Pediatrics Billing

Accuracy Billing & RCM Services to Pediatrics Practices

A pediatric medical billing is actually a mini adult billing but it is hugely regulated, specific and detail filled and is offered on account of the special healthcare needs of babies, children, and teenagers. Pediatric practices offer a broad range of care, including preventive well-child visits, urgent care visits, and complicated immunization schedules that require correct coding and billing in order to be reimbursed correctly

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    Case Short Description – Billing Pediatrics

    At NexCure LLC we see where pediatricians struggle with: having a patient visit every other week, tracking patient growth by age CPT code when they do visit, multipart administration rules on vaccine administration, having multiple payers involved covering both parents often means multiple reimbursements.

    Your end game with our AAPC-certified pediatric billing experts is not just a billing service, it is a revenue cycle management partner that understands how to work within pediatric coding specifics, maximum reimbursements, minimize denials, and be in complete and total compliance with HIPAA and any system payers.

    Reasons Why Pediatrics Billing is Special

    Compared with other specializations in pediatrics, however, you require:

    Watchwords of CPT coding and ICD-10 Coding Principles

    CPTs and ICD-10 codes vary according to age (ex, newborn, toddler, adolescent).

    High frequency of visits

    Several patients make numerous visits to the hospital annually to make well checks, immunization and sick visits.

    Complicated vaccination

    In this, the vaccine billing is complex and the administering is also intricate and in most cases a separate payers code reimbursement different parts.

    Preventive service guidelines

    The coverage is extremely varied depending on the insurance plan, with a possible implication of whether screenings and developmental assessments will be covered.

    Coordination of benefits (COB)

    A lot of pediatric patients have several insurance covers and there is a need to handle claims accurately.

    Same-day care modifiers

    There will be multiple procedures that take place on a single visit, so proper use of a modifier is important to prevent denials.

    Seasonalities

    Seasonalities are related to the flu seasons, where there are volume and has complicated billing and also back to school physicals.

    Full Pediatrics NexCure LLC Billing Services

    Pediatric Coding Documentation Accuracy Review

    We are an end-to-end provider of pediatric billing solutions that deal with all the stages of the revenue cycle.

    • Create Behavioral Health Visits that will have Bill Developments Screenings as documented.
    • Code correctly about the preventive visits, sick visits, and the urgent care with regard to CPT, ICD-10, and HCPCS codes.
    • Make sure that there is the age-specific coding compliance done when it comes to the newborn, infant and child, and adolescent services.
    • Vax and Vaccination Insulin Billing faces: Use the appropriate modifiers on same-day services to avoid getting the payers to reject.
    • Compare documentation of the providers to ensure that not all billable services are not overcoded.

    Vaccine Billing

    • The separate charge should be adequately charged, the vaccine product and an administration fee.
    • The name of the program is VFC (Vaccines for Children).
    • Ensure observation of multi-dose and seasonal immunization such as influenza.
    • Stop losing money to the underpayment of claims due to the matching on NDC code with the proper CPT/HCPCS code.
    • Maintain proper vaccine inventory reconciliation by which they are able to charge account and audit.

    Claims Filing / Clearinghouse Management

    • Claims electronic submission with the support of the pediatric claim scrubbers.
    • Notify missing/mismatched documentation and/or code marked prior to submission.
    • Make arrangement with large clearinghouses in order to make fast settlement of claims.
    • Keep track of claim status in real-time to prevent missing claims and slow-down claims.

    ERA Balancing & Posting Payments

    • Post ERA is machine-based where man counts correctness.
    • Bargain and confront low payments covered by insurance provider.
    • Vaccine services, Match bills and Inventory.
    • Keep proper account balance of the patient so it can be transparent to the family in terms of billing.

    Denial Management

    • Determine the refusals on claims and the reasons at once.
    • Embellished on appeal packets, medical and payor policy should be prepared finely.
    • The patterns of denials are followed and reported to counter them.
    • A shorter than 7 business day denial resolution turnaround.

    Pediatric Practice Consulting & Improvement

    • Pediatric procedures should be solicited to be pre-authorized as specialty.
    • Confirm coverage prior to every visit regarding preventive, sick and vaccine services.
    • Verify the benefits co-coordination of patients on more than one plan.
    • Reduce the amount of rejections of claims based on eligibilities.

    Untitled (2000 x 2000 px) (3)
    12

    Years Of Experienced in Medical Services

    Pediatric practices

    Common Billing Issues in Pediatrics

    Pediatric practices that are being billed are disappointing with their experience.

    Coding of some of the denials has been done in a wrong way hence the resultant denials.

    Insufficient modifiers, incorrect age-dependant CPT codes or alternative misconnection of diagnosis.

    Trivial codes of management or incorrect billing of VFC program.

