As a pediatrician, you have felt the financial pressures of rising overhead, payer inconsistencies, staffing challenges, and an ever-shifting patient schedule. Many practices assume they’re simply stuck with these realities, but PCC’s Chip Hart wants you to know: most practices are leaving money on the table — often in the same predictable places.
In our latest webinar, Where Am I Losing Money?, Chip walks through the four biggest categories where pediatric groups unknowingly lose revenue every day. Whether you’re a practice owner, office manager, or biller, this session is full of “wait… we should be doing that?” moments.
With Chip’s characteristic humor, knowledge, and enthusiasm, you’ll walk away with at least one tip (and most likely more!) to help improve your practice’s bottom line. Here are some key takeaways to get you started.
The Work You Do: Clinical Decision-Making
Chip begins with a reminder: your clinical decisions directly shape your revenue.
For example: Are your Bright Futures screenings complete and consistent? Chip shares a rapid-fire diagnostic trick: Pull your teen well visit count (99394) and compare it to your depression screening count (96127). As a rule, you should have at least as many 96127s as 99394s. If not, your team is either not doing the screenings, doing them but not documenting them, documenting but not billing them, or losing the charge another way.
Whatever the cause, the result is the same — lost money and perhaps even lost clinical opportunity.
Patient Recall Requires a System
Chip calls it the most important piece of advice he’s given in 35 years: “Have a fully developed patient recall system.” A system is more than a list or an occasional email reminder – it’s a plan to regularly recall patients in ways that are convenient to them – whether by text, phone calls, email, or a combination.
Even among high-performing PCC clients, one-quarter to one-third of teenagers are overdue for well visits, leaving a care gap and a financial missed opportunity. Chip shares real-world recall strategies (including which communication methods actually work) and emphasizes a simple truth: an empty schedule is the enemy.
Coding: The Big-Ticket Items You Can’t Ignore
Next, Chip highlights the areas where practices lose real money – remember, it’s all in how you code (correctly!). Here’s his advice:
Vaccine Admins
One quick check-up he recommends: compare the number of commercial vaccines you administered to the number of commercial primary admin codes (90460, 90471–90474) you billed. They should match.
Use the 99051 (After-Hours Code)
If you're open after typical business hours, you should be billing 99051. Most practices underuse it, leaving money unclaimed for hours they already staff and pay for.
E&M 2021 Changes: Still Underused
Due to the COVID-19 pandemic, many practices overlooked the importance of the 2021 E&M changes; however, there’s no time like the present. Many practices still aren’t billing according to updated time-based rules. Chip points out that time spent before and after the visit (including charting) counts. If you’re doing “pajama time,” you’re likely missing legitimate revenue opportunities.
A Quick Word About G2211
In short: bill it. G2211 is a code meant to acknowledge the intensity and time pediatricians use to support long-lasting relationships with patients.
Collections: It’s Not All AR Days
Chip flips a common assumption on its head: AR days aren’t the main indicator of billing performance. A fuller picture is needed to examine your billing performance.
Instead, he urges practices to track:
- Net Collection Rate. If you're under 98–99%, “your house is on fire,” he says. Many practices don’t realize they’re at 94% or even lower simply due to poor fee schedules or missed adjustments.
- Over-60-Day AR. More than any other billing metric, Chip looks at the amount sitting in the 60–90 day bucket. That’s where timely filing limits live (and languish). It’s also where problems show up first.
- Automation is Non-negotiable. If your team is still manually posting insurance payments, Chip is blunt: it’s time to automate. Anything that can be automated should be, if you want to maintain financial stability.
You Are What You Pay For: Compensation and Vaccines
This is the area where Chip says practices lose the most money — and often don’t even know it.
Compensation Models
If your overhead is 65% and you need at least a 10% margin, only 25% remains to pay clinicians. Many practices unknowingly pay employed clinicians (or even partners) 30–40% — mathematically guaranteeing financial trouble.
Chip calls this one of the biggest contributors to unexpected cash crises.
Your Vaccine Purchasing Strategy
Chip is unequivocal: “Every practice should belong to a GPO.” A group purchasing organization helps you save money on one of your highest costs: vaccines.
The difference between a practice in a buying group and one purchasing solo can be $10,000+ per physician per year, and that’s before rebate programs.
He also urges practices to evaluate newer “vaccine delivery” companies carefully. While they may solve inventory problems, many practices regret the switch financially.
Final Thoughts: You’re Not In This Alone
Chip closes the webinar with the hope that every attendee finds at least one tip that meaningfully improves their financial picture. He also encourages private practices to join the AAP’s SOAPM – a $35 fee per year brings you a community of practices similar to yours facing the same questions and challenges. Chip and PCC are proud to be a part of the community, too.
Watch the full webinar Where Am I Losing Money? to see the real examples, benchmarks, and quick tests you can run in your own practice.
