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. 

Reference 
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/

 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.

1. Broad access for small usage fees. Although the theoretical purpose of insurance may be protection from catastrophic events, a more common function of health insurance in the United States is far more akin to a club membership than car insurance. In exchange for an annual fee, beneficiaries receive access to free or low out-of-pocket cost services, such as routine doctor visits. These services are largely predictable—such as well-child visits for people with children or medication refills for people on lipid-lowering medications. Policies aimed at the club membership function generally aim to customize policies to people’s needs. Medicare beneficiaries enrolling in Part D prescription drug coverage, for instance, enter the medications they are currently taking to find the plan that best subsidizes those items.
2. Negotiating health services. Health insurers leverage their market power to obtain price concessions from clinicians or hospitals and health care systems or, alternatively, to screen out high-cost providers from their networks. Covered patients benefit from these discounts even when paying out of pocket for services (with the exception of prescription drugs, for patients often pay list prices even when they have insurance). Policies that focus on this function of health insurance affect the negotiating leverage of clinicians and hospitals relative to insurers. Medicare, for example, sets payment rates via fee schedules, rather than allowing health care systems to use their market leverage to drive up the prices they charge. The Affordable Care Act (ACA) encouraged insurers to construct “narrow” networks of clinicians and hospitals to help commercial plans obtain lower rates through increased negotiating leverage. Insurance company consolidation strengthens the insurer’s negotiating position as well.
3. Enhancing and ensuring the quality of clinicians and hospitals. Both commercial and government insurers have developed measurement efforts that aim to monitor and improve the quality of hospitals. Examples include both quality ratings that help patients and plans select which hospitals to engage, and exclusion of certain hospitals from providing types of services based on quality. Medicare Advantage plans have quality ratings. Medicare limits which hospitals can perform the transcatheter aortic valve replacement procedure to those with adequate volume and expertise. Policies focused on this function of health insurance focus on more comprehensive measures and quality measurement.
4. Midwives get control over the claims. Midwives, along with all other healthcare providers, virtually always bill insurance companies far more than what we would expect in payments. Why? The simple answer is that we usually don’t know what to expect. Insurance companies will always pay whatever a medical provider bills up to the maximum amount they’re willing to pay for any service. So, if a doctor bills $100 for an office visit, and the insurance company is willing to pay $75, the midwife will get $75. If the midwife bills only $60 for that office visit then $60 is all he’ll receive. There is absolutely no penalty in health care for over billing, but any medical provider who under bills will short change themselves. This is why billing charges have exploded by so much in health care. This payment system is far too confusing for any health care provider to really understand, so the best strategy is to bill high for every service then take what they give us.

Some of the benefits of outsourced medical billing include:

• Dedicated specialists: Medical billing and coding companies have dedicated staffs of medical billing specialists, whose sole job is to ensure that claims are filed correctly and denied claims are resubmitted properly. Because of their specialized experience and duties, they can pay attention to the minutiae medical office employees can miss in the bustle of their daily duties.
• Fast submissions: Highly trained staff members can submit claims much more quickly and with greater attention to detail.
• Greater focus on patients: Once they’ve eliminated the time spent on billing and staffing concerns, doctors and nurses can better focus on their patients.
• Up-to-date standards: Medical billing companies are compliant with the most recent health care laws, and they are required to stay up-to-date with the most current regulations in order to meet the changing demands of serving hospital-based specialty practices.

 
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.
 
References

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

When we talk about matters pertaining to your client’s insurance, you have probably heard the terms “in-network” and “out-of-network” care thrown around quite a bit by different healthcare provider including midwives. But what do these terms actually mean, and more importantly what do they mean for you as a midwife? How will these affect your practice and you be able to apply these terms to your midwifery practice?

What does in-network mean?

In-network refers to a midwives that has direct contract with the health insurance plan to provide health care services to its plan members at a pre-negotiated rate. Because of this relationship, clients pay a lower cost-sharing when they receive services from an in-network midwife.

What does out-of-network mean?

