rcm solutions Pediatrics facilities

Medical Billing And Revenue Cycle Management Solutions For Pediatric Facilities

Pediatric providers, primarily known as pediatricians, are medical doctors specializing in the care of infants, children, adolescents, and young adults. They require specialized revenue cycle management because of their unique patient population type, age-specific procedures for children, and vaccine schedules. At StafGo Health, we offer services keeping the unique needs of pediatric facilities in mind. From routine well-child visits and immunizations to chronic care management, our team is well-versed in applying pediatric-specific CPT codes and fulfilling insurance requirements. We also manage other functions like prior authorizations, payer credentialing, and patient billing. We can manage your billing cycle very efficiently and let you focus more on caring for young patients.

Key CPT Codes Management for Pediatric Practices with StafGo Health

At StafGo Health, we specialize in managing commonly used pediatric codes such as 99381–99385 and 99391–99395 for new and established patient well-child visits, which are foundational to pediatric care; immunization administration codes like 90460–90461; and vaccine product codes like 90633 (Hepatitis A), 90698 (DTaP-IPV-Hib), and 90744 (Hepatitis B); sick visits and E/M services, codes such as 99213–99215; and pediatric-specific services like developmental screenings (96110) and vision/hearing screenings (99173).

Why Outsource Medical Billing And RCM To Stafgo Health For Your Pediatric Practice?

Managing billing for a pediatric practice is not just submitting claims, but it also requires a deep understanding of age-specific CPT coding, vaccine schedules, and frequent changes that occur in insurance coverage for children. At StafGo Health, we have a team of fully trained people who know how to navigate challenges like vaccine bundling rules, Medicaid documentation, and coordination of benefits. By outsourcing your medical billing and RCM to StafGo Health, you will have the support of a dedicated team that ensures accurate coding, timely submission, and proactive denial management for both preventive and acute care visits.

Common RCM Challenges Faced by Pediatric Practices

Frequent and Time-Sensitive Visit Types - Pediatricians routinely handle so many types of visits, which are time-sensitive, such as well-child visits, immunizations, sick visits, and developmental screenings, in a day. Every type of visit has different billing rules, which increase the chances of errors and denials.
Vaccine Administration and Inventory Tracking - Billing for immunizations and managing vaccine stock, which requires accurate coding, is one of the constant tasks for pediatric practices.
Coordination of Benefits for Dependent Coverage - Coordination of Benefits for Dependent Coverage is also a very common problem in pediatric billing. Since children are covered in their guardians’ insurance plans, verification and coordination in dual policies is a time-consuming task that can lead to claim rejections or delays.
Denials from Missed Preventive Service Requirements- Many payers have certain rules regarding coverage for preventive services, like frequency limits and timelines. Failure to adhere to these rules can result in claim denials.
High Patient Volume with Lower Reimbursement - Pediatricians often face lower reimbursement rates and a larger volume of patients in a day. In the absence of an optimized RCM system, even small mistakes can lead to revenue loss.
Denied Well-Child Visits & Immunizations—Due to incorrect coding, missing modifiers (25, 59), or incorrect vaccine and administration codes, linking can lead to claim denials.

Solving Your Pediatrics Practices Challenges with StafGo Health

Accurate Pediatric Coding & Claims Management -Our team of certified coders has comprehensive knowledge of codes and modifier application, ensuring clean claims for well-child exams, sick visits, and developmental screenings. We can help you reduce claim denials by applying the correct codes and modifiers.

- Immunization & Vaccine Billing Expertise - Our team can manage billing for vaccines and administration codes and also help you to streamline your inventory reporting and charge capture to inhibit revenue loss.
- Efficient Eligibility Checks & COB Handling - Our team has experts who verify insurance eligibility in real-time for their patients and handle complex coordination of benefits (COB) between primary and secondary payers to avoid chances of claim rejections.

Preventive Care Compliance Monitoring - Our team monitors each and every payer's specific rules. This assures that we stay compliant and avoid claim denials caused by incorrectly timed or coded preventive services.

Optimized Medicaid & CHIP Expertise - Our team has deep experience with both Medicaid and commercial insurers. We help you with customized billing solutions to enhance your collections and reduce write-offs, hence claim denials.
Maximizing Billable Services—Our team helps you capture revenue from underused services like developmental screenings, chronic care management, prolonged visits, and behavioral health codes.