Important to Understand the Difference Between Professional and Facility Fee Claim Processing Guidelines

When it comes to insurance claim processing for midwives, there are different considerations for professional versus facility claims. Here are some tips for both types of claims:
Professional Claims:

1. Verify Insurance Coverage: Before providing services, it's essential to verify the patient's insurance coverage for midwifery services. Some insurance plans may have specific requirements or limitations for coverage.
   
2. Use Correct Coding: Accurate coding is essential for successful insurance billing. Use Current Procedural Terminology (CPT) codes to bill for your services. Each service should be billed separately using the appropriate codes.
   
3. Document Care: Accurate documentation is crucial for successful insurance billing. Be sure to document all services provided, including the date, time, and nature of the service. Include detailed notes on the patient's medical history, any complications, and the care provided.
   
4. Submit Claims Promptly: Submit claims promptly to ensure timely payment. Use electronic claim submission whenever possible.
   
5. Follow Up on Claims: Insurance companies can take time to process claims, so it's important to follow up regularly to ensure timely payment. If a claim is denied, you may need to resubmit it with additional documentation or appeal the decision.
   

Facility Claims:

1. Verify Insurance Coverage: Before providing services, it's essential to verify the patient's insurance coverage for midwifery services provided in a facility. This may include hospitals, birth centers, or clinics.
   
2. Coordinate with Facility Billing: Coordinate with the facility's billing department to ensure that your services are billed correctly. You may need to provide additional documentation or work with the facility's billing staff to ensure accurate billing.
   
3. Use Correct Coding: Accurate coding is essential for successful insurance billing. Use Current Procedural Terminology (CPT) codes to bill for your services. Ensure that the facility's billing staff uses the correct codes and billing procedures for the services you provide.
   
4. Document Care: Accurate documentation is crucial for successful insurance billing. Be sure to document all services provided, including the date, time, and nature of the service. Include detailed notes on the patient's medical history, any complications, and the care provided.
   
5. Submit Claims Promptly: Submit claims promptly to ensure timely payment. Use electronic claim submission whenever possible.
   
6. Follow Up on Claims: Insurance companies can take time to process claims, so it's important to follow up regularly to ensure timely payment. Coordinate with the facility's billing staff to ensure that claims are processed correctly.
   

Remember, accurate documentation and coding are critical for successful insurance billing for midwifery services. Don't hesitate to seek the help of a billing professional or billing service if needed.