Out-of-network refers to midwives who does not have a contract with the health insurance plan. If a client use an out-of-network provider, health care services could cost more since midwives don’t have a pre-negotiated rate with the client’s health plan. Or, depending on the health plan, the health care services may not be covered at all.
 
Depending on the coverage the client have purchased, the plan has established deals with a wide range of midwives and other specialists. These are the health care providers that the insurance company considers in your client’s “network.”  The insurer has identified a group of providers who are “in-network” and has contracted with these providers on the client’s behalf to get services at “discounted” rates. The primary advantage of using an in-network provider is that your client receive this negotiated or discounted rate for your services, and the insurance provider generally picks up a larger portion of the bill than with an out-of-network provider.

This means that as a midwife, once you’re in an agreement with the insurance company to accept your client’s plans and contracted rate as payment for your full services. This contracted rate that was negotiated by your client and its insurance company includes both the insurer’s share of the cost, and the part that your client will be responsible for paying. The part that your client’s responsibility for paying may be in the form of a co-payment, co-insurance or deductible depending on their negotiation.

Simply speaking, as a midwife, when you accepts your client’s health insurance plan we say you’re in network. You will also be called as “participating providers”. When you don’t take your client’s plan, we say you’re out of network. The two main differences between them are cost and whether the plan helps you receive enough value for the care you provide as out-of-network provider.
​
Healthcare is an important aspect aspects of our daily lives. As a healthcare provider, we are expected to give the best services to our clients and in order for our practice to keep on growing we must receive proper compensation out of that service. Remind your clients that they can avoid unexpected medical bills by knowing how their plan works. Certain choices they make can affect what they'll pay out-of-pocket. Know the difference between in-network and out-of-network care to help them save on health care expenses.

Reference

Outreach & Education. CMS.gov Centers for Medicare & Medicaid Services Health Insurance. (n.d.). Retrieved May 13, 2022, from https://marketplace.cms.gov/outreach-and-education
https://www.desertridgeperiodontics.com/pdf/In%20Network%20vs%20Out%20of%20Network.pdf

Accurate diagnosis can have a significant impact on the midwifery practice's claim for billing. It is evident to us that coding and billing are among the most crucial elements in every midwifery clinic. The accuracy within each of them is essential to ensure the safety of patients, quick payments and effective operations.
 
Historically speaking midwives, other health care providers and payers were on the same page' with regard to fee-for-service reimbursements. Midwives performed a task and the they earned the payment. Simple and straightforward. However, with reforms in healthcare is the requirement for health care professionals to be precise and thorough in the diagnosis codes they use. The shift to pay-for-performance (P4P) programs, originally initiated by the CMS, but increasingly adopted by private payers, demands this accuracy. Along with offering incentives to Midwives for providing quality care, there are now penalties for midwives and other health care professionals who may not be offering patient care of acceptable quality. With this reform, accurate diagnosis became a top priority in order for midwives to claim bills accurately, here’s the reasons why.

Accuracy Was Always an Issue
While accurately recording diagnosis codes has always been important, until P4P programs, many payers accepted marginally thorough supporting information to approve claims and pay providers. The new emphasis on claims clarity often proves to be challenging for midwives and billing staff, particularly for those providers not in the habit of submitting fully documented reimbursement claims.
In the past, claims with faulty diagnosis codes typically were denied. Yet, some insufficiently explained claim submissions slipped through and were approved. If payer claim reviewers were hurried into claim examinations, it was always possible that some submissions that could have had payers ‘scratching their heads’ were approved.
 
However, most of the diagnosis coding rules have changed. Accuracy, always a factor, has become the primary component of claims approval. Along with approved/rejected decisions, medical providers now face quality care issues, requiring further justification and explanation to eliminate payer confusion.

Proper Diagnosis Critical for Payment
Some midwives and billing personnel seem forgetful that Medicare Advantage plans pay, in part, as a function of the number and severity of sickness in the total population of patients. CMS calculates variable per month payments based on the levels of the ‘sick’ population. Some private payers are endorsing this approach, demanding that physician diagnosis coding ‘fits’ the matrix.
 
