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Case study · Pediatrics
$216K more in annualized collections for a 4 provider pediatric practice
Denials were running at 18% and $180K sat in A/R past 90 days. Patients were paying only 70% of what they owed. Ninety days after WeBill Health took over the revenue cycle, every one of those numbers had moved.
The practice
Care was delivered. Payment was not keeping up.
The practice saw children on a mix of commercial plans, Medicaid and CHIP. The money broke down between the front desk, the coding and the payers, and nobody had time to trace where.
| Specialty | Pediatrics |
|---|---|
| Providers | 4 |
| Annual collections | $1.2M, about $100K a month |
| Payer mix | Commercial, Medicaid and CHIP |
What we found in the audit
18% of claims denied
Too many claims came back unpaid, with the same denials repeating month after month.
$180K stuck past 90 days
Earned money was sitting in aging A/R with no one working it by payer or by filing deadline.
89% clean claim rate
Too many claims needed rework before a payer would even process them.
70% of patient balances collected
Copays and balances were left behind at checkout and never recovered.
What WeBill Health changed
Seven fixes before the visit, in the coding and after submission
Every claim received human pre submission review by pediatric coding experts, checked against our payer rule libraries for each carrier this practice bills.
Stop denials at the front desk
- Medicaid and CHIP eligibility verified before every appointment, since coverage for children changes often
- A patient balance workflow so copays and prior balances are collected at checkout
Code the pediatric visit correctly
- Preventive and sick visits billed correctly when both happen on the same day
- Vaccine product codes paired with the right administration codes, including 90460 and 90461 when a physician counsels the family
- A coding and documentation audit so each code matched the chart
Recover what was already earned
- Aging A/R worked in priority order by payer and by age
- Every denial appealed and defended with the payer until paid
90 day results
Before and after WeBill Health
Denial rate
Lower is betterClean claim rate
Higher is betterA/R over 90 days
Lower is betterPatient balances collected
Higher is betterMonthly collections
Higher is betterEvery bar starts at zero. Figures come from the practice's own billing reports, comparing the baseline month with month three.
Where the $216K comes from
An extra $18K collected every month
Monthly collections rose from $100K to $118K by day 90. Held for a full year, that is $216K the practice collects on care it was already delivering.
The gain came from specialty specific coding and fewer days in A/R. Fewer claims were denied, and balances that had aged past 90 days were finally collected.
Net return is the annualized increase in collections, minus the annual WeBill Health fee, divided by that fee. It is calculated before any savings from the practice's previous billing arrangement.
What other pediatric practices can take from this
Three pediatric billing gaps worth checking this week
Recheck Medicaid and CHIP eligibility at every visit
Children move between Medicaid, CHIP and commercial plans more often than adults. A card that was valid last month can produce a denial today.
Bill the well visit and the sick visit separately
When a child comes in for a checkup and a new problem is treated, both services can be billed if the documentation supports each one.
Pair every vaccine with its administration code
Each vaccine needs a product code and an administration code, and the right administration code depends on whether the physician counseled the family.
Your practice next
Find out what your pediatric practice is leaving uncollected
The Revenue Health Audit reviews your denials, aging A/R and patient collections the same way we did here. You get a written report that ranks the fixes by dollars at stake. We reply within one business day.
Questions
About this case study
How fast did the results appear?
Every figure on this page was measured at day 90, comparing the practice's baseline month with its third month on WeBill Health.
Why is the practice not named?
We protect our clients' privacy. The figures come from the practice's own billing reports.
What drove the biggest change?
The denial rate. Cutting denials from 18% to 5.6% meant far more claims were paid the first time, which lifted monthly collections and stopped new balances from piling up in aging A/R.
Does WeBill Health work with other pediatric practices?
Yes. Pediatrics sits in our Office Visit and Consultation billing group. Every account is handled by coding experts who work pediatric claims every day.