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.
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!
The fee schedule defined by the Centers for Medicare and Medicaid Services (CMS) is a complete list of charges for health care services on a fee-for-service basis. Fee schedules play a critical role in reimbursing practitioners for clinical laboratory services, durable medical equipment, ambulance services, prosthetics, orthotics, and other supplies.
Understanding the breaking point between discount and making a profit, setting a defensible fee schedule helps in overcoming many problems. Updating the fee schedule every 3 to 12 months is mandatory so that you are not missing out on revenue. The updated fee schedule will keep up with market dynamics, such as your liability insurance rates and patient volume, by cross-checking with private and public payers to avoid any glitches.
How to decide the fee schedule?
First and foremost, a self-cost study or hiring a consultant to account for every cost is essential. It is so much so that you have a reasonable margin to reinvest in your clinic. Perhaps the simplest way is to break down your cost and margin into hourly units of work. It is essential that your service includes a list of all overhead charges, margins, and the actual charges. For instance, the fee for a flu shot should contain nursing staff’s pay, a fraction of the rent, insurance premium, electricity bill, your take home pay, and a fraction of the cost of an upcoming x-ray machine.
It is important that your fee schedule ensures that you stay in business using the Centers for Medicaid and Medicare services on the resource-based relative value scale (RVUs) plus your expense. RVUs are relative values, so every code is multiplied by the conversion factor to get a fee schedule. Once the total cost is calculated, list every CPT code to your practice bills, excluding the ones w/o an RVU. Figure out the RVU for every code, practice expense & liability, and practitioner’s work RVU. Next, with the total cost and total RVUs billed each year, allocate a dollar value to each RVU. Finally, multiply each RVU cost factor with the RVU per code to have a fee schedule. If you choose to create a fee schedule on the hourly rate, calculate how much time each service takes. After the calculation, you get an idea of what others are charging without breaking antitrust laws.
Having Accurate Fee Schedules to Reflect Your Services Being Billed to Insurance Plans
Accuracy of your Fee Schedules helps you bill insurance companies faster and easier. Fee schedules are confidential information. Insurance companies often have strict policies about disclosing this document to anyone but the provider named on the contract. Fee schedules cannot be shared between providers. If you share the fee information with patients, don't share the entire fee schedule. You can tailor the information to your patient by only sharing the CPT codes and associated cost to their treatment.
You can request the fee schedule from your insurance company if you have not received it. This is similar to requesting a contract. We recommend that you request both your contract and the fee schedule from the insurance company if you're also missing them. Fee schedules are usually only available to contracted providers. If you have not been credentialed with insurance companies, you won't be able to see their fee schedule. This depends on the policy of your insurance company. It is possible for a credentialed provider to access your fee schedule online. You could then call the insurance company to request it.
It is essential to know your fee schedule in order to run a successful practice, particularly with the implementation of the No Surprises Act. The best tools for providing accurate estimates to patients are your fee schedule and eligibility checks. Our article on the No Surprises Act provides more information about good faith estimates and compliance to the new law.
A copy of your fee schedule is very helpful so you can confirm that you are being paid the correct amount by your insurance company. It is helpful to have a copy of your fee schedule in order to submit claims and provide information for benefit checks. To determine how much a patient would owe for coinsurance, you will need to have a copy of your fee schedule. This is because the contracted rate is used to calculate the amount.
You can use information from your fee schedule as a practice owner to project revenue. This method is more accurate than an aging report because it shows the actual cash value of each session, not the contracted amount. To project income for your practice, you can either use the fees schedule numbers or set goals on how many sessions you will need in a given time period to achieve a certain income level. If you feel lost, make copies of your fees and contracts, you might be ready to set up a consult with us to see if we are the right fit to work together!
Practice Solutions, L. L. C. (2022, March 29). What is a fee schedule? practice solutions llc. Retrieved November 29, 2022, from https://www.practicesol.com/single-post/what-is-a-fee-schedule#:~:text=It%20is%20 extremely%20 helpful%20for,company%20 according%20to%20your%20 contract.
What is the fee schedule in medical billing? Revenue Cycle Management. (n.d.). Retrieved November 29, 2022, from https://www.caplinehealthcaremanagement.com/what-is-the-fee-schedule-in-medical-billing/#:~:text=It%20is%20 important%20that%20your,to%20get%20a%20 fee%20 schedule.
