Pediatric Council

WHAT IS THE PEDIATRIC COUNCIL?

The pediatric council is a group of volunteer physicians who meet to discuss pediatric issues with payers. The council aims to facilitate better working relationships between pediatricians and health insurance plans.  Unified under the common purpose to improve the quality of care for children, the Council argues the merit of improving coverage for pediatric services that have important value to overall health outcomes.

The pediatric council is not a forum for joint contract negotiation, individual contract discussion or other fee-related concerns.  The council's goal is to help pediatricians to smoothly and efficiently run their practices and improve adjudication of health plan claims.

HELP US ADVOCATE FOR YOU

Many wonder what they can you do when encountering a payer issue, an administrative problem, or a claims processing concern.  The simple answer is tell us.

The online Hassle Factor Form can be completed online to report these insurance issues and irregularities.  Both the chapter's pediatric council and National AAP will receive this information in our joint effort to identify trends and facilitate our advocacy with payers.

Without sharing your experience, we cannot help!  

NEW CODING CHANGES IN 2021

The largest overhaul to the office-based evaluation and management (E/M) services since 1997 will take place on January 1, 2021. The guiding principles for these changes are to:

1. Decrease documentation burden and note bloat
2. Make code level selection more intuitive
3. To decrease the need for audits, through the addition and expansion of key definitions
4. Retain current code distribution
5. Code level should be based on physician work in managing the patient’s problem(s) with focus on decision making, not simply on volume of tests/treatments