As a pediatrician, you offer comprehensive care and continuity for families. You see them through nervous moments as parents of a newborn, routine school check-ups, developmental milestones, the full slate of coughs, colds, ear infections, vaccination schedules, and more. It’s time to make sure the full breadth of the services you render are properly compensated.
The goal is to make sure you’re bringing in the revenue you deserve to support your practice, says PCC Pediatric Solutions Consultant Jan Blanchard, CPC, CPEDC, CPMA. It’s also important to lay the groundwork for a proper valuation of your time and your staff’s time.
“Your patient can only value your time and expertise as much as you do,” she says. “You’ve got to lead the charge in that respect.”
Here are seven pediatric services that you should be routinely billing for or offering in your practice. If you need convincing, each tip includes the revenue your practice stands to bring in for each service. The dollar figure is based on the volume that could be expected for a four day per week practice for a single, full-time equivalent pediatrician seeing 25 patients per day 50 weeks per year.
#1. Consider adding fluoride varnish application to your practice
The U.S. Preventive Services Task Force recommends that children have fluoride varnish applied every three to six months from the time teeth erupt through age 5. The American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care also supports fluoride varnish for kids’ teeth.
“It’s a good preventive service that pays well,” says Blanchard.
She recommends joining the AAP’s Section on Administration and Practice Management (SOAP-M), if you’re not already a member, for information about how and where to purchase supplies, and for resources to train staff. Bottom line: fluoride varnish application is a cost-effective service that helps kids thrive. The average reimbursement across payers is just under $20 per application. The average cost per dose comes in at under $5.
Why do pediatricians hesitate to add this service? Not all of their carriers cover it. But, she argues, if you get permission from parents and explain the potential to prevent dental issues in the future, they may be willing to pay for it even if it’s out of pocket, especially if they lack dental insurance.
#2. Hearing and Vision Screenings
You’re already doing these screenings for your patients, but are you maximizing your billings for them? Not only are you following best practices as a pediatrician – keeping kids healthy and preventing health problems as they grow up – you have the opportunity to capture revenue to grow your practice. Blanchard recommends reinvesting the dollars that come in when you bill for these standard preventive screens to develop programs and services for the kids who have positive results.
“What you’re trying to do is turn that back around and improve patient satisfaction and outcomes,” she says. “Hopefully that is another compelling reason to make sure that you catch this stuff and make sure that you bill it properly.”
Again, a common refrain for not billing for these services is that carriers may not cover the screenings, which results in families picking up the costs. The key is education, says Blanchard. Talk to your families about what the guidelines recommend and why – many are likely to want to support your practice and the work you’re doing to keep their kids healthy.
If you’re consistently billing for all of the hearing and vision screenings that you’re doing, you’ll have a compelling rationale to appeal denials and capture write-offs.
#3. Developmental and Behavior Screenings
When you score and interpret questionnaires related to a child’s developmental or behavioral milestones, make sure you bill for that service. Every person for whom you score and interpret a questionnaire– be it a parent, teacher, school nurse, grandparent, or other caregiver – should be billed as one unit.
“Every one of those questionnaires from every one of those sources can be billed independently,” says Blanchard.
One important point: Make sure the questionnaires you use are peer-reviewed with a standard scoring system. For additional information, click here to download a PDF webinar's slide deck.
#4. After Hours
If you or members of your team are seeing patients on evenings, weekends, or holidays, you’re providing an invaluable service. It’s important that you’re adequately compensated for that time.
“This is one set of codes that has a really direct effect on a clinician’s quality of life and their work life balance,” says Blanchard.
You’re also doing the important work of keeping children out of the emergency room, providing them comprehensive care. This is important for insurance carriers as well as families. Although pediatricians often worry about pushback from families if they begin to bill for after-hours care, Blanchard says clear communication about the rationale for the change can go a long way.
“The best recommendation that I can make is to warn your patients,” she says. “Educate them and make them aware that you’re going to adopt a policy of billing for these services in the future.”
#5. Simple Treatments
Even though the conversations may be short, if you’re talking to a concerned parent about a relatively simple question or concern, you should bill for that work. Maybe a patient comes into the office with a sunburn or a nosebleed: You treat them, offer reassurance, and perhaps a few tips to help their child feel better.
“Give yourself the credit you deserve for the comprehensive care that you offer,” says Blanchard.
Families appreciate the access to a pediatrician and the quick advice. You also saved them a trip to the ER. Make sure you value your time and expertise as much as your patients do by seeking compensation for it.
#6. Foreign Body Removal
Sometimes it happens: A child gets something stuck up his or her nose. There’s a CPT code for removing the foreign body, and Blanchard recommends using it when the time comes. Same comes for several other procedures, including the removal of a foreign body from the eyeball; the removal of earwax, and treating an abscess. “This can be as simple as washing,” says Blanchard.
#7. Patient-Initiated Remote Care
Although Blanchard cautions that “a little bit of thought has to go into whether and how to bill these,” it is worth the time and effort to figure it out. The key is that an established patient has to initiate the service. For example, you talk to the parent of a patient who has been in multiple times over the years for less than ten minutes and are able to assess a new complaint and offer a treatment plan. If that plan does not result in them seeking in office services within 24 hours or your first available appointment, that phone-based treatment should be billed. It also applies to questions received over a patient portal. Patient-initiated remote care rendered by non-medical professionals can also be billed.
“Carriers are getting smart,” she says. “They’re getting wise to the fact that this is keeping kids out of emergency rooms.”
She suggests reviewing call and message records and billing one week out to ensure that there was no follow-up care rendered and the service matched the billing requirements.
Taken together, the above services represent $55,276.64 in revenue that could be reinvested in your practice to improve care for your patients. Think about the possibilities, including new or updated equipment, staff training, additional waiting room amenities, or any number of other possibilities. Claim that time you’re spending with your families and make it work for your practice.
This blog post was written using excerpts from Jan Blanchard’s webinar. Watch the full recording.