Case Study: Reducing Pediatric Days in A/R From 45 to 34: What Made the Difference
A pediatric clinic in Massachusetts was struggling with delayed payments—especially for common services like well-child visits, immunizations, and developmental screenings. High claim denials and slow reimbursements were hurting cash flow.
After partnering with MBW RCM, a leader in pediatric billing services, the practice reduced its days in A/R by 24%, improved collections, and simplified its revenue cycle management—all in just six months.
Client Overview
Location: Massachusetts, USA
Specialty: Pediatric Medical Billing Services
Monthly Patient Volume: 400+
Revenue Cycle Volume: $350,000
Previous Collections: $260,000
Average Days in A/R (Before): 45
Despite strong patient volume, inefficient pediatric billing workflows and inconsistent claim follow-ups were slowing down payments.
Challenges in Pediatric Revenue Cycle Management
Claim Denials for Pediatric Services
Frequent rejections for child wellness visits, vaccine billing, and screening services due to coding or documentation errors.
Complicated Insurance Rules
Varying payer guidelines led to errors in submission—especially with Medicaid and commercial plans.
Authorization and Referral Issues
Manual tracking caused delays in getting required approvals for certain pediatric procedures.
Pediatric Medical Coding Errors
Mistakes in CPT and ICD-10 codes for routine care created unnecessary resubmissions and lost revenue.
Delayed Claim Follow-Up
Without a structured A/R strategy, overdue claims were often left unresolved for too long.
Our Pediatric Billing Strategy
We performed a comprehensive audit of their pediatric revenue cycle and implemented improvements designed for the specific needs of pediatric practices:
| Problem | What We Did |
|---|---|
| Incorrect Coding | Our certified coders reviewed and corrected CPT/ICD-10 codes based on clinical documentation and payer rules. This drastically cut errors. |
| Frequent Denials | We introduced real-time claim validation tools and held focused training sessions with staff to improve submission accuracy. |
| Authorization Delays | A live tracker and instant insurance eligibility checks were implemented, reducing approval delays before procedures. |
| Late Payments & Underpayments | We began following up on unpaid claims starting Day 15 and introduced escalation workflows to resolve payer issues faster. |
| Patient Billing Issues | Rolled out an automated portal with flexible payment plans, making it easier for patients to pay and for staff to track balances. |
Results After 6 Months
Reduced pediatric days in A/R from 45 to 34
Monthly collections increased by 18%
Claim denials dropped by 30%
Reimbursement turnaround improved by 11 days
Saved over 15 administrative hours per week
By optimizing its pediatric billing operations, the clinic now benefits from accelerated reimbursements, reduced error rates, and enhanced overall financial performance.
Conclusion
Pediatric practices often face unique billing challenges that require more than just general RCM support. From accurate pediatric coding to payer-specific claim submission and timely follow-up, MBW RCM delivers customized solutions that work.
This Massachusetts clinic is now operating more efficiently, collecting faster, and spending less time on paperwork—thanks to our dedicated approach to pediatric medical billing.
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