While some midwives during the fee-for-service era always went the extra mile to fully explain their diagnostic coding and process, many other providers, often because of billing staff time constraints, neglected to thoroughly document their diagnosis procedures. However, providers now risk facing claim denials with P4P programs if payer review staff is unsure that the doctor performed diagnostic services that were necessary to design a treatment plan.
 
Accurate and thorough coding for chronic conditions is another prime area of payer scrutiny. ICD-9 guidelines require providers to use these codes ‘as often as applicable’ when treating chronic conditions. P4P quality care evaluation depends on proper use of these codes. The penalty consequences of taking coding ‘shortcuts’ can result in lower income for the midwife.
 
These are some of the reasons that using accurate diagnosis codes are critical for maximum claim approvals and CMS decisions that physician care qualifies as meeting quality guidelines. The strong focus on procedural diagnostic coding accuracy is here—possibly affecting your compliance and income levels.
 
Accurate diagnosis coding, backed up by thorough documentation regarding the necessity of diagnostic procedures, is no longer a payer ‘luxury.’ Accuracy and clarity are now a necessity for all physicians. Achieving this result typically demands some combination of the following actions.

• Designing an almost foolproof internal procedure for billing staff or midwives to review all claim submissions for accurate diagnosis codes and supporting document clarity.
• Have experienced coders review EHR document derived diagnostic codes before submitting claims.
• Retaining a leading independent coding and documentation firm, to assume the responsibility of submitting accurate, clearly explained diagnostic procedure claims for you.
• Midwives developing the habit of fully documenting all diagnostic procedures for every patient, helping billing staff and payer reviewers to understand the reasons for the diagnosis process used.

 
Midwives and other healthcare practices using these tips should remain in HIPAA, CMS and P4P compliance, maintain or increase revenue and create evidence of delivering quality care to all patients. Properly using diagnosis codes and supporting your diagnostic procedures with valid documentation will achieve these results.

Reference

Diagnosis coding has taken center stage in medical billing. Coronis. (n.d.). Retrieved September 29, 2022, from https://www.coronishealth.com/blog/diagnosis-coding-has-taken-center-stage-in-medical-billing/ 

Insurance fraud is any act made to deceive an insurance procedure. It occurs when a claimant attempts to obtain some benefit or advantage they are not entitled to, or when an insurer knowingly denies some benefit that is due. It is also a deliberate deception perpetrated against or by an insurance company or agent for the purpose of financial gain. Fraud may be committed at different points by applicants, policyholders, third-party claimants, or professionals who provide services to claimants. Insurance agents and company employees may also commit insurance fraud. Common frauds include “padding,” or inflating claims; misrepresenting facts on an insurance application; submitting claims for injuries or damage that never occurred; and staging accidents.
​
People who commit insurance fraud include:

• organized criminals who steal large sums through fraudulent business activities,
• professionals and technicians who inflate service costs or charge for services not rendered, and
• ordinary people who want to cover their deductible or view filing a claim as an opportunity to

Inside the healthcare industry lies good opportunity for insurance fraud as well. Insurance fraud causes tens of billions of dollars in losses each year. It can raise health insurance premiums, expose you to unnecessary medical procedures, and increase taxes. If you’re in the healthcare industry, you must learn to identify what are the common types of healthcare and insurance fraud.
Common types of healthcare and insurance fraud:
1. Fraud Committed by Medical Providers

• Double billing: Submitting multiple claims for the same service
• Phantom billing: Billing for a service visit or supplies the patient never received
• Unbundling: Submitting multiple bills for the same service
• Upcoding: Billing for a more expensive service than the patient actually received
  

2. Fraud Committed by Patients and Other Individuals

• Bogus marketing: Convincing people to provide their health insurance identification number and other personal information to bill for non-rendered services, steal their identity, or enroll them in a fake benefit plan
• Identity theft/identity swapping: Using another person’s health insurance or allowing another person to use your insurance
• Impersonating a health care professional: Providing or billing for health services or equipment without a license
  

3. Fraud Involving Prescriptions

• Forgery: Creating or using forged prescriptions
• Diversion: Diverting legal prescriptions for illegal uses, such as selling your prescription medication
• Doctor shopping: Visiting multiple providers to get prescriptions for controlled substances or getting prescriptions from medical offices that engage in unethical practices

 
How to Prevent Insurance Fraud?
 
