“Pediatric specialty is a specialty of volume.” It’s estimated that every pediatric physician was visited by over 40 to 50 children during last year’s flu season. Since 2020 things have rapidly changed, the flu season is matching with the Covid pandemic, resulting in the number of incoming patients increasing almost two-fold.

One month into the pandemic Legion Healthcare Solutions (LHS) understood that pediatric physicians have now become one of the frontline answers to the pandemic. We introduced telemedicine technology with patients and building a video file for each such patient visit to keep track of a child’s health progress.

“Over the last year, I would say Pediatric physicians have gone through a rapid change in the way they function. Anyone coming with flu-like symptoms could be a potential covid patient, so we introduced tele-medicine technology to reduce the patient travel and visit rates. This also meant we had to change our billing and coding system to make the payers understand what we are billing for.” Billing Manager for Pediatric Billing.

“Keeping up with the myriad of problems and unannounced billing changes, physicians need to be up to date with billing requirements.”

– Certified Coder for Pediatric Billing at LHS

Keeping up With Standards

Defining the error is one of the primary challenges for pediatric physicians as the payers keep changing the regulations.The announced and unannounced changes in billing help legion define their pediatric billing standard. The standards in many cases even assist in defining where the billing errors occur. Standards help our Legion team of coders and billers define their target even if it's moving.

Coding Errors

Pediatric physicians in many cases are unaware that they can add Nursemaid’s Elbow into their claim. Legion team conducts a thorough audit of claims before they reach any clearinghouse, hence any such errors in billing the claim are sent back to be confirmed by physicians.

Rejected Bills

Pediatric claims are usually rejected rather than denied. There might be errors creeping up through the systems that result in rejection. Legion healthcare has a system in place for all the rejected claims and over the years we have observed most rejected claims have to be patient paid.

Pediatric physicians have to deal with a huge load of patient volume and it results in missing out on the billable procedures.

Rejected claims are due to two reasons: Billing errors and patients having no insurance cover.

Provider Credentialing

Credentialing is part of medical billing and coding. The volume of patients usually affects the pediatric physicians who submit the claims completely forgetting about their credentialing. Before beginning the pediatric clinic always convey with the major payers in the region, credentialing usually takes over 30 to 90 days.

24/7 certified billing and coding experts are available for pediatric physicians.

Technology support for EHR and telemedicine.

Analytical solution to identify regular claim errors and for denial management.

API and RPM-based tech solution to improve the customer experience for pediatric billing.