Resolution for 2008: Focus on contracts and vaccines

Why This Topic Matters

The piece helps readers evaluate whether their current billing, contracting, and vaccine purchasing processes are protecting practice revenue. It is especially relevant for pediatric practices facing payer denials, underpayment concerns, and the financial impact of vaccine-related costs.

Article Sections

1. Know your coding

   Discusses the importance of understanding coding patterns, documentation support, and how reported services connect to practice revenue. It also addresses claim support and denial management in pediatric office settings.

2. Cultivate payer contacts

   Covers the value of having designated payer contacts and communicating directly with plans when reimbursement problems arise. It also addresses clinician-to-physician communication with medical directors.

3. Negotiate with payers

   Focuses on contract discussions, reimbursement advocacy, and using practice data to evaluate payer arrangements. It also addresses the broader business impact of payment levels on pediatric practices.

4. Vaccines

   Reviews vaccine-related reimbursement and purchasing concerns, including contract considerations, product costs, and billing at the encounter level. It also discusses planning for new vaccines and payer communication about coverage and payment.

5. AAP vaccine pricing recommendations

   Summarizes pediatric practice pricing considerations presented in relation to American Academy of Pediatrics guidance. The section covers general cost categories and business factors involved in vaccine pricing.