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
Tips For Appealing Midwife Claim Denials
A health insurance denial happens when your health insurance company refuses to pay for something. If this happens after you've had the midwifery service and a claim has been submitted, it's called a claim denial. Insurers also sometimes state ahead of time that they won't pay for a particular service, during the pre-authorization process; this is known as a pre-authorization--or prior authorization--denial. In both cases, you can appeal and may be able to get your insurer to reverse their decision and agree to pay for at least part of the service you need. There are literally hundreds of reasons a health plan might deny payment for a healthcare service. Some reasons are simple and relatively easy to fix, while some are more difficult to address.
Why Would a Health Insurance Claim Be Denied?
A health insurance company may deny a claim for many reasons, including:
As a maternity care provider, claim denials are pain in the butt. Even practitioners who take precautions to avoid insurance payment pitfalls sometimes find themselves faced with a claim’s denial. Handling denied insurance claims can be a frustrating, time-consuming and complicated process for practicing psychologists and their administrative staff. Knowing some basic strategies for resolving claims denials can save practitioners time and improve their practice’s cash flow. Some basic pointers for handling claim denials are outlined below.
1. Take the time to review all notification regarding the claim Although it sounds obvious, this is one of the most critical steps in claims processing. You should carefully read any notification you receive from an insurance company about a claim. Notifications should state whether the claim has been paid in full, partially, delayed or partially. If the claim is deemed "unclean" or contestable, the carrier will provide instructions on how to resubmit the claim with any missing or corrected information. In the event that the claim is not paid in full or denied for any reason, the notification must state the reasons and the procedures and documentation needed to resubmit or appeal the claim.
For more information, contact the carrier if the notification is unclear. You may discover that the claim was incorrectly adjudicated by the payer, in addition to the stated reason for denial. It is possible that your submission processes do not meet the requirements of the payer. However, you may be able to make simple changes to improve your claims submissions.
2. Be persistent
If you feel the insurance provider has wrongfully denied your resubmitted claim, you can appeal. You should be clear about what information you must include with your appeal. Keep in mind, appeal procedures can vary depending on the state law and insurance company.
An explanation of your appeal and any supporting documentation such as a copy of the claim, and copies of communications to the company regarding the matter, should be included in your appeal. Additional information may be required to prove medical necessity if your claim is denied. It is important to comply with your obligations under the Health Insurance Portability and Accountability Act, (HIPAA), to protect psychotherapy notes and provide only the "minimum required" information.
Sometimes, you may have to submit the claim again or appeal multiple times to reverse an insurance company's decision. But don't lose heart. The insurance company will appreciate your persistence in resolving the issue and getting paid.
3. Don’t delay
It is crucial to submit and resubmit claims within the deadlines specified by the company, or any applicable laws in your particular state. If you don't, your claim could be dismissed based on information already provided.
4. Get to know the appeals process
Make sure to familiarize yourself with the appeals process of your carrier before you file an appeal. You will be better equipped to respond to your carrier's actions if you have a good understanding of their policies. You should keep current information about the appeals and claims adjudication processes for every carrier you work with. This information is often available on the websites of carriers. If applicable, you should also keep hard copies of it whenever you sign a contract.
5. Maintain records on disputed claims
Keep a written record of all information that you receive from an insurance company regarding a claim. Also, make sure to include the name and contact information of the representative you spoke with. This information should be kept with key information about your claim such as the reason the claim was delayed, partially paid or denied, the actions taken by your office to follow-up on it, and the final outcome.
These records could be used to help you in the future, whether it is to appeal to higher levels or to complain to the state insurance commissioner. These records can be used to help your office avoid or resolve future claims denials.
6. Remember that help is available
Although handling claims denials is frustrating, it can help you save time and money by alerting to the expectations of the insurance companies you contract with. You may be able to reduce rejections and denials by ensuring your billing procedures conform to the requirements of the company. If you have any reimbursement issues with an insurance company, please contact your state insurance commissioner for assistance.
Insurance denials are very frustrating. It will give a huge impact to your practice if you are not mindful enough of every action you take. But it is preventable if you collect the right information and verify it thoroughly.
