Pediatric Medical Billing Services
Optimize your revenue cycle with our specialized pediatric medical billing services. We handle the complexities of pediatric claims, ensuring accurate coding with CPT, ICD-10, and payer-specific codes, while maintaining full compliance with HIPAA and Medicaid regulations.
Our team manages timely claim submissions, proactive follow-ups, and effective denial management to maximize reimbursements for services like vaccinations, well-child visits, and chronic care treatments. Efficient billing is key to securing proper reimbursements and maintaining a healthy revenue cycle for your practice.
What Does Our Pediatric RCM Include?
Insurance Verification
Real-time verification of patient coverage, plan details, deductibles, and benefits to prevent claim denials and ensure seamless billing for pediatric procedures.
Prior Authorization
Fast-tracking pre-approvals for well-child visits, vaccinations, diagnostic tests, and chronic condition treatments, preventing delays in care and reimbursement issues.
Charge Capture
Documenting all pediatric services accurately to prevent missed revenue, ensuring correct coding and invoicing for maximum reimbursements.
Medical Coding
Precision ICD-10 and CPT coding for surgeries, fractures, sports injuries, and post-op care, reducing denials and improving claim accuracy.
Accounts Receivable (AR) Management
Tracking insurance and patient payments, resolving payment delays, and managing claim appeals to boost cash flow and revenue recovery.
Reporting & Performance Analysis
Custom financial reports providing insights into denial trends, reimbursement rates, and revenue cycle efficiency for data-driven practice management.
Pediatric Medical Billing Solutions We Offer
Our billing services are designed to meet the unique needs of each practice. We offer comprehensive solutions, ensuring that every aspect of your billing process is optimized for maximum efficiency and reimbursement.
Routine Visit and Vaccination Billing
Pediatric practices handle routine well-child visits and immunizations regularly. We ensure these services are coded accurately, including vaccine administration and product codes, to minimize claim rejections and delays.
Chronic Condition Management Billing
Children with chronic conditions like asthma or diabetes require ongoing care and monitoring. We track and document these services meticulously, ensuring timely and accurate reimbursements for long-term treatments.
Developmental and Behavioral Screening Billing
Developmental assessments, including autism screenings and ADHD evaluations, require specific codes and documentation. Our team specializes in managing these claims, reducing errors and optimizing reimbursement rates.
Emergency Pediatric Care Billing
Emergency visits for injuries or acute illnesses require quick and accurate claim submissions. We handle urgent care billing with precision, ensuring no delay in your practice’s payments.
Pre-Auths for Specialized Treatments
Some pediatric treatments, such as growth hormone therapies or surgeries, need prior authorization. We manage the pre-authorization process to ensure compliance and prevent interruptions in patient care.
Billing for In-Hospital and NICU Services
Pediatricians providing hospital or neonatal intensive care unit (NICU) services often face intricate billing processes. We handle these complexities, ensuring all services are documented and reimbursed properly.
Outsource Pediatric Billing to CLICKVISION BPO
Outsourcing pediatric medical billing to CLICKVISION BPO simplifies the complexity of managing well-child visits, immunizations, and chronic condition treatments. Handling payer-specific guidelines, Medicaid/CHIP compliance, and revenue cycle management (RCM) can overwhelm in-house teams.
Outsource your pediatric billing to us for accurate claim submissions, reduced denials, and maximized reimbursements, enhancing your practice’s financial performance.
Specialized Coding & Compliance
Accurate CPT and ICD-10 coding for well-child visits, immunizations, and chronic condition management, ensuring compliance with payer-specific regulations and minimizing denials.
Maximized Reimbursements
Expertise in pediatric coding, payer policies, and compliance audits, reducing claim discrepancies and increasing reimbursement rates.
Revenue Cycle Efficiency
Optimized billing workflows, faster claim submissions, and reduced A/R days, improving cash flow and financial performance.
Higher Collections
Efficient claim processing, modifier usage, and prior authorization management, reducing delays and maximizing collections.
Cost Reduction
Up to 40% reduction in billing costs through automated processes, denial prevention, and optimized documentation.
Data Security & Compliance
HIPAA-compliant billing processes with secure data handling to ensure regulatory compliance and patient privacy.
