Pediatric Coding Alert

When Linda Walsh, MAB, the new senior health policy analyst at the American Academy of Pediatrics (AAP) was practice manager at a six-pediatrician practice, she instituted a system that reaped financial rewards. My strong recommendation is to get a staff person to go through each and every EOB (explanation of benefits), she says. Once the person gets to know the fee schedules, it wont take long at all. It will just be a matter of going through the correct ones quickly. But there will be some that will definitely be too low.

Typically, when the reimbursements from plans are too low, pediatricians write them off. Our write-offs were going way up, Walsh recalls. So we made phone calls to the carriers, got good contact people and followed up the follow-ups. When more people start doing this, says Walsh, pediatricians will be taken more seriously. And its worth it. There are a lot of small things, but the money really adds up, she says. And remember, the healthcare plans are committing fraud if theyre not holding up their end of the contract.