American Psychological Association. (2005, March 1). Six tips for handling insurance claim denials. https://www.apaservices.org. Retrieved November 28, 2022, from https://www.apaservices.org/practice/business/finances/insurance-denial
Martin, E. (2022, November 16). How to appeal a health insurance claim denial. Forbes. Retrieved November 28, 2022, from https://www.forbes.com/advisor/health-insurance/appeal-health-insurance-claim-denial/
Insurance billing can be daunting with running your own midwifery practice. It is easy to bill for services with cash, but many families are very dependent on getting their insurance to pay for care. Especially maternity and newborn care since the Affordable Care Act legally requires insurance companies to cover preventative care.
Midwives that deliver in the hospital typically don’t do newborn care (pediatrician on call covers that service). Even though it is part of the CNMs scope of practice to care for babies first month of life, most in hospital practices don’t provide that aspect of care. Out of hospital birth practices, midwives typically do the newborn care (especially the initial newborn exam). How is billing for babies done? Do all insurance companies reimbursement midwives for that service?
Most insurance companies are easy to bill for newborn care. CNMs are recognized with most insurance plans as a covered provider for that service. I have had a couple plans state as denial reason “not covered provider type.” That is part of importance in thorough verification of benefits (VOB). I have trained my staff to ask VERY DETAILED questions to insurance reps if a phone VOB is done. They don’t just ask maternity care coverage with plan. We state, “Does this plan cover a CNM in the home setting for delivery care?” “Does this plan cover an independent Certified Nurse Midwife for newborn care codes 99381 or 99391 in the home setting?” There are some plans that won’t cover a midwife not working under a physician, newborn care in the home setting, or home visit codes for these services like 99349.
Available billing codes for newborn services revolve around screenings and care offered in the first month of life. Our practice offered the vaccinations to families. We gave the Hepatitis B vaccination at the birth center prior to discharge if families desired it. We billed to insurance companies codes 90744 (Hepatitis B Vaccination) and 90471 (immunization injection). Some families wanted eye ointment and vitamin K injection given. Those billing codes were J3490 (erythromycin eye ointment), J3430 (vitamin K injection), and 96372 (IM injection).
Newborn assessments are vital to make sure baby is transitioning well to life outside its mother. Don’t you want to get paid for all your valuable being provided? You have two patients in the postpartum recovery period, make sure you are getting reimbursed for everything you are doing. Initial newborn exam billing code is 99381. Repeat exams 99391. If it is done in the home setting, some insurance companies want you to bill a home visit code and others want the initial newborn screening placed in home setting on claim paperwork. I would usually do 99350 for initial exam and then 99348 for subsequent home visits during postpartum care when insurance plan wanted home visit codes submitted.
Make sure families are aware that coverage level is different for preventative codes like newborn exams versus home visit codes. Many insurance plans don’t have home visit coverage. If coverage present, it may be a co-payment or completely count towards their deductible versus newborn exam codes being covered 100% in the office.
I have had families drive to office for 24hr postpartum exam versus me coming to the home purely because their insurance had no home visit coverage, but would cover a newborn exam 100% in office setting. Families should have a right to know their coverage level and be given options of your services based on what their insurance coverage is actually like.
Newborn hearing screen and newborn metabolic screening (state mandated in many places) are covered 100% by insurance plan. You can refer families out to local resources lab or audiology to complete these screenings or offer them as part of your services. Hearing screen code is V5008 and metabolic screen is 83516. Capillary sample collection billed in conjunction with metabolic screen is 36416.
Another state mandating testing in Michigan is pulse oximetry reading on newborn. That code is 94760. Some insurance plans will recognize all these subset screening codes and others won’t. Unfortunately when most babies are born in the hospital, many of these services are bundled with the hospital facility or nursery charge placed to insurance companies.
Newborn care is very important part of a midwife’s job. Being able to have another revenue stream come into your practice from those services that many people a Pediatrician can only do, really helps your bottom line of business success. I had an average extra $500 from each family’s care come into the practice by performing those newborn exams first month of life.
It was also great to keep the baby’s out of a sick doctor’s office and let mother and baby truly stay home the first few weeks after delivery. Last thing a recovering mother and baby need is getting out into Michigan winter to get all those check ups completed.
