It is no secret that the healthcare sector is flourishing, and future expansion is anticipated. Thus, the billing procedure is essential to the ongoing operation of any hospital or midwifery office. Creating billing claims and submitting them to insurance companies are both involved. This guarantees that the hospital or midwife's office is paid the appropriate sum for the services they render to patients. Keeping your patients informed about their bills is a difficulty that all midwives encounter.

When receiving emergency treatment, non-emergency care from out-of-network midwives at in-network institutions, or air ambulance services from out-of-network providers as of January 1, 2022, patients will have new billing protections. Emergency services must continue to be covered without any prior authorization and regardless of whether a midwife or birth center is in-network thanks to new regulations intended to protect consumers.

Before, if patients had health insurance and sought treatment from an out-of-network practitioner, their health plan would typically not cover the whole out-of-pocket expense. Many ended up paying more as a result than they would have if they had seen an in-network provider. In an emergency, when customers might not be able to select the supplier, this is very typical.

A client may receive treatment from out-of-network providers at a facility even if they go there. In many instances, the out-of-network providers may charge patients the difference between the fees they billed and what was covered by their health plan. This practice is called balance billing. A surprise bill is a balance that appears out of the blue.

The No Surprises Act under title I and Transparency under title II are just two of the many measures in the Consolidated Appropriations Act of 2021 that assist shield customers from unexpected bills. This law was passed on December 27, 2020. Learn more about consumer protections, anticipating prices to avoid unpleasant surprises, and what happens when disputes over payment develop after obtaining medical care.

What are the new protections if I have health insurance?
If you get health coverage through your employer, the Health Insurance Marketplace®, or an individual health insurance plan you purchase directly from an insurance company, these new rules will:

• Ban surprise bills for emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
• Ban out-of-network cost-sharing (like coinsurance or copayments) for all emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services, and any cost-sharing you pay counts towards your deductible and maximum out-of-pocket limits for the policy year.
• Ban out-of-network charges and balance bills for supplemental care (like anesthesiology or radiology) by out-of-network providers who work at certain in-network facilities (like a hospital or ambulatory surgical center).
• Require that health care providers and facilities give you an easy-to-understand notice explaining that getting care out-of-network could be more expensive, and your options to avoid balance bills. You’re not required to sign this notice or get care out-of-network.

If you have a health insurance plan with an out-of-network benefit, like a Preferred Provider Organization (PPO), you can choose to go to an out-of-network provider. But you can’t be billed more than in-network cost-sharing amounts for items or services provided by an out-of-network provider at in-network facilities unless you consent to get care out-of-network by signing a notice and consent form.

Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan's in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can't balance bill you and may not ask you to give up your protections not to be balance billed.

Are there exceptions to these protections?
These protections don’t apply in all situations.

• If you have a vision- or dental-only plan, these new billing protections generally don’t apply to services these plans cover. But if you have a health plan that includes dental or vision benefits, these protections could apply to any dental or vision services covered by your health plan.
• The balance billing protections generally don’t apply to ground ambulance services.
• Some health insurance coverage programs already have protections against high medical bills. You’re already protected against surprise medical billing if you have coverage through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. These new rules don’t apply to these programs.

Policies are crucial since they outline what is and isn't permitted within the healthcare industry. They will make sure that all actions conducted within the healthcare provider are done so that the organization may reach its goals if they are created properly. They can assist in determining the type of work they do, the types of jobs they won't do, and the values they uphold. Policies are created to improve the situation of the healthcare sector. When properly followed, it will assure productivity and prevent problems that could affect patients as well as healthcare providers. If you feel wronged or in an unjust situation. Feel free to visit the CMS website at https://www.cms.gov/nosurprises/consumers

Reference
Ending surprise medical bills. CMS. (n.d.). Retrieved January 2, 2023, from https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills

Are you passionate as a midwife to offer breastfeeding support? All midwives want the best option for feeding a baby. Consider the profitability options for breastfeeding visits. You can either bill to insurance plans a home visit for breastfeeding or office visit. With the Affordable Care Act, most insurance plans cover breastfeeding visits one hundred percent (grand fathered insurance plans rarely cover this service – do a verification of benefits before providing any care to women and her babies to let you know what is covered by her insurance plan and what is a cash option for services with your practice). The insurance reimbursement for 30-60min visits range from $90-250 depending on billing codes utilized.

Breastfeeding support can be marketed with benefits of breastfeeding stressing both newborn and mother aspects. Newborns have lower chance of obesity, sickness, allergies, automimmune conditions, and diabetes with prolonged breastfeeding. Mother’s metabolism is actually higher with breastfeeding than pregnancy (demand of extra 500 calories/day versus 300 calories/day). Longer mother breastfeeds decreases her chances of breast and ovarian cancer, obesity, diabetes, heart disease, and depression. Cost savings alone from breastfeeding compared to formula can be part of your marketing tactic.

Breastfeeding support can be focused on availability for problem visits. I like to stress marketing in a direction of prevention and education. Create breastfeeding educational topic timelines:
*Prenatal prep for initial latch techniques, skin to skin when baby is born, advocating for yourself and baby in the immediate postpartum period. Women can be taught about breast pumps and how to get one prior to baby’s arrival.

