# Pediatrics Case Study

> See how WeBill Health defended revenue for a pediatric practice by capturing vaccine administration units and separating well and sick visits.

Source: https://webillhealth.com/case-studies/pediatrics/  
Publisher: WeBill Health  
Last updated: October 27, 2026

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.

4 providers$1.2M annual collections beforeCommercial, Medicaid and CHIPResults measured at day 90

**+$18K**Monthly collections, from $100K to $118K

**5.6%**Denial rate, down from 18%

**$85K**Cleared from A/R over 90 days

**91%**Patient balances collected, up from 70%

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.

Before the visit

### 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

Coding

### 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

After submission

### 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 better

Before**18%

After**5.6%

### Clean claim rate

Higher is better

Before**89%

After**97%

### A/R over 90 days

Lower is better

Before**$180K

After**$95K

### Patient balances collected

Higher is better

Before**70%

After**91%

### Monthly collections

Higher is better

Before**$100K

After**$118K

Every 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.

Monthly collections before$100,000

Monthly collections at day 90$118,000

Increase per month$18,000

Annualized increase$216,000

Net return on the WeBill Health fee205%

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.

The math

## Where the $18,000 a month came from

Estimated breakdown, built from pediatric billing benchmarks and 2026 Medicare rates, tied to this practice’s measured before and after figures. Each line is a claim count multiplied by what those claims pay. A/R cleared from the old backlog is reported separately and is not part of this monthly gain.

| Change | Added a month |
|---|---|
| Denials stopped before they happenedAbout 833 claims a month at an average of $120 collected. Cutting the denial rate from 18% to 5.6% means 103 fewer denials a month. Before, about half of denials were never reworked, so 52 of those claims are now paid that were not. | $6,240 |
| Patient balances collectedPatients owe about $10,000 a month in copays, deductibles and coinsurance. Collection rose from 70% to 91%. | $2,100 |
| Vaccine components counted correctlyAdditional 90461 units on combination vaccines that were billed per vaccine instead of per component, 500 a month at about $9 each. | $4,500 |
| Underpaid claims recovered86 claims a month paid below the contracted rate, short by an average of $60, now appealed and recovered. | $5,160 |
| Added collections a month at day 90 | $18,000 |

Prior authorization moved to WeBill Health as well. The AMA 2025 survey puts that work at 13 hours a week per physician, or about 52 hours a week for 4 providers. At the national median wage for medical administrative staff ($45,930 a year, BLS May 2025) plus benefits, that workload is worth about $85,298 a year in staff time.

Codes and conditions

## The claims behind these numbers

| Visit type | Codes and rules | Typical conditions (ICD 10) |
|---|---|---|
| Well visit with vaccines | 99391 to 99395 plus 90460 for the first component and 90461 for each additional component | Routine child health exam Z00.129; immunization Z23 |
| Sick visit at a checkup | Problem E/M with modifier 25 and a separate problem diagnosis | Acute upper respiratory infection J06.9; otitis media H66.90 |
| Developmental and behavioral screening | 96110 and 96127 per instrument | Screening for global developmental delays Z13.42 |
| Vaccines for Children doses | Product line at $0 with the state Medicaid modifier, admin codes billed in full | Immunization Z23 |

What it costs

## The 5% fee against the cost of doing this in house

This practice’s WeBill Health rate is 5% of collections. At $118,000 a month that is $70,800 a year. Here is what the same work costs a 4 provider practice that staffs it in house, before software and clearinghouse fees.

| Item | Per year |
|---|---|
| In house billing staff1.5 billers for 4 providers (MGMA: about one per two to three providers) at $73,160 each, the BLS median of $51,140 plus benefits | $109,740 |
| Prior authorization staff time13 hours a week per physician (AMA 2025), 52 hours a week, at the BLS median for medical administrative staff plus benefits | $85,298 |
| In house cost | $195,038 |
| WeBill Health fee, 5% of collections | $70,800 |
| Saved against in house staffing | $124,238 |
| Added collections a year | $216,000 |
| Better off each year with WeBill Health | $340,238 |

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.

[Request a Revenue Defense Audit](https://webillhealth.com/audit)[See all specialties](https://webillhealth.com/specialties/)

Your practice next

## Find out what your pediatric practice is leaving uncollected

The Revenue Defense 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.

[Request a Revenue Defense Audit](https://webillhealth.com/audit)[Check my Revenue Defense Score](https://webillhealth.com/revenue-defense-score/)

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.

WeBill Health is a specialty focused revenue cycle management partner for independent practices. Request a Revenue Defense Audit at https://webillhealth.com/form/