Importance of Getting All the Information from Clients Before Billing Midwives Insurance Claims
Billing plays a significant role in your practice’s revenue. When you have your patient, you either bill them out personally or through their health insurance coverage. Getting cash from clients may be easier but what if they will use their insurance? Not all insurance claims get approved, there are times that patients get rejected and as the healthcare provider, it will greatly affect you and your practice. Study shows that insurance claims can also be denied or rejected for a variety of reasons. Many of these denials are due to human error. 75% of claims were incorrectly coded. To avoid this to happen, you must get all the information needed and verify it first hand before submitting claims.
Insurance claim data entry is very challenging. It is common for insurance claim documents to be copied, shared, and reviewed by multiple departments depending on the type of claim. Multiple employees cannot work on the same claim simultaneously if they have to deal with physical documents. These steps can cause errors or omissions in claim management software by manually entering data from different documents in a claim. This could lead to chaos, delay payments, mishandling the claim, and/or create delays in payment.
It is vital to have a healthy revenue cycle to support the expensive work of every midwife. However, it can be difficult to ensure that your practice receives payment for the services it rendered. This can be especially difficult because midwives often get reimbursed by third party payers after the patient has left. There is also a delay between rendering services and receiving payment. Below are the reasons why it is important to get all the information from clients with billing insurance claims out:
Having your midwifery business is worthwhile, hence deciding how to get paid what you are worth is challenging. It can be difficult to decide how much you should charge for your midwifery service since midwives just started to be recognized with the value they put in the healthcare industry. You could be priced out of the market if you charge too much. If you charge too much, you might be earning nothing. As a midwife, you must charge a reasonable amount of money that can help you survive your practice in the long run. To help you decide, here are some ways you can use to determine your pricing point for your midwifery business.
1. Do not be a discount queen Although it might seem tempting to offer sales to get new business, if you discount certain things without asking why, you could lose money.
2. Take into consideration all costs This is an important step in pricing your services. Calculating your cost of sales (COS) is essential. You should make a list of all the steps involved in creating or delivering your midwifery services. This includes your time and the cost of outsourcing or hiring help.
3. Calculate Your Overhead Percentage
You must also include costs related to staying in business. I think overhead costs are like a roof above your head. Freshbooks offers a detailed guide which explains everything. These costs include utilities, taxes, office equipment, and office rent. Direct costs refer to the costs associated with each project, such as gas, filing fees and your time. These are the overhead costs listed above. Divide the indirect costs by direct costs to calculate your overhead percentage. Then multiply 100 by 100.
4. Avoid Low Balling Your Prices at First Although it might seem tempting to offer low rates to attract customers and undercut the competition, don't. It will be harder to raise your prices later if you do. Customers might be price sensitive and you could lose customers if your prices are raised to a livable level. Instead, determine the price you would like them to be at the beginning.
5. Fee for Value Consider the value of your services when pricing your services. A professional midwife who has had experience delivering babies will charge a mom more than someone who doesn't. It is important to invest in your education and training. Be valuable to your customers.
6. Don't confuse Rate and Price It's simple to do but don't let your personal rate get in the way of the price you charge. You don't want to charge $100 an hour if you want your hourly rate to be $100. Also, you need to factor in overhead and COS. You might earn less than $75 an hour if you take these into account. If you would like your hourly rate to be $100, then calculate the costs first, and include your rate within those costs. You should then charge $125 and not $100.
7. Take into consideration the market demand You can make changes to your midwifery service if there isn’t much demand. Printing paper flyers is not a popular service in today's market. Consider offering social media graphic design as an alternative if this is your business or skill.
8. Find Ways to Increase Sales Upselling is a great way to increase your income. Do not include additional fees in your base price. These extras should be kept secret and offered to clients as valuable options. You may add ancillary services to your midwifery practice such as ultrasound and other test that will be helpful to the customers
9. Invest in the business to increase rates Find ways to invest in your business to increase your rate of return. You might be more productive with a new technology. Continuing education can give you more authority, knowledge and confidence. Clients will pay more if you offer faster turnarounds and other value.
10. Identify Your Ideal Customer When setting your prices, keep in mind your ideal customer. If you offer discounts and set extremely low rates, you will attract this type of customer. Midwifery services are quite expensive if you don’t have insurance coverage in the US. It is important to determine that your customers have the ability to pay for your services rather than expecting to get discounts in every service that you offer.
11. Create a written fee agreement Make sure everyone signs the fee agreement after you have established your fees. Make sure you are clear and answer every question upfront. This will prevent any confusion or arguments later. Pricing is the first step to establish your business, and you must remember that the first step is always the hardest. Yet, if you realize the value of the midwifery service you can offer to your community, along the way things will go smoothly as how you perceived your practice to be. Have patience and you will get there.