• Immediate postpartum period: either visit at home and at the hospital to help with colostrum transition and immediately getting a good latch technique in place to help avoid cracked and sore nipples. Breastfeeding rates drastically decrease the first 48hrs from lack of support of health care team.
• First week after baby comes: when the milk supply comes and engorgement sets in, many women have trouble with latch. Sleep deprivation, frequent feedings, and temptation of easy access bottles hinder breastfeeding success.
• Developmental stages of newborn: teething, introduction of food, and weaning
• Common problems that most breastfeeding support is sought after are nipple pain, poor latch techniques, cracked nipples, colicky baby, over abundance issues, poor milk supply, baby in NICU, failure to thrive, mastitis, and yeast infections

I have seen a few Lactation Consultants flourish with being independent contractors for Family Practice offices in an area as breastfeeding support. Midwives can do the same thing. We can add this charge to the global postpartum care currently being offered or strictly make a breastfeeding clinic as our business model.

Find out the needs in your area. Are there any support groups for women to attend for breast feeding? There are billing codes that cover the midwife offering these services. Prenatal and postpartum breastfeeding classes including support groups would be billing code S9443 (Lactation Classes, Non‐Physician Provider, Per Session). Office visits with Certified Nurse Midwife would be 99201-99205 new patient depending on time spent with pt (10-60min). Established patients would be 99212-99215 depending on time (10-60min). Your note for visit needs to stress more than 50% of visit was spent counseling and write exact time spent in front of patient.

Home visits are paid if patient’s insurance plan has home visit coverage. Those billing codes are 99341-99345 for new patients and 99346-99350 for established patients depending on time spent and complexity. Code 99404 can be used if a Lactation Consultant is seeing patient in your office. Short and long term benefits to community of supporting breastfeeding need to be promoted. Having a financial backing to your cause only makes it that much sweeter!
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Reference
https://midwiferybusinessconsultation.com/breastfeeding-as-business-tactic-midwife-consulting-for-profits/

Insurance reimbursement is the bread and butter of many midwifery practices. If you have a cash paying only population like Amish or Mennonite home birth practice, you can just skip this posts. For the rest of the midwives out there needing to understand this confusing health insurance game, continue reading. Medical expenses are a huge burden for Americans and to be able to run your practice long term successfully, you will need to learn this system.
Insurance reimbursement is the bread and butter of most midwifery practice. If you have a cash paying only population like Amish or Mennonite home birth practice, you can’t just skip this posts. My resources are available for the rest of the midwives out their needing to understanding this confusing health insurance game. Medical expenses are a huge burden for Americans and to be able to run your practice long term successfully, you will need to learn this system.
The goal of this blog article is to help with basics of billing and coding. We will do further posts about details of different aspects of practice and insurance billing. There are billing codes (CPT codes) that are sent to an insurance company for services rendered by a CNM and her team. The diagnosis code applicable with CPT codes are needed to be attached to the claim.
Verification of benefits is strongly recommended prior to seeing a patient to make sure coverage for service being offered are covered, no prior authorization is needed for services, and what level of patient financial responsibility for care is warranted. Does today’s visit go towards deductible, co-payment, or co-insurance? Is it covered completely even if deductible isn’t met due to the Affordable Care Act? Will the insurance plan cover a birth with a CNM, but only in hospital setting versus home? Is the midwife in network or out of network with insurance plan? If out of network, does insurance have out of network benefits (called a PPO plan). HMO listed on the card states only in network provider coverage. These are all examples of really important questions to ask when checking into an insurance plan.
You can directly do your billing, hire a Billing Specialist as part of your team, or out source the Billing Services. Each one has pros and cons. With a small midwifery practice, it does make sense to directly do your own billing for care. You would directly know the services rendered, be in charge of how quickly claims are sent out and paid by insurance plan and patient, and not have to pay additional commission to billing staff or agency. Downside is billing and coding is a complicated system and many providers would rather care for patients and not deal with billing regulations and jargon involved. 
Having someone in house is cheaper if the practice is large enough to support the employee costs. With having a smaller practice, paying a commission for services actually paid for with a billing agency makes the most sense.
I have always liked using a Electronic Health Records (EHR) system that is a one stop shop for resources for my practice. Having an EHR system that does your billing for you is really helpful. Athena Health has been my “go to” system for years. I have been really impressed with their small practice customization. I can use all or none their administration services like billing, charting, appointment reminders, scheduling, patient portal, e-prescribing, lab and imaging ordering, and electronic referrals to specialists. 
There is no up front costs and they are paid when I get paid. It is a great option when there is little start up funds for practice and long term knowing that the EHR system will continually try to improve their services. If I don’t get paid, they don’t get paid. WIN-WIN!

Youtube video: https://www.youtube.com/watch?v=jUZuJrrGcOo

Reference
https://midwiferybusinessconsultation.com/midwife-business-billing-and-coding-tips-essentials-for-success/