Pediatric practices are busier than ever. Between rising patient volumes, staffing challenges, and increasing administrative complexity, it’s easy for revenue optimization to fall to the bottom of the list. The good news? You don’t need a full operational overhaul to see meaningful financial improvements. Every small change helps!
If you’re a pediatrician, biller, or office manager, you know that a lot can happen in one week at your practice. Whether you implement these small wins in one day or seven, you can start seeing financial improvements right away.
1. Tighten Up Insurance Eligibility Checks
One of the simplest ways to reduce claim denials is ensuring eligibility is verified before the visit, rather than at check-in or after. Here are some quick wins to ensure eligibility issues become a thing of the past:
- Run eligibility checks 24 to 48 hours in advance
- Flag inactive or mismatched coverage early
- Train front desk staff to confirm details proactively
Eligibility-related denials are among the most preventable and the most time-consuming to fix. With these workflow processes and PCC EHR’s Automatic Real-Time and Nightly Eligibility Reports, you can save families and the front desk time and frustration. You can also check eligibility in the EHR without an appointment.
2. Standardize Front Desk Scripts
Your front desk team is your first (and often best) opportunity to collect patient balances. Whether it’s copays or patient collections, preparing your staff with standardized practice expectations and policies can facilitate communication and encourage swift account balance resolution.
Create simple, consistent scripts for:
- Collecting copays
- Addressing outstanding balances
- Explaining billing policies
Example scripts:
“Welcome back! Before we get started, I see there’s a balance on your account. It's a practice policy to settle copays at the time of the visit. How would you like to cover that balance today?”
“That’s a great question. If you have time today, our office manager will be able to discuss our billing policies with you in more detail in a private area.”
“How nice to see you! In your forms today to complete, you’ll find our annual billing policy notice. Please let us know if you have any questions.”
Why it matters:
Consistency creates safety for front desk staff and families during what can be a frustrating conversation. That safety helps smooth communications, which can increase collection rates without adding friction to the patient experience.
Did you know? PCC offers Patient Pre-Check-In to make the check-in process even smoother and easier. Caregivers can update demographics, upload photos of their insurance cards, and pay balances, right from the Patient Portal! Check out this PCC Learn article to learn more.
3. Audit Your Top 10 Denial Codes
You don’t need a full denial management overhaul to make progress. Start small to reduce claim denials, address the gaps in your workflow, and find opportunities to get claims paid.
To get started with reducing claim denials:
- Pull a report of your top 10 denial reasons
- Identify patterns (coding errors, eligibility, timely filing, etc.)
- Address the root cause of the top issues
A small number of denial types often account for the majority of lost revenue. By identifying a common problem, you’ve identified an easy win to help your biller or billing service submit clean claims and untangle revenue caught in the claims cycle.
4. Proactively Manage No-Show Rates
Missed appointments can mean missed revenue for practices, so it’s important to be aware of your no-show rates to keep your schedule full and your revenue moving along as expected. When you keep track of missed appointment reasons, you can help your practice meet gaps in access like patient transportation or caregiver work schedules, and also identify opportunities to close them, such as evening office hours.
How to get ahead of no-shows:
- Implement automated text or email reminders
- Build convenience for caregivers using online tools such as the Patient Portal, Patient Portal Self-Scheduling, and Pre-Check-In
- Maintain a waitlist to fill last-minute cancellations
- Evaluate your provider schedule utilization rate
Reducing no-shows by even a small percentage can improve annual revenue. Even better, no-shows become opportunities for increasing your patient volume without causing undue stress for you or your staff.
5. Revisit Your Coding
Pediatric coding guidelines are updated annually, but there are consistent things you should be watching for to ensure you maintain compliance and maximize your revenue. Here are some coding practices pediatricians often miss:
- Vaccine admin codes: A tip from PCC’s Chip Hart: compare the number of commercial vaccines you administered to the number of commercial primary admin codes (90460, 90471–90474) you billed. They should match.
- After-hours codes. Visits after hours should be billed using 99051.
- E&M Coding Guidelines: Because E&M coding guidelines were updated in 2021 during the COVID-19 pandemic, many practices got behind on updates to time-based coding. Time spent before and after the visit counts and should be coded (and billed) for.
6. Trim Accounts Receivable (A/R) Aging
Healthy Accounts Receivable (A/R) is essential for consistent cash flow, and a growing percentage of old A/R can signal systemic billing or payer issues. While you can and should be keeping an eye on your overall A/R health consistently, here are some quick ways to trim A/R aging this week:
- Organize your A/R encounters by status in order to filter by things such as “waiting on payor” or “under review”
- Assign tasks to specific billers to keep everyone on track
- Leverage EHR tools such as Real Time Claim Status to improve claim tracking
Reducing older A/R improves cash flow and gives you visibility into which payers or systemic issues are causing delays.
7. Maximize Billing for Ancillary Services and Screenings
Capturing codes for non-visit services converts services you are already offering your patients into reimbursable revenue. From fluoride varnishes to ear piercings, consider which services you’re offering that you should be billing for.
Quick wins:
- Confirm your EHR templates include CPT codes for all required and optional developmental screenings (e.g., M-CHAT, PHQ-9)
- Bill for qualifying chronic care management (CCM) or complex care coordination services
- Implement a workflow to ensure you are capturing and billing for time-based counseling codes
By capturing and billing for these services, you convert the high-quality care you are already providing into realized revenue.
Frequently Asked Questions
What is the fastest way to improve revenue in a pediatric practice?
The fastest way is to reduce preventable claim denials, especially by improving insurance eligibility verification and front desk workflows. Denials are obstacles to revenue you have already earned.
How can pediatric offices reduce claim denials?
Focus on eligibility checks, accurate coding, and analyzing top denial reasons to fix root causes instead of reworking claims repeatedly.
What are easy revenue cycle improvements for busy practices?
Low-effort improvements include standardized front desk collections, and enabling digital patient payments.
How can front desk staff improve collections?
By using consistent scripts, collecting at the time of service, and clearly communicating patient financial responsibility.
Small Wins, Big Payoffs: Final Thoughts
You don’t need a massive transformation to improve your practice’s financial health. In fact, the most effective changes are often the simplest.
Start with one or two of these “easy wins” this week. Once they’re in place, build from there. Over time, you’ll see your revenue gaps closing, reduced friction in common workflows, and potentially a less-stressed staff. Big wins!
In pediatric practices, small operational wins compound quickly for your team, your patients, and your bottom line.
Looking for more ways to simplify your billing workflows and reduce administrative burden? PCC helps pediatric practices streamline operations, improve collections, and spend less time chasing revenue, so you can focus on patient care.
Explore more insights at PCC.com/blog or connect with our team to learn how we can support your practice. Ready to find out more about where your revenue could be getting off-track? Check out Chip Hart’s presentation, Where Am I Losing Money?, for more revenue wins.
