Pediatric Billing Case Study: Fewer Rejections, Faster Payment
Improving claim acceptance and revenue cycle performance for a pediatric practice over eight months.
In this pediatric billing case study, a pediatric practice working with Express MBS over eight months cut eligibility-related rejections from 8.6% to 2.7%, raised first-pass claim acceptance from 89.2% to 97.1%, reduced days in A/R from 51 to 32 and grew average monthly collections from $82,000 to $103,000.
Practice Profile
- Specialty: Pediatrics
- Engagement period: 8 months
- Focus: Eligibility verification, claim acceptance, A/R management and collections
The Challenge
The pediatric practice faced recurring insurance eligibility issues, claim rejections and delayed reimbursements.
Inconsistent verification and follow-up made it harder to keep claims clean, control aging receivables and collect payments efficiently.
The Express MBS Solution
A structured revenue recovery and claims management process.
Verify eligibility before visits
Check insurance eligibility and coverage before appointments.
Check claims before submission
Run pre-submission checks to catch missing or inaccurate information.
Track and fix rejections
Track rejections and correct the recurring billing errors behind them.
Follow up on unpaid and denied claims
Follow up in a timely way on unpaid and denied claims.
Prioritize A/R over 90 days
Work the oldest balances first, before they become uncollectible.
Review performance monthly
Hold monthly reviews to spot collection and claim-processing trends.
Results
Measured over eight months.
| Performance metric | Before | After |
|---|---|---|
| Eligibility-related rejection rate | 8.6% | 2.7% |
| First-pass claim acceptance rate | 89.2% | 97.1% |
| Average days in accounts receivable | 51 days | 32 days |
| Accounts receivable over 90 days | $38,500 | $16,200 |
| Average monthly collections | $82,000 | $103,000 |
What these results mean
- Eligibility-related rejections: decreased by 5.9 percentage points.
- First-pass claim acceptance: improved by 7.9 percentage points.
- Days in A/R: decreased by 19 days.
- A/R over 90 days: decreased by $22,300, about 57.9%.
- Monthly collections: increased by $21,000, about 25.6%.
Results are the figures reported for this practice over eight months. Collections also depend on patient volume, payer mix and the starting point, so results differ from practice to practice.
The Takeaway
A consistent approach to eligibility verification, claim review, denial resolution and aged A/R follow-up can strengthen revenue cycle operations for pediatric practices.
Frequently Asked Questions
Helpful Resources
Official sources for the rules we follow when we bill.
- CMS.gov: Medicare coverage, billing and payment rules.
- Florida Agency for Health Care Administration: Florida Medicaid information.
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