How does your practice deal with recurring denials or reductions in payment that are, for example, caused by incorrect coding edits used by payers or inappropriate interpretation of Current Procedural Terminology (CPT®) guidelines? Unfortunately, many practices do not appeal inappropriate denials because they are concerned that it will increase practice administrative costs. Many practices are reluctant to take the next, most important step of meeting with the payer to try to provide education and resolve the issue. Further, many never take the time to completely review and understand their payer contracts or take the opportunity to renegotiate their contracts.

It is essential for pediatricians to negotiate a good contract with each payer. Each practice should work hard to negotiate, monitor, and maintain the best possible contract to ensure that it consistently receives appropriate payments for all provided services.

The following suggestions are designed to assist pediatric practices in the education...

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