Inks, S. (2020, May 23). How to price your services and get paid what you deserve. SMI Financial Coaching. Retrieved November 28, 2022, from https://smifinancialcoaching.com/how-to-price-your-services/
The New Year is a new opportunity to start fresh. We use a very important concept called "self-efficacy" when we make New Year's Resolutions. This means that we can set goals and follow through on them, giving us a sense of control over my life. New year, new business opportunities, new chances to grow. People in the business industry use this opportunity to create new habits that will help them in their business. Habits to maintain up to the end of the year.
In midwifery, particularly in billing for your practice, it is important to measure the habits you have, improve the old habits that helped your practice, and remove those habits that made your billing procedures difficult. It is possible to resolve and improve your medical billing process by setting aside some time. In a matter of days, this can make a huge difference in your bottom line. We recommend that you take the time to read these seven tips and find cash where it is missing. What are the best ways you can improve your billing for your midwifery practice?
1. Collect patient contact information and insurance details prior to their appointment
It will save both you and your client a lot of time by collecting the necessary information before your clients visit the clinic. This will also allow you to plan the end of your day. Your receptionist/front desk staff should be able to collect the most current and complete information from patients calling your office to schedule an appointment. Patients can also choose to send or mail their information. This information should be available on your patient portal and online appointment tool. Staff will be able to verify the patient's insurance information and follow-up with them throughout treatment and collection.
2 Check your client's eligibility for insurance and calculate any outstanding balances
Verify coverage with payers before or during service. These steps will allow you to identify any changes in patient collections, determine what percentage of the treatment will be covered and who is responsible for payment.
3. Adopt a payment policy that places patient responsibility at check in
Patients should be required to pay copays at check-in. This is the best way to collect patient balances. Create a policy for medical offices to ensure that patients are aware of the requirement. Include a patient responsibility agreement for patients to sign in your check-in paperwork. This policy provides clear guidelines to your staff and patients regarding collection. You can also use your patient message solution for automated appointment reminders that communicate what is due at the time you are providing service.
4. Transparency in your billing and collection processes
Patients should be aware of your terms and conditions for medical billing and collection. They won't be surprised if a bill arrives and they don't know what to do. Transparency in billing can help reduce the stress for both your staff and your patients. You can also help your patients by keeping all their current information on file, so that claims are correctly submitted and not denied.
5. Accept multiple payment methods
You can increase your chances of getting balances collected at check-in by offering multiple payment options, such as cash, credit/debit cards, and checks. A convenient and simple-to-use online payment system can be included in your patient portal. This will facilitate patient payments.
6. Provide payment plans and keep track of them
Establish payment plans to help with larger balances. Train staff how to explain and track these options. Your practice will increase its collections by offering flexible payment options. Patients will feel more secure knowing that they can afford the treatment they require.
7. Monitor unpaid accounts
To maximize collections, persistence is the key. Create a plan to contact patients who have not paid on time and a protocol for staff. Your staff should be able to request payment in full, discuss payment options and offer a plan of payment if necessary. You should track accounts at all stages of your revenue cycle. Also, pay attention to unpaid accounts. These accounts can often lead to problems or unresolved billing. A tracking system should be in place to track every account's status. It can tag any status as unpaid, pending or paid. You can also manage tricky accounts by keeping a list of problem accounts that you check on regularly.
8. Learn how to bill Medicare or Medicaid and how to train your staff regularly
Every week brings new medical billing issues. It is important to keep your staff trained and current on how to bill Medicare, Medicaid, and your insurance partners. It will save you time and money on corrections and resubmissions. It is easy to improve your medical billing process by hiring professionals to visit your practice and learn about your accounts receivables and then implement a better billing strategy. The most trivial part of having a new year’s resolution is it may only happen for three months after the new year itself. Many people fail because they lack consistency and motivation to push through. Remember, when you start something, always make sure to finish it.