Seamless Integration
Smooth ICD-10 implementation, bundled payment tracking, and payer compliance, preventing revenue loss.
Transparent Billing
Structured billing workflows, real-time reporting, and claim tracking, ensuring financial stability and revenue optimization.
Common Challenges in Pediatric Medical Billing
Vaccine Billing Challenges
Vaccine billing is complex due to varying administration and product charges based on payer and patient age. This often leads to coding errors, claim denials, and reimbursement delays.
Insurance Coverage Variations
Pediatric services face inconsistent coverage rules across insurers, causing underpayments and claim denials. This variability complicates billing and disrupts revenue flow.
High-Volume Visit Management
High patient volumes, especially during peak seasons, increase the risk of billing errors and missed claims, leading to revenue loss and payment delays.
Denied Claims for Specialized Services
Denied claims for services like screenings or therapies can disrupt cash flow, often caused by coding errors, documentation gaps, or payer policy mismatches.
Pre-Authorization Delays
Specialized treatments often face pre-authorization delays due to complex payer requirements, leading to disruptions in patient care and delayed reimbursements.
NICU & Critical Care Billing
NICU and critical care services involve complex coding and strict documentation requirements, increasing the risk of claim denials and payment delays.
Get In Touch with Our Pediatric Billing Experts
Send a message to discuss your pediatric billing needs, challenges, and how we can help optimize reimbursements and streamline your revenue cycle.
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Leadership Team
Dimitar Talevski
Dimitar is a seasoned marketing specialist and the visionary behind CLICKVISION. With over 10 years in digital marketing, he excels in crafting marketing strategies that boost rankings, which in return increase leads, conversions, sales, profits, and ROI.
Filip Dimitrijevski
With a strong background in the marketing industry and healthcare leadership roles, Filip is responsible for CLICKVISIONBPO's sales strategies and onboarding new clients. With a passion for sharing insights gained from his experience, he also shares valuable knowledge through industry related articles.
Most Common ICD-10 and CPT Codes Used in Pediatrics
Pediatrics billing involves submitting claims for medical services provided to children. It requires accurate coding of diagnoses and procedures to ensure proper reimbursement. Pediatric billing is unique due to the variety of services, such as wellness visits and specialized treatments.
Here are some of the most common ICD-10 and CPT codes used in pediatric billing:
| ICD-10 Code | Description | CPT Code | Procedure |
|---|---|---|---|
| Z00.129 | Encounter for routine child health examination | 99381 | Initial comprehensive preventive medicine evaluation, infant (age 0-1) |
| J03.90 | Acute tonsillitis, unspecified | 99382 | Initial comprehensive preventive medicine evaluation, child (age 1-4) |
| H66.90 | Otitis media, unspecified, unspecified ear | 99391 | Periodic comprehensive preventive medicine evaluation, infant (age 0-1) |
| R62.50 | Failure to thrive, unspecified | 99406 | Smoking and tobacco use cessation counseling, intermediate (greater than 3 minutes) |
| B34.9 | Viral infection, unspecified | 90460 | Immunization administration, with counseling by physician or other qualified healthcare professional |
Understanding Payer and Compliance
| Topic | Details |
|---|---|
| Payer-Specific Rules | Pediatric billing requires tailored strategies for Medicaid and private insurance. |
| HIPAA Compliance | Ensures confidentiality of children’s health records, adhering to privacy standards. |
| PQRS Reporting | Focuses on quality measures specific to pediatric care, impacting Medicare reimbursement. |
| MACRA Compliance | Links pediatric reimbursements to quality care, ensuring adequate compensation. |
| Telehealth Billing | Covers billing for remote consultations, especially in behavioral health and follow-ups. |
| EHR for Pediatrics | Ensures accurate documentation for compliance and billing accuracy. |
| Modifiers in Billing | Adjusts codes for specific situations, preventing denials and under-reimbursement. |
Related Specialties We Excel In
Primary Care Billing Services
Pediatrics is a key component of primary care, focusing on children’s health from birth through adolescence. Primary care providers work alongside pediatricians to ensure continuous, comprehensive healthcare for children, addressing preventive care and common health concerns.
