Resources to help with the financial aspects of your pediatric practice, including information on coding, valuation, payer contracting and advocacy, and strategies aimed toward reducing expenses and facilitating compliance.

Coding and Valuation

Find resources on CPT, ICD and HCPCS coding for common pediatric issues. Including vaccine financing and code valuation (RBRVS).

Payer Contracting, Advocacy and Other Resources

Learn more about how the Academy is supporting efforts around public and private payer advocacy. This includes resources on payer contract negotiation and other payer advocacy resources.

 

Payment Models

Value-Based and Other Alternative Payment Models

Payers are moving away from fee-for-service (FFS) volume-driven health care services to value-based and other alternative payment models that incentivize providers on quality, outcomes, and cost containment. Learn more about these payment models here.

Accountable Care Organizations

​​​​Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers who come together to provide coordinated, high-quality care to their patients. Learn more about the ins and outs of ACOs.

 

Practice Tools and Tips

Improving Claims Processing Procedures

Being able to submit clean claims for timely and accurate payment is vital. However, it is not always simple and having tools to manage your claims processing and secondary insurance covered is important.

Coordination of Benefits

The following tips are designed to assist physicians/providers and their billing staff to reduce payment delays attributed to COB-related problems.

Responding to Payer Audits

Provides details on how to respond to a medical insurance carrier (payer) overpayment audit.

No Surprises Act

The No Surprises Act went into effect on January 1, 2022. Learn more about implementation of the No Surprises Act here.

 

Reducing Expenses and Waste

Group Purchasing Organizations (GPOs)

Information about GPOs which can help healthcare providers and practices realize savings and efficiencies by aggregating purchasing volume to negotiate discounts with manufacturers, distributors and other vendors.

Choosing Wisely

Review this Choosing Wisely resource with tips on 10 things physicians and patients should question.

Last Updated

02/14/2022

Source

American Academy of Pediatrics