6 tips to improve collections and cash flow at your medical practice. Greenway Health. (2020, June 22). Retrieved November 28, 2022, from https://www.greenwayhealth.com/knowledge-center/greenway-blog/6-tips-improve-collections-and-cash-flow-your-medical-practice
Marketing, P. (2021, April 26). 4 ways to improve your medical billing process - frost-Arnett. Frost. Retrieved November 23, 2022, from https://www.frost-arnett.com/4-ways-to-improve-your-medical-billing-process/
A private midwifery practice 's success is not determined only by the quality of patients care, but it also includes your financial stability. However, they often have little or no experience in handling the financial aspects of a business. But finances are something that cannot be ignored. Many practices have fallen prey to financial ruin. One reason is that health care professionals often write off patient debts out of compassion. It is important to understand that deductibles may be deemed insurance fraud if they are not written off.
Private midwifery practices are no different. Every midwife depends on stable revenue sources. In the past, there was no such thing as a steady revenue source. Revenue from your midwifery practice mostly relies on cash flow and insurance reimbursements. This revenue responsibility shifts more towards consumers. Midwives choose to write off more 75% patient balances. This can have a severe impact on practice income. You can increase your practice's revenue by making sure your balances are clear of any overdue bills and by not writing off any deductibles or out-of-pocket expenses.
How can your practice address patient balance collection issues?
Importance of timely collection of patient balances on practice financials. Practolytics. (2022, January 27). Retrieved November 29, 2022, from https://practolytics.com/blog/importance-of-timely-collection-of-patient-balances/
s a midwifery practice owner, you must decide whether or not you'll accept insurance for healthcare or if you would like that your service be cash-based which means that the client pays on their own and at a predetermined fee for each appointment. There are advantages and disadvantages to accepting both forms of payment therefore your final decision will depend on the goals you have to achieve for the practice. There is no law which says that if you start with healthcare insurance, it is not possible to switch to cash-based services later on. date.
Most hospital-based midwifery services accept insurance. Nearly half of birth center practice accepts insurance. A smaller percentage of home birth clinics provide insurance processing. Families usually have to provide an insurance coverage with an itemized bills of service for reimbursement directly if out of network benefits are available.
Insurance plans with fewer benefits do not have out-of-network benefits, and being part of the network typically requires some type of malpractice insurance. Smaller midwifery practices may not be able to manage the monthly payments needed for that protection. The more extensive your practice or is expected to become more likely that to be insured and billing for services be essential to ensure that your business is profitable.
The choice between cash payment and billing insurance policies has numerous pros and cons every midwife should consider. Billing insurance plans do not just ensure that midwives receive the right amount of money, it also leaves a variety of benefits to the healthcare industry.
Functions of Healthcare Insurance and why Midwives Should opt to Billing Insurance Plans
In 2017, the average insurance premium for US families with employer-sponsored health insurance cost $18 764, an increase of 3% over the previous year. What this mean value hides, however, is the enormous variance in the amount of health care received by different people in the United States.
That variance is reflected in huge disparities in health care spending. In 2016, the top 5% of US health spenders accounted for 50% of total spending, or about $50 000 per person. The bottom half of the population, based on health expenditures, accounted for only 3% of total health spending, or $276 per person in 2016. People in both groups buy health insurance, but the benefits they gain from doing so are different.
In addition to helping people stay healthy and improving their health when they get sick, our system of health insurance serves at least several functions to enable everyone to benefit from being insured. These functions, however, are not always compatible.
Some of the benefits of outsourced medical billing include:
There is no certain reason for you to choose between choosing cash payments or billing insurance policies for your practice than knowing what you truly need. You need to look at your specific mission, goals, area, and services wanting to provide to the community. Typically, care is a hybrid between insurance reimbursement and cash discount prepayment models of payment. It will give families choices that can fit a family that doesn’t have good and poor health insurance coverage.
Midwiferybusinessconsultation. (2020, December 11). Cash versus billing insurance for midwifery care? MIDWIFERY BUSINESS CONSULTATION. Retrieved September 30, 2022, from https://midwiferybusinessconsultation.com/cash-versus-billing-insurance-for-midwifery-care-2/
Hoffman, A. (2022, March 8). 6 proactive medical billing tips to maximize revenue: HAP. Healthcare Administrative Partners. Retrieved September 30, 2022, from https://www.hapusa.com/6-proactive-medical-billing-tips
Pranammya Dey, B. S. (2019, April 2). The 6 functions of health insurance. JAMA. Retrieved September 30, 2022, from https://jamanetwork.com/journals/jama/fullarticle/2729357