Family Medicine Billing Services
Family medicine encompasses care for individuals of all ages, including pediatrics. Family medicine providers often manage the health of children alongside adults, ensuring that all members of the family receive holistic and preventive care from a trusted physician.
CLICKVISION BPO is specialized pediatric medical billing company focused on maximizing reimbursements, reducing claim denials, and optimizing revenue cycle management for pediatric practices. With offices in Sweden and Macedonia, we provide scalable billing solutions tailored to pediatric practices of all sizes.
In 2024, we processed over $1.2 million in monthly charges, securing $700,000 in reimbursements. Our advanced billing technology integrates with EHR and practice management systems, enabling real-time revenue tracking and automated claim submissions.
With a certified team of pediatric billing specialists, coders, and denial management experts, we ensure ICD-10 and CPT accuracy, payer compliance, and faster reimbursements. Practices partnering with us experience a 30% reduction in denials and a 25% revenue increase.
As a trusted pediatric billing company, we prioritize HIPAA compliance, secure data management, and efficient workflows, helping pediatric practices improve cash flow and scale with confidence.
Why Choose Our Pediatric Billing Company?
Years of Experience
Days in AR
Eliminate Claim Denials & Revenue Loss with CLICKVISION BPO
Denied claims cost healthcare providers billions. A Change Healthcare analysis found that $262 billion in medical claims are initially denied, leading to lost revenue, administrative burdens, and costly resubmissions.
At CLICKVISION BPO, we eliminate billing inefficiencies by ensuring accurate coding, proper documentation, and insurance verification, reducing claim denials and maximizing reimbursements.
By outsourcing to us, your pediatric practice avoids costly resubmissions, delayed payments, and administrative headaches while securing a stronger cash flow and a more efficient revenue cycle.
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Pediatric billing requires specialized knowledge of CPT codes for age-specific services, including well-child visits (99381-99385), immunizations (90460-90474), and developmental screenings (96110). Unlike adult billing, it involves managing vaccine schedules, growth milestones, and Medicaid EPSDT programs. CLICKVISION BPO ensures accurate coding to avoid underpayments and maximize reimbursements.
At CLICKVISION BPO, we reduce denial rates by up to 30% through proactive denial management. We identify the root cause—coding errors, eligibility issues, or documentation gaps—correct them, and resubmit promptly. Our data-driven approach ensures faster reimbursements and minimizes revenue loss for your practice.
Complex codes include vaccine administration (90460-90474), preventive care (99391-99395), and behavioral assessments (96110-96127). These require age-specific modifiers, time-based billing, and compliance with payer-specific guidelines. We ensure accurate coding, reducing errors that lead to claim rejections.
Our certified coders specialize in ICD-10, CPT, and HCPCS codes. We conduct regular audits, use AI-driven claim scrubbing tools, and follow AAP and CMS guidelines. This ensures over 98% coding accuracy, reducing denials and improving revenue cycle efficiency.
We handle Medicaid billing with precision - verifying eligibility, securing prior authorizations, and complying with state-specific policies. CLICKVISION BPO ensures accurate claims submission for EPSDT services, reducing claim denials and improving reimbursement timelines.
We manage both product (e.g., 90698) and administration codes (90460-90474) with proper modifiers. Our billing process tracks vaccine inventory, handles VFC (Vaccines for Children) program claims, and ensures compliance with payer rules, preventing common billing errors.
Outsourcing to CLICKVISION BPO streamlines your revenue cycle, reduces administrative burdens, and improves cash flow. We optimize claim submissions, manage denials effectively, and ensure faster reimbursements—boosting your revenue by up to 25% while allowing you to focus on patient care.
Coding errors can lead to claim denials, delayed payments, and compliance risks. In pediatrics, errors in age-specific codes or vaccine administration can cost your practice thousands in lost revenue. We mitigate this with expert coders and strict quality control, maintaining high claim acceptance rates.
CLICKVISION BPO adheres to strict HIPAA protocols, securing patient data with advanced encryption, regular compliance audits, and role-based access controls. Our systems meet industry standards, ensuring data privacy while maintaining billing efficiency.
We ensure quick claim submissions within 24-48 hours of receiving documentation. Our automated billing systems and real-time claim tracking reduce turnaround time, accelerate reimbursements, and maintain steady cash flow for your pediatric practice.