Pediatric billing services

Pediatric Billing and Coding

Medical billing for pediatrics must consider the fact that pediatricians often spend 25% more time with their patients than other specialist practices and frequently offer a range of complex and extensive services to them. In order to enable pediatric practices to better support their patients and focus on doing without worrying about maximizing revenue for the services they offer to patients, pediatric practices need competent and qualified pediatric coding and billing professionals. Pediatric billing has certain specific billing requirements that other billing specialties may not have. Say, for instance, the vaccine administered is failed to bill for resulting in a large miss of the revenues. We assure you that our billing experts will ensure that your vaccinations are billed properly.

We provide billing services for a wide range of pediatric sub-specialties:

  • Pediatric Oncology
  • Pediatric Neurology
  • Behavioral Psychology
  • Nutrition Services
  • Child Life Program
  • Pediatric Infectious Diseases
  • Pediatric Cardiology
  • Pediatric Diabetes
  • Pediatric Endocrinology
  • Pediatric Gastroenterology
  • Clinical Genetics
  • Pediatric Nephrology
  • Pediatric Pulmonology


Steps followed in Medical Billing Pediatric:

  1. The first step is to assess the documentation for correctness, compliance, insurance coverage, medical justification, and billable claims. Demographics and insurance eligibility verification along with prior authorization are undertaken to ensure clean claim submissions.
  2. Data entered is verified and the charts proceed for coding operations. Pediatric procedures have a wide range which makes them complex to account for. Our coding teams are certified and follow the guidelines of in-hospital/in-patient coding, DRG/ICD-10-CM, CPT/ ICD, HEDIS, and Audits.
  3. Coded charts are checked for misinformation and errors if any and are followed up by our teams with the patients and contacts to fill in any missing details. Charges are entered and billed as per the procedures and diagnoses administered to the patients.
  4. Claims are submitted to the payers and clients are updated about the same after the confirmation from the authorities is received.
  5. Rejections and Denials if any are closely monitored by our teams and are followed up.

Services we offer for Pediatric Billing and coding:

  1. Eligibility Verification and prior authorization: Verifying insurance eligibility is one of the first and most important tasks in the entire medical billing and coding process. Since patients frequently provide inaccurate or insufficient coverage information during their visits, insurance companies frequently delay or deny medical claims. Our teams stay updated with all the frequent changes in health plans and policies aiding you to avoid delays and denials of insurance claims.
  2. Coding Services: Correctly coded charts ensure clean claim submissions and quick reimbursements, and involve translating diagnoses, procedures, and supply information from patient records into universal medical codes. Our AAPC Certified coders ensure that ICD 10 and CPT guidelines are followed while coding operations. Qway delivers accurate & reliable medical coding services that enable your practice to accelerate payments and save overhead costs & valuable time.
  3. Quality checks and audits: Data entered is audited and checked by our Quality teams to eliminate any discrepancies and errors. Coded charts are cross-checked for any over or under-coding of the procedures and diagnosis performed.
  4. Denial Management services: Denial management is a critical component of the medical billing process that looks into each underpaid or unresolved claim, deals with claim rejection, and re-appeals for claim acceptance in accordance with the provider’s contract. We identify the primary reason why the claim was denied. Our team of professionals in medical billing thoroughly analyses your billing practices and administration while comprehending the main causes of ongoing insurance claim denials.
  5. AR follow-up and clean-up: Healthcare providers often face challenges like long receivable cycles, delays in revenue, and denied claims, that require AR follow-up services. QWay helps you in streamlining your accounts receivable follow-up processes and ramp up your revenues. By routinely checking on unpaid claims, our knowledgeable team may assist you in shortening the AR process time as we use cutting-edge, powerful tools to precisely investigate, amend, appeal, and re-file the claims.

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