    Not being familiar with certain screening and check up rules by payers.

    Time on the part of the staff in checking the insurance on individual visits per child.

    Wrong billing of insurance primary/secondary.

    The NexCure LLC Cycle

    Our Pediatrics Billing Cycle

    Collaboration between NexCure LLC and the company has a lot of benefits:

    1. Contract check with the pediatrics payers so you can monitor your level of reimbursement.
    2. Provide best diameter training to employees on documentation in order to be accurate in billing.
    3. Insurance Sterilize/Become insured.
    4. Be ready to have compliance auditions to payers and government.
    5. Give reports about financial performance with pediatric-specific measures on a monthly basis.
    Why NexCure LLC

    Advantages of Partnering with NexCure LLC

    Collaboration between NexCure LLC and the company has a lot of benefits:

    • Higher clean claim rates – highest first-pass acceptance rate up to 98 percent.
    • Improved reimbursements – speedier claim-payload cycles.
    • Minimized administrative load – liberate your employees so that they can tend to the patients.
    • Compliance assurance – be current on the latest code directions.
    • Enhanced patient experience – family billing is made clear and very accurate.

    Workflow Process

    • Proper insuring & insertion of such data on demographics.
    • Undertaking pre checks before appointments.
    • Submission scrubbing assertion and reconciliation postings, payment postings.
    • Enter proper codes of every service, vaccines and screenings.
    • Make sure that there is documentation of the billed codes.
    • Automated and manual completeness and compliance checks.
    • Inventory reconciliation postings and payment postings.
    • Electronic submission through clearinghouse in a speedy manner.
    • Couple patient payments and ERA/EOB payments.
    • Find out about short payments and differences.
    • Know the causes of denial and make efforts to reverse.
    • Denial management and timely appeals.
    • Reports on clean rates, trends involving denial and reimbursement performance reporting by the month.

    Why Go to NexCure LLC for Pediatrics Billing

    AAPC-Certified Pediatric Billers

    Proficient on preventive care, urgent care and billing of vaccines.

    HIPAA-Compliant Systems

    Seals all the handling of the patient information.

    Demonstrated Success

    Higher collection rates, lower AR days and better clean claim rates.

    Personalized Services

    Specific to single pediatric physicians, group practices and urgent care clinics.

    Transparent Communication

    Real-time access to dunning data and financial report on the dunnings.

    Put NexCure LLC to Pediatrics Billing Work

    Call NexCure LLC and have them do your Pediatrics Billing.

    Pediatrics would be happy to have a billing service provider with the expertise in dealing with children and handling revenue cycles in the specialization. We make sure all your check-up, vaccine, procedures are all coded, billed, and collected properly; to maximize your reimbursement, and keep your practice in full compliance.

    To know how NexCure LLC can help your practice succeed, Contact NexCure LLC today and find out more information on our pediatric billing solutions.

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      Client Testimonials

      What Healthcare Providers Say About Us

      "Working with NexCure LLC has been a relief for my clinic. They took care of my credentialing process from start to finish, no delays, no confusion. I also like how they keep up with CMS quality programs and explain things clearly. Honestly, they’ve made my life much easier."

      Dr. Ayesha Rahman, MBBS

      "Before NexCure LLC, our billing was a nightmare — denials, delays, you name it. Their team stepped in and fixed our revenue cycle quickly. What I appreciate most is their guidance on MIPS reporting; they walked my staff through the requirements and we’ve already seen the results. Dependable and professional."

      Dr. James Whitman, MD

      "The attention to detail at NexCure LLC is impressive. They helped us get credentialed with several payers and made sure everything stayed compliant. Their support with HEDIS reporting boosted our scores, which directly benefited our contracts. I’m grateful for their hard work."

      Dr. Maria Gonzalez, MD

      "I’ve been very satisfied with the services from NexCure LLC. They keep me updated on payer rules and compliance, which is something many billing companies overlook. My billing cycle is smoother now, and their assistance with MIPS reporting has been a real plus. It feels like they are part of my team."

      Dr. Omar Al-Farouq, MD

      "Our practice needed someone who really understood billing and coding. NexCure LLC improved our collections and made the whole process less stressful. They’re straightforward, easy to reach, and they actually deliver on what they promise. I recommend them without hesitation."

      Dr. Alejandro Ramirez, DO
      12+

      Years of Expertise in Medical Billing & Revenue Cycle Management

      85+

      Providers Across Multiple Specialties Trust NexCure LLC Consultancy

      97%

      Clean Claims Rate Achieved on First Submission of Project Delivery

      15K+

      Claims Accurately Processed Every Month

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      (929) 587-3833

      Email address:

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      1500 N Grant ST #5001, DENVER, CO, 80203

      United States

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