcing Pediatrics Medical Coding and Billing:
Like every other kind of outsourced medical billing and coding service, outsourcing pediatrics medical coding and billing also comes with several benefits. Some of the benefits include:
– More focus on providing the safe patient care
– A visible drop in medical billing errors and medical claim denials
Outsourcing pediatric billing also impacts the revenue cycle (lesser claim denials, faster payments, and higher revenues).
– Not just better and improved cashflows, but you also get to save administrative expenses like salaries, training sessions, computer equipment, staff benefits, and all the expenses related to billing software (purchasing, upgrading, and maintenance). Including this, you also get to save yourself from the issues like ‘what if your medical biller has to go on a vacation?’ which results in late submissions (the claims have to wait till they come back). But with outsourced medical billing, you don’t have to worry about this anymore.
– With an outsourced medical billing and coding service, you also get billing compliance. Hence, making sure that the medical billing is done according to the latest changes in CMS (Centers of Medicare and Medicaid Services) and insurance payer’s rules and regulations or changes in the codes. It is a full-time job, staying up to date about any recent changes and submitting a clean claim to increase the revenues and reimbursement rate—all of this by following the Pediatrics medical coding and billing guidelines.
– With a medical billing company working solely to prepare and submit the claims in time without any errors.
– User-friendly implementation of the billing software
– Another big advantage of having a medical billing company handle the claim submission is that the healthcare providers don’t have to deal with a number of insurance payers directly. The medical billing company is your single point of contact, and the rest is handled by them (medical billing company).
Why UControl Billing?
UControl billing is a well-reputed medical billing company providing you with more than just medical billing. With our team of expert medical billers, you get personal attention and a leading resource for your healthcare specialty. UControl Billing offers you an end-to-end Revenue Cycle Management (RCM).
Following is the list of tasks or services offered by the UControl Billing: –
– Creating the claims
– Claim Submission
– Claim denials management
– From payment posting to appeals
Our medical billing services include eligibility verification, claim tracking, reduction in claim denials and rejections, scrubbing the claims based on the rules, and being HIPAA Compliant. We don’t believe in the “One Size Fits All.” We rather adapt according to your needs.
Services we offer:
With our timely follow-ups and 24-hour billing services, we consider ourselves as a “Remote Business Office” – we are right there with you! Following are the services we offer at UControl Billing: –
– Revenue Cycle Management (RCM)
– Medical Billing Services
– Medical Coding services
– Front Office Management
– Telemedicine Billing Services
– Medical Transcription Services
– Medical Credentialing Services
– Value-Added Services like
o MIPS MARCA & Eligibility
We only get paid when you do!
Another benefit of outsourcing your medical billing services to UControl billing is that you get competitive and affordable pricing. We offer two pricing plans: –
- Medical Billing (Only)
- Revenue Cycle Management (RCM) Complete
Your billing cost depends on your monthly receipt with UControl Billing. If you face a dip in your production, your billing costs also go down. We believe in providing you with the best, high-quality medical billing services to increase your reimbursement rate by decreasing errors and claim denials so that you can focus on your primary cause that is patient care, and not worry about the paperwork.
Frequently Asked Questions (FAQs)
What is Pediatric Coding?
Pediatric medical coding involves billing and coding for the healthcare services provided by the physicians to infants, children, or adolescents. It includes the age group from birth till 21 years old
What is coding and billing in healthcare?
Medical coding and billing are essential processes used to receive payment against the healthcare services provided by the physician to the patient. It is a process of coding or translating the patient-physician meeting into a medical claim for reimbursement.
What do bill and coding do?
Medical billing and coding are essential processes for any healthcare provider. They ensure that the healthcare provider or the physician is reimbursed and compensated according to their services. A medical biller or coder is the middle man between the healthcare provider and the insurance carrier.
What are some of the most common billing and coding errors?
Medical billing and coding are complex yet essential processes for running a healthcare facility. Now in healthcare medical billing, even minor errors get the claims rejected or denied by the insurance provider, therefore lost or late payments.
- Incomplete or insufficient patient information
- Use of wrong codes
- Use of wrong modifiers
Here ends our guide to pediatrics medical coding and billing. I hope now you completely understand the medical coding and billing for Pediatric. If you have any queries, please let us know in the comment section or simply contact our 24/7 available support from the right bottom of your screen corner.