Over coding by pediatricians refers to a situation where the services provided to patients are coded or billed at a higher level than warranted based on the documentation and medical necessity. This can have several impacts on the pediatric practice: Compliance risks: Over coding or over billing can lead to compliance issues and potential legal…
DetailsUnder coding or under billing by pediatricians refers to a situation where the services provided to patients are not accurately coded or billed at the appropriate level, resulting in lower reimbursement than deserved. This can have several impacts on the pediatric practice: Financial implications: Under coding or under billing can lead to decreased revenue for…
DetailsOperating a pediatric practice involves more than just providing medical care to children. In today’s digital age, it also means managing sensitive patient data and protecting it from cyber threats. Unfortunately, the healthcare industry is a prime target for cybercriminals due to the valuable information it holds. In this article, we’ll discuss the highest cyber…
DetailsOverview: Managed care payers in the United States negotiate contracts with healthcare providers, such as pediatric practices, to set payment rates for services rendered to their members. These payment rates may be based on a fee schedule or a negotiated rate. One way that managed care payers may control costs is by “down coding” claims…
DetailsOverview: Pediatric phone triage protocols are structured interviews that help a nurse or other medical provider make a decision about whether a patient needs to be seen immediately. This decision is referred to as telephone triage, and it’s an important part of the patient phone call process. There are several approaches to pediatric phone triage…
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