business of pediatrics

Family Care for Pediatricians: Billing, Siblings, & More

It happens to every pediatrician, usually often -- you have just completed a visit for a child when a parent asks if you can please address a concern regarding their already-present sibling. For these and many other sibling-related circumstances, pediatricians are in a unique position relative to physicians who treat adults. Here, we cover the practices and tools your practice should be using to make sure your practice runs smoothly for families of any number.

Billing for Siblings: from Surprise Visits to Multi-household Families

Whether your practice is firm in requiring an appointment for every patient or you’ve been known to see more than one sibling in a single appointment slot when asked, billing for siblings can get complex. Here are some situations your practice might be familiar with:

Services for a Sibling During an Appointment

Sometimes, a parent may come in with one child for an illness or well visit and ask the provider for a look at a sibling (or two) as well. Some tips for covering these surprise visits include preparation for coding and billing, administrative, and operational tasks.

First, always bill for services rendered -- surprise visits are still important sections of a physician’s working hours and revenue, especially when you consider time lost in the day’s scheduled appointments. You should bill for the visit based on time or complexity, depending on observations and treatment offered.

Simple admin tasks can help to prevent or at least anticipate surprise visits. Administrative and front desk staff can inquire about siblings during the call to schedule the initial appointment, for example: “We’ll see Alex at 2pm today for a sore throat. Does his sister Amy have any symptoms you’d like the doctor to check?” Alternatively, parents can elect to provide this information if your office provides online scheduling.

Your office can also elect to customize procedures for surprise visits, making them an expected part of your daily operations. For example, you may accept surprise visits only if the sibling is sick, you may choose to charge an additional fee, or you may choose not to accept surprise visits at all, requiring all patients to schedule an appointment. The best choice is one that works for your schedule and for your patients, but in any case, be sure to communicate clearly and consistently so that families know what to expect.

Billing for Multi-household Families

From step-siblings, half-siblings, to de facto brothers and sisters, family billing makes sense for a pediatrician’s office. Billing for families is easier when your EHR is pediatric-specific. In PCC EHR, you can view a patients’ siblings from their chart. You can also change demographic information so that it’s always clear who to bill, even if kids and parents live in different households, or the custodian of a child isn’t the guarantor of the account. Learn more about how you can bill for families with this video from PCC Learn.

Clinical Care for Siblings

Another perspective on clinical care unique to pediatricians is that you care for families as well as individuals. While much of your guidance may be directed at parents or patients, in many cases, the care of a sibling is as important as care of the patient themselves.

New siblings are a cause for celebration in most families, but for children set to become older siblings for the first time, it’s also a time of transition. Your practice can offer valuable advice on age-appropriate language and making sure an older sibling has quality time with parents, so that they understand they’re still safe and cared for with the addition of a new family member. 

Your practice may opt to connect families with parent groups, or host groups or classes at the practice online or in person. There are lots of supportive resources available on Healthychildren.org from the American Academy of Pediatrics, from managing older siblings while breastfeeding to sibling rivalry

If a child becomes ill, has a disability, or requires long-term complex care, their sibling will need extra support as well, both to understand the needs of their brother or sister and to emotionally cope with the shifts in parents’ time and attention. This 2017 report in Pediatrics explores the effects of children’s chronic illness on their siblings -- findings include shifts in relationships at home, new roles or responsibilities for the sibling, and alternative ways for comfort and coping. This often involves social and emotional support, as well as learning skills to help in the emotional and practical support of the entire family.

Your practice can play an important role in supporting siblings by helping them understand their sibling’s illness or condition, asking direct questions about their feelings and thoughts, and providing resources where needed. For example, siblings may benefit from additional childcare while parents are caring for an ill child. Behavioral healthcare, including therapy and social groups can help children understand their feelings and build a support system. Finally, skill-building activities of interest to the healthy child can help them feel empowered at home -- for instance, they may know the location of their sibling’s medications, help a parent with chores, or have a special role in accompanying their sibling to appointments or activities.

Making Room for More: Scheduling Families

How does your practice schedule for siblings? Whether you simply stack visits for siblings in 5 to 15 minute blocks for well visits or you’re more likely to see one sibling this week and the other the next, scheduling for families can be complicated, but it should be a top priority at your practice to save time for parents and for your staff.

Using PCC EHR, you can schedule for multiple appointments with additional siblings prompted automatically when you open the Schedule Multiple Appointments window. This makes it much easier to schedule siblings for one visit.

The advantages of scheduling for the whole family at once are many. 

  • Scheduling for a set of siblings allows mom or dad to make a single trip out of the house and minimize lost school or work time, leading to happier customer satisfaction
  • Kids may find immunizations or examinations easier if their sibling got through theirs, making clinical work smoother
  • Seeing a set of siblings is an efficient use of clinical time
  • Seeing sets of siblings can prevent return visits for multiple sick children, and with the right preparation, can also keep the whole family up to date on preventative care and immunization schedules

When you work in pediatrics, you’re an expert in the care of whole families. Taking a new perspective on sibling care can help your practice grow in the clinical and operational ways to help every member of your patients’ family thrive. Whether your families are nervous new parents of one infant or old parenting pros with a big family, to give them the latest that your practice offers, from family scheduling to your new flu clinic, you’ll need to be able to communicate effectively. Learn how to get your practice’s services and values to the parents who need to see them most with our practical ebook: Marketing Your Pediatric Practice in the Digital Age.

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Allie Squires

Allie Squires is PCC's Marketing Content Writer and a transplant from upstate New York. She holds a master's in Professional Writing from NYU.