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​Beware of Misleading Letters of Agreement with Payers

4/30/2020

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One of our providers files her professional claims, she entered an agreement with Aetna and thought she would be paid $6000 for providing global maternity care. Imagine her surprise when the fine print she agreed to was for "Aetna's Market Fee." After ten months of care, she made $1600. :-(
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SC Supreme Court on Payer Bait and Switch

4/30/2020

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“Insurers generally are attempting to convince the customer when selling the policy that everything is covered and convince the court when a claim is made that nothing is covered.”
— South Carolina Supreme Court
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Nursey Charges for Rooming-In

4/30/2020

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Newborn Nursery Charged Even When Baby Stays with Mother
THE PROBLEM: Kunal Kampani was upset when he got a bill with a hospital nursery charge. His newborn baby had stayed in the room with his wife. "There was $1,650 in nursery room charges for two days. It was surprising because we never used it at all during the hospital stay," he said. "They are now threatening a collection agency. Can you please advise what should I do?"

"Children are expensive - and it starts from the moment they show up. Whether they sleep in the room or in the nursery, hospital charges are exactly the same" says Texas Health Presbyterian of Plano.

"Each infant is assigned a nursery nurse, who provides the same care, the same supplies, and the same amount of time and attention whether the infant is in mom's room or the nursery," hospital spokeswoman Rachel Horton Raya said by e-mail. "Daily charges are the same in either situation and include nursing care and supplies such as diapers, wipes, linens, etc."

Read full article here: Hospital Charges Apply Even When the Newborn Don't Use It
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Bad Faith Insurance Practices

4/30/2020

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Insurance companies owe a duty of good faith and fair dealing to the people who they insure. This duty is often referred to as the "implied covenant of good faith and fair dealing," and it automatically exists by operation of law in every insurance contract. As a general rule, if an insurance provider violates the covenant of good faith and fair dealing, a policyholder may sue in tort in addition to bringing a standard breach of contract claim. Suing in tort is advantageous to a plaintiff because it allows him or her to collect punitive damages in addition to general and special damages for the provider's breach. For this reason, attorneys prefer to include a cause of action in tort for bad faith insurance practices whenever possible.

Most insurance companies process our claims lawfully; however, in the event they don't, we are prepared to move forward legally.
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Telemedicine

4/30/2020

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For services provided using telemedicine (real-time, interactive, audio and visual) between Jan. 27, 2020 (the day the public health emergency was declared) and June 30, 2020, CMS says to add modifier 95, synchronous telemedicine services rendered via real-time interactive audio and visual video telecommunication system, on the claim.

For services going forward via telehealth, until June 3, 2020, use modifier 95.
For telehealth services performed starting July 1, 2020 until the end of the public health emergency use HCPCS code G2025 to identify services that were furnished via Tele health in an RHC or an FQHC these claims will be paid at the $92 rate.
  • The visit must use real-time, interactive, audio and visual telecommunication systems
  • Practitioners can furnish these services from any location, including home
Although CMS says practictioners can also bill on-line digital E/M codes, 99421—99423 and virtual communication code G2012 and G2010, these are reported with HCPCS code G0071. G0071 will be paid at $24.76 beginning March 1, an increase from the prior rate of $13.53.
MACs will automatically reprocess claims with G0071 for claims processed after March 1. The new rate is a blended rate, based on the payment rates of 99421—99423, and the two HCPCS codes for virtual communication, G2012 and G2010. 

Credit: Coding Intel @ www.codingintel.com
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ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020

4/24/2020

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15. Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)
s) COVID-19 infection in pregnancy, childbirth, and the puerperium
During pregnancy, childbirth or the puerperium, a patient admitted (or presenting for a health care encounter) because of COVID-19 should receive a principal diagnosis code of O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, followed by code U07.1, COVID-19, and the appropriate codes for associated manifestation(s). Codes from Chapter 15 always take sequencing priority.
Exposure to COVID-19
For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.
​
For cases where there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
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COVID-19 New Clients Looking for Care

4/6/2020

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Midwives are reporting that they receive calls from potential clients that have HMO policies. Clients can call their insurance and ask for a single case agreement to use an out-of-network facility due to the COVID-19 pandemic. Insurance companies are granting these requests. This is good news for midwives! Potential clients can email us a info@midwivesadvantage.com if they have questions.
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    Author

    Stacy has been a midwife for 30 years. She has 9 kids and at last count, she had 16 grandkids.

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What Midwives Are Saying 

We were paid quickly and our clients were able to finance their birth with my practice through insurance. Thank You Midwives Advantage!"

"I've used all the billers for my claims! Midwives Advantage is definitely the best!"

"At first, I thought this was too good to be true but decided to give it a try. I really couldn't see that I had anything to lose by submitting a few claims from births that I'd already done. My clients were all for it! I got my first payment a month later, and I've never looked back. I really can't thank you enough for all you've done for my clients and me. It is such a relief to have a solution to offer my clients that have insurance!"

"This company is one of those things in life that almost seems too good to be true! I've been with Midwives Advantage for six years, and although they've had some struggles with some payers, I can say they never stopped working on claims. These women don't stop. They are constantly improving. I've seen a lot of changes over the years, and it just continues to amaze me. I am so happy to be able to give care to my clients and know I have responsive experts handling the insurance claims. Thank you for all you've done, and you continue to do for midwives!"

"My midwife emailed me and told me about Midwives Advantage. I submitted my insurance information, and she submitted the information for my claims. Imagine my surprise when all the claims were paid within 30 days! This was my fourth home birth with the same insurance and the only one that my insurance paid for!  What your company is doing for the birth community is amazing. You guys are worth your weight in gold! Thank you!"
Midwife Request  for information

Midwife Businesses We Recommend

Midwifery Business Consultation
Midwifery Business Consultation provides guidance, support, and resources to elevate any midwifery practice.  Extensive resources in the areas of billing, accounting, contracting, business plan writing, and midwifery clinical expertise is available to make your midwifery practice thrive!  

Empowering Midwifery Education
Empowering Midwifery Education has
 a series of educational courses devoted to midwives and being entrepreneurs in today's fast paced health care system. Look through our series of great courses to learn about tax savings, accounting, policy creating, starting a home birth practice, starting a birth center practice, marketing, and so much more!


We are excited to promote opportunities for midwives to expand their skill sets like this new ultrasound course for midwives. Ultrasound for Midwives is designed for any midwife (CNM, CM, CPM, LM, DEM) or Nurse Practitioner considering offering ultrasound services to their practice and prep for the Midwife Sonography Examination of the American Registry of Diagnostic Medical Sonographers (ARDMS). This online course has over 8hrs content including Point of Care, limited, obstetric and basic gyn ultrasound, business implementation, and billing tips. 

Ultrasound Course for Midwives
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  • Home
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      • ADMINISTRATIVE HEADQUARTERS
    • Our Advantage
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  • For Midwives
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    • Provider Education
  • Midwife Clients
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    • Information After Claims Are Filed
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