If you run a pediatric practice, you already know the pressures aren’t slowing down. Staffing is harder to find, vaccine costs keep climbing, payer requirements keep multiplying, and margins keep shrinking. It’s tempting to think the answer is one big fix, a new EHR, a new biller, a new contract with a payer. But after years of working inside pediatric practices, we’ve found that’s rarely where the real money is.

Most practices don’t have one giant revenue problem. They have dozens of small leaks. Twenty dollars here, ninety dollars there, two hundred somewhere else. Multiply that across thousands of visits a year, and it adds up to real money walking out the door, quietly, month after month.

The good news is that fixing this doesn’t require you to become a professional biller. It just requires knowing what questions to ask, what numbers to watch, and when something doesn’t quite add up. That’s the idea behind our recent webinar, “The Pediatrician’s Playbook: 10 Revenue Leaks Costing Pediatric Practices Money,” and it’s the idea behind this post: a practical framework, and ten specific leaks worth checking for in your own practice.

The framework: Spot it, prove it, fix it

Every leak below follows the same three-step process. First, spot it: notice a pattern, a comment from staff, or a number that seems off. Second, prove it: pull the data and confirm whether the pattern is real and how big it is. Third, fix it: change the workflow, not just the individual instance. A single correction feels good, but a fixed workflow keeps the leak from coming back.

With that in mind, here are the ten leaks.

1. Doing the work, not billing for it

Capillary draws, vaccine counseling, prolonged care, G2211, and more routinely happen without ever making it onto the claim. One practice captured this work and saw an 18% increase in average payment per visit, without seeing a single additional patient. Pull your top 20 CPT codes, ask staff what routine work isn’t on that list, and fix one gap at a time.

2. Underestimating visit complexity

A visit that sounds simple, like “he’s having trouble sleeping,” can turn into a conversation about anxiety, bullying, food insecurity, housing instability, or a medication question. Routine to you doesn’t mean low complexity, and if your documentation and coding don’t reflect what actually happened, you’re leaving money on the table.

3. Assuming vaccines lose money

One practice saw $200 to $300 in losses on a single remittance and assumed their whole vaccine program was underwater. Looked at in full, that same program had generated roughly $18,000 in margin. Don’t judge a program by one bad claim. For your highest-volume vaccines, compare acquisition cost to actual payment times doses given, and know the real number.

4. Treating denials as normal

“That payer never pays for it.” “It always denies.” These become accepted wisdom, repeated so often no one checks if they’re still true. Denied doesn’t mean correct. Pull last month’s true denials, find your most common reason, and verify whether it was valid, preventable, corrected, appealed, or paid.

5. Forgetting the revenue cycle starts before the claim

Demographics, insurance details, eligibility, newborn enrollment, and coordination of benefits all get captured, or missed, at the front desk, long before a claim exists. One missing piece at intake means multiple extra touches later. Follow a few newborns through registration, eligibility, claim, and payment, and fix the workflow where it breaks.

6. Assuming your system captures what you actually bill

Hearing screens, vision checks, strep tests, and vaccines happen in the room every day, but that doesn’t guarantee they reach the claim. Audit a handful of charts per provider and compare what clinically happened to what was billed. If the same service keeps disappearing, that’s a workflow issue, not a one-time mistake.

7. Letting claims get old

One practice had roughly $3.5 million in annual insurance collections, but more than $10 million sitting in insurance accounts receivable over 90 days. Healthy practices keep A/R over 90 days under 5%, ideally closer to 2%. Old claims don’t need another report. They need someone picking up the phone.

8. Writing off office visits without review

A pediatrician who was already seeing 20 to 25 patients a day still felt she needed to see more. It turned out her practice had written off 237 office visits, roughly two weeks of patient care provided for free. The fix wasn’t seeing more patients. It was making sure no office-visit write-off happens without review.

9. Measuring too much and learning too little

A 40-page monthly report sounds thorough, but if you still can’t answer “how are we actually doing,” more data isn’t the fix. If a number wouldn’t change a decision, it doesn’t deserve to be a headline metric. A handful of numbers, days in A/R, insurance A/R over 90 days, office visits written off, collections trend, and payment per visit, will tell you more than forty pages ever will.

10. Letting billing depend on heroes instead of process

At an 11-provider practice, one employee alone owned patient statements and recall notices. When she left, there was no documented process behind her. It took over a year to discover that collections had dropped and recall notices had simply stopped going out. Ask yourself what would break if your key billing person left tomorrow, and document it before you find out the hard way.

Where to start

Ten leaks is a lot to look at once, and that’s exactly the mistake to avoid. Don’t try to fix all ten tomorrow. Pick the one that sounds most familiar, walk through spot it, prove it, fix it, and then move on to the next.

If you’d like to see this framework explained in more detail, along with the full data behind each of these leaks, you can watch the complete recorded webinar here: Watch The Pediatrician’s Playbook