Managing pediatric medical billing services can be incredibly challenging, even for those who are experienced in the field of pediatric coding and billing. Some countless unique challenges and situations can be found in pediatrics medical billing, making it critical to have the highest degree of accuracy and completeness in your billing and coding, to avoid the potential of claim denial. 

We’re going to dig into pediatrics medical billing and some of the common challenges that are associated with the field. We’ll also cover some of the leading best practices to keep your revenue cycle as short as possible, as well as why outsourcing might just be the best decision you can make for your practice. 

Why are Pediatric Medical Billing Services Unique?

Pediatric practices face distinctive challenges when it comes to their medical billing and coding requirements, patient demographics, and even regulations. Pediatric medical billing services need to have a deep understanding of these complexities to ensure accurate and efficient medical billing and claim submission. This, in turn, maximizes revenue and streamlines the management of the entire practice.

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Best Practices for Managing Pediatric
Medical Billing Services

If you are running your coding and billing department with in-house resources, implementing these best practices can help your practice overcome some of the billing challenges frequently faced by local billing teams, and optimize your overall revenue cycle.

  1. Accurate Coding – Developing a thorough understanding of all ICD-10 and CPT codes that are relevant to pediatric care, and ensuring proper documentation to avoid denials or underpayment. Accurate coding is the biggest contributing factor to a short revenue cycle.
  2. Stay Current With Regulations – If your coding and billing team is internal, you’ll need to make sure you’re investing heavily in their training and regulatory compliance. Neglecting training and compliance is the fastest way to see your practice hit with substantial fines and penalties.
  3. Insurance Verification – Verifying insurance eligibility and coverage levels for each patient, before rendering services, is a cornerstone of preventing denied claims and ongoing payment delays.


Accurate and timely claim submissions that minimize denials
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Dedicated professionals that increase cash flow and reduce A/R 
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Consistent maintenance to confirm compliance 
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Why Outsource Pediatric Medical Billing Services?

There are countless benefits to outsourcing pediatric medical billing services, but many of them will be unique to each practice that implements outsourcing. That said, some more general benefits are seen in nearly every situation where a practice outsources its coding and billing, some of these are below.

Focus on Patient Care

One of the biggest drawbacks to keeping your coding and billing in-house is the massive amount of time that it takes to do the job correctly. Since many practices, particularly smaller ones, don’t have dedicated billing departments, this means other staff are being taken away from other duties to manage billing. By outsourcing your billing services, your staff can start to focus exclusively on what they do best, care for your patients. This boost in patient care often leads to measurable increases in referrals and revenue.


Outsourcing your medical billing means that you now have a dedicated team of coding and billing experts, with an in-depth understanding of the entire scope of pediatric medical billing, resulting in dramatically increased accuracy and efficiency. What’s more, if one of your account specialists doesn’t have the answer they need, they have countless resources at their disposal to ensure your claim is accepted and paid on time, every time.

Compliance Management

As a professional medical coding and billing service provider, AMS ensures that all of our billing specialists are kept abreast of all regulatory changes, and other legislative updates. This is far more important than many people realize, and it’s more than just making sure your billing staff is kept updated on simple code updates or changes. Without strict regulatory compliance and credentialing, your practice could face substantial fines and penalties from regulatory agencies. Outsourcing your coding and billing takes that worry out of the equation.

Cost Savings

The cost savings of outsourcing pediatrics medical billing can cause a dramatic reduction in the overhead costs commonly associated with running an in-house coding and billing department. This includes the cost to not only hire and train those specific employees but also their ongoing salaries, as well as the potential cost of benefits. Outsourcing your billing services may have an initial cost to switch, but going forward you will be able to record the cost as an expense, not payroll, which can help your practice to become far more profitable.

Enhanced Revenue Cycle Management

By partnering with a medical billing company that can provide specialized pediatrics medical billing, there is the potential to greatly streamline your revenue cycle process. This means your claims are being submitted and paid quicker and with fewer delays and denials due to claims. Over time, this leads to a greatly improved general payment cycle, faster reimbursements, and improved cash flow for the practice in general.


One of the biggest challenges to scalability is managing the growth and maintenance of a larger staff and requiring more billing staff as a natural result. However, by outsourcing your medical coding and billing, your practice is free to grow and take on as many patients as you can care for, without worrying about overworking your billing department. This instant scalability is one of the biggest benefits for small practices looking to grow over the next few years.


Common Challenges in Pediatrics Medical Billing

Just as other practices face challenges unique to their specialty, so too, do pediatric practices. Some of the issues that pediatric practices frequently grapple with, that can impact their overall medical billing practice include:

  • Complex Coding: Pediatric billing requires the use of ICD-10 and CPT codes that are specific to the pediatric age group. With a simply massive number of codes to track and manage, accurate coding and billing can be an incredibly daunting task.
  • Keeping Up With Regulations: Staying up-to-date with the constantly-changing healthcare regulations and legislation, including the Affordable Care Act (ACA) and HIPAA, can be a challenge even for those considerably well-versed in pediatrics medical billing.
  • Vaccine Administration: One of the many things that pediatric offices do in relatively high volumes, is administering vaccinations. Vaccinations all have their own unique coding and billing rules and requirements, and understanding those is crucial for reducing denied reimbursement claims.
  • Insurance Verification: There are wide-ranging insurance eligibility and coverage specifics for pediatric patients. Billing departments need to ensure accurate and efficient insurance verification to reduce denied claims and payment delays.
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Why Partnering With AMS Solutions Is The Right Choice

When you trust AMS Solutions to handle your pediatric medical billing services, you’re gaining several benefits you may not even realize. Not only do you get our proven track record of client satisfaction, but you’ll have the confidence and peace of mind of knowing that all of our billing specialists are certified and kept compliant with all coding and billing updates, changes, and regulatory issues. 

You also get to customize your services to an incredible degree, while also benefiting from some of the leading software in the industry, without having to invest in purchasing it. On top of all of that, you also get some of the industry’s best customer support and most knowledgeable account managers. Reach out to our medical billing company in Dallas today to learn more, or to get started making the switch to outsourced pediatric medical billing services.

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