A Step-by-Step Guide to Auditing Pediatric Vaccine Administration Payments

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Vaccine administration is an important source of revenue for pediatric practices, but payment problems can easily go unnoticed when hundreds of vaccine claims are processed each month. Incorrect code selection, payer underpayments, missed administration charges, and claim denials can all reduce expected reimbursement. A regular audit can help pediatric groups identify these issues, recover missed revenue, and improve their billing process. Here is a step-by-step approach to auditing pediatric vaccine administration payments. Step 1: Review the Vaccine Administration Codes Start by reviewing the administration codes reported on vaccine claims. Pediatric practices commonly use codes such as 90460 and 90471 , but these codes have different reporting requirements. The billing team should verify that the administration code matches the service actually provided and that the documentation supports the code reported. For a detailed comparison, review Vaccine Admin Codes 90460 vs. 90471 in Ped...
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Value-Based Reimbursement in Behavioral Health

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Value-based care is also known as accountable care. A value-based care system is focused on getting value from quality services. Value-based healthcare is a payment system that rewards healthcare providers in accordance with the quality of care provided to their patients. Payments are based on better health for populations and other things, such as cost reduction, which can lead to a focus on preventative care. The benefit of value-based care is a patient in a value-based healthcare model will have fewer doctor’s visits, medical tests, and medical procedures. Additionally, they pay less on medication as their health gradually improves.
BlueCross BlueShield came into the value-based reimbursement arrangement with Value Network. The provider group has 100+ providers in behavioral health care in Western New York.
“This is another step we’re taking to build a behavioral health care model that’s designed to effectively treat the whole person,” said Dr. Thomas Schenk, Senior Vice President, Chief Medical Officer, BlueCross BlueShield of Western New York. “BlueCross BlueShield of Western New York is proud to partner with the region’s leading behavioral health care providers to introduce the first payment model designed to directly enhance quality care for our members with mental health and/or substance use disorder diagnoses.”
If you want to read the complete blog then click below: Value-Based Reimbursement in Behavioral Health
Location: United States

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