5 Red Flags in Your Pediatric Medical Billing to Look Out For

Running a pediatrics practice comes with special requirements for medical billing. When you don’t have access to an experienced team, things in your practice can start to get messy. If the following signs ring any bells for you, consider working with a team of experts in pediatric medical billing as soon as possible. 

1. Slow Billing and Payment Process


Reduced reimbursements when seeing more patients can be a major red flag in your medical billing process. This could signal an increase in claims being denied. Taking follow-up action on your submitted claims is important (but we understand this can be time-consuming especially when having access to limited staff) for making the process move along and minimizes stalling.  

You may also notice increased efforts towards collections. Receiving payment from patients or the responsible party can sometimes be a difficult task when not taken care of early on. The longer time passes, the more difficult it can be to receive payments.

2. Amount of Billing Errors Could Be Improved 

Have you ever had a patient’s legal guardian reach out to dispute charges on a medical bill or caught a charge that just doesn’t look accurate? If this sounds familiar, we get how much of a nuisance this could be to take the necessary steps to adjust.  

When you work with a pediatrics billing services company like Benchmark Solutions, we make sure to go through all medical coding with a fine-tooth comb to assist in minimizing the chances of billing errors. Assigning the correct ICD-10 and CPT codes the first time around can save you time, resources, and an overall frustrating situation. 

3. Burden on Administrative Staff

Tasks related to billing and collections can quickly pile up. Duties such as keeping a child-friendly environment and intaking patients along with their families can be stressful at times when there is so much to do at once. Unfortunately, pediatric administrative staff can become overwhelmed with these types of tasks which can limit the amount of time they have for face-to-face patient care and practice management.  

Burnout for medical staff has been an increasing problem and working as administrative staff in a pediatric office is no exception. When your staff lacks experience or the proper training for insurance, benefits, billing and so on, this can contribute to an ongoing pressure to continuously perform at an unrealistic level while juggling an abundance of tasks. When prioritizing reducing the burden on administrative staff, they can get valuable time back to focus on their patients and their own well-being. 


Some clients like that option to be able to take that burden off of their administrative staff.


Angie Martin

RCM Manager

4. Lack of Pediatric Billing Expertise

Pediatric billing staff may need to communicate information with their patients, their families, co-workers, and insurance companies. Coordinating between multiple parties accurately could become a complex process to keep track of. Understanding pediatric medical billing is important for explaining and using insurance coverage, co-pays, deductibles, and out-of-pocket costs.  

Pediatric services offer a diverse range of medical coding related to children’s health issues, including immunizations, developmental and behavioral assessments, and preventative/wellness visits.  

5. Limited Financial Transparency and Reporting 

The inability to access real time financial data and performance metrics can hinder the growth of a pediatric practice. If you are unable to see how your practice is currently doing from a financial and performance standpoint, it is difficult to make important decisions that could have a lasting impact. Real time reports such as days in A/R, claims submitted vs claims received, etc. are needed to continue supporting your mission. Not understanding where your funds are being spent could cause inefficient resource allocation in the long run. 

By prioritizing financial transparency and reporting, pediatric practices can better position themselves for long-term growth. Keeping tabs on your pediatric medical billing health can ensure this success is easier to obtain. 

Benchmark Solutions Is The Top Choice for Solving Pediatrics Medical Billing Issues

If any of the above signs sound familiar to what you are experiencing at your own practice, it is time to work with a dedicated pediatric medical billing company. Outsourcing your revenue cycle management team can be just what your practice needs to reach its full potential. Our billing software and team of experts are here to make your life easier in these kinds of situations. You’ll be asking yourself why you didn’t go through with this sooner. 

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