iPatientCare Blog - Why Pediatricians are facing Medical Billing Issues?

Why Pediatricians are facing Medical Billing Issues?

MACRA is the biggest thing that has hit the healthcare payment system. The healthcare reimbursements are migrating from volume to value-based, MACRA will most likely serve as the roadmap for other payers. Documenting and reporting every treatment through a certified EHR or other approved method is the only way physicians can get paid for the services. The law directs all pediatricians to choose one of the two reimbursement paths – advanced alternative payment models (APMs) or the Merit-based Incentive Payment System (MIPS). Most physicians opt for MIPS, which measures quality, advancing care information, and clinical practice improvements.

Due to these updates, there are some issues faced by all the pediatricians

The introduction of new ICD – 10 codes that are introduced for vaccines by HIPPA. There are lots of newborns and vaccinations that can be approved by the medical insurance companies only if the ICD – 10 codes are properly used.

Secondly, the major issue is complications occurring due to ICD – 10 codes. The new codes are more on the logical side and hence, need more patience by the medical coders to perform their tasks.

The newborn babies are taken from hospital to home and then new insurance policies are being taken for the newborn babies. As the child becomes an adult, he/she will be exposed to new diseases for which the patient will not be covered by that particular insurance.

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The other kinds of possible errors when a medical claim is submitted for a newborn baby are –

  • Wrong codes – it is possible for the billers to file a claim with wrong codes, for example, a medical biller will enter the code for anesthesia instead of diarrhea which can cause obvious hurdles to the doctor as well as the patient.
  • Wrong details – if the name of the patient is entered incorrectly or with spelling mistakes, this will affect the doctors as the claim form will be rejected.
  • One of the most expensive errors – Many pediatric practices are unaware that they can bill for many services which they believe to be ‘specialty services’. For example, a common childhood injury is Nursemaid’s Elbow. This is actually an elbow dislocation. Many pediatricians do not realize that they can bill for this but they think it is an orthopedic surgery code. This procedure is not invasive but rather an orthopedic manipulation and therefore billable by the pediatricians.

The changes are on the way for the Maintenance of the Certification process. The biggest change that doctors need to know about is a partnership with American Council on Continuing Medical Education (ACCME). Enhancing the recertification exam itself is another top priority.

Another possible challenge faced by the Pediatricians is the lack of EHR interoperability. Many doctors are still not able to transfer all the information he needs to share.

The Pediatricians need to create a vision to get their practice together and develop a plan. This means you need to ensure that every diagnosis is part of the billing for the patient and that all ICD-10 codes are attached to the bill. The focus should be on patient wellness and must include an annual wellness visit plan and transitional care management (TCM) visits. For this reason, it is important to share some responsibilities with qualified medical billers.

How will you choose your medical billers?

Now the question arises whether you would like to have an in-house medical biller or outsource to the medical billing company. There are three vital factors to in-house hiring and outsourcing – cost, expertise, and flexibility.

In-house VS Outsourcing

The benefits of in-house medical billers:

  • You would have control over time and quality generated by the people you hire.
  • You are able to have face-to-face conversations and can offer more engagement between employees on the same project.
  • You may offer room for growth to your employee so they stay put for the long term as the voice of your practice.
  • All the strategies you apply are likely to remain confidential.
  • The in-house biller can direct all attention to the problem and get to the solution faster.

In spite of these benefits, it is difficult to find qualified billers, especially in smaller cities. Also hiring a qualified biller is likely to demand a high salary which will grow annually. If the employee departs, the process begins again – finding, interviewing, and negotiating. Therefore it is best to outsource your medical billing works to a reputed company.

Outsourcing is cost-effective as they distribute their expenses across the entire client base providing an economy of scale.

These specialists are dedicated and highly trained, their only purpose is to increase the profitability of your practice.

The practice also gains access to a large combined knowledge base of billing experts as they are always updated with the ever-increasing health care industry changes.

These experts work closely with office staff to ensure an efficient overall workflow and also provide training if required.

Adding an expert billing team helps the practice gains control as the billing company has the ability to run any report 24 hours a day. So the providers can have breathing space and can focus on their valuable patients.

A professional billing service will ensure that you are transmitting claims electronically to all possible carriers, reducing turnaround time and achieving the highest reimbursement possible in less time.

Consequently, these are just a few reasons why it is a good idea to outsource your billing to specialists. A good billing service like iPatientCare always works hard to improve the collection rate and helps you to see an increase in revenue and decrease in denials.

iPatientCare provides 24/7 medical billing services. It is an expert in pediatric billing with updated ICD – 10 codes for every vaccine. They provide the utmost care and knowledge to your medical bills. They make sure there is no room for errors when joining an insurance plan for the child and newborn baby. iPatientCare supplies you with comprehensive performance reports automatically and grants your practice unparalleled visibility into your billing operations without requiring you to micromanage any of your staff members.


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