The Affordable Care Act of 2010 included fraud-fighting efforts, such as allowing the U.S. Department of Health and Human Services (HHS) to exclude providers who lie on their applications from enrolling in Medicare and Medicaid and the Improper Payments Elimination and Recovery Act, which requires agencies to conduct recovery audits for programs every three years and develop corrective action plans for preventing future fraud and waste.
Other efforts included:

• Implementing an Automated Provider Screening system to review enrollment applications;
• Allowing HHS to impose a temporary moratorium on newly enrolled providers or suppliers, if necessary to combat fraud;
• Authorizing the Centers for Medicare and Medicaid Services, in conjunction with the Office of the Inspector General, to suspend payments to providers or suppliers during the investigation of a credible allegation of fraud; and
• Ensuring that providers and suppliers found guilty of fraud in one of the Centers’ systems, such as Medicare, cannot have service privileges in another area, such as Medicaid, or within state programs.

 
Additionally, in 2012, HHS and the Department of Justice formed the National Fraud Prevention Partnership to combat health care fraud. The group also consists of private and public groups such as health care companies and their organizations, the National Association of Insurance Commissioners, the National Insurance Crime Bureau and the National Health Care Anti-Fraud Association. The groups will share information on claims from Medicare, Medicaid. and private insurance to be administered by a third-
party vendor.
 
Fraudulent acts have no escape with the law. Whether you’re a healthcare provider trying to slip away money from your clients, or a client who doesn’t one to compensate the services provided to you.  Either way, one must be vigilant enough to take part in protecting his/her right and preventing these things to happen.  Keep all your records intact and avoid providing your information to anyone asking for it. Always verify, verify, verify!
 
Reference

Background on: Insurance fraud. III. (n.d.). Retrieved June 18, 2022, from https://www.iii.org/article/background-on-insurance-fraud

Through the years, the field of midwifery as a profession has been the subject of a variety of misconceptions that can go as far as the idea of comparing midwives to quacks. Even today, the job of a midwife can be misinterpreted as simply helping births. Often times, midwives experience misconception about the true quality of service they provide, as it is not only vital for all women and newborns to access care – it is critical that this care is of a sufficient quality to provide a safe and positive childbirth experience, and that it is provided with respect and dignity.
 
Midwives should be recognized for the excellent the services they provide. It's not a flimsy hoax. There are a few reasons to believe it;

• The possibility of midwives for enhancing the quality-of-care 83 percent of all stillbirths, maternal deaths, and newborn deaths could be prevented with the full package of midwifery care (including family planning);
• 62 percent of successful practices within the scope of midwifery reveal the importance of optimizing the normal procedures of childbirth and early life and enabling girls to take care of themselves and their families;
• 56 maternal and neonatal results were found to be enhanced through midwifery philosophy and practice of care;
• 87 percent of service demand can be delivered by midwives when trained to international standards;
• 82% decrease in maternal mortality potential with universal midwifery policy
• Midwifery is related to more efficient utilization of resources and improved results when supplied by educated, trained, licensed, and regulated midwives in global standards. Midwifery is a ‘best buy’ investment;
• Midwifery is associated with decreased maternal and neonatal morbidity, decreased interventions in labor, enhanced psycho-social results, and increased contraceptive use and birth spacing
• Community-based midwives have been found to rank favorably for economy, efficiency, and effectiveness;
• Midwifery ought to be considered a core component of universal health care. Quality midwifery care is essential to achieving national and international priorities and securing the rights of women and newborn babies;
• Quality relates to the right for teens and women to the maximum standard of health and is interchangeable with women-centered care. Providing quality care is most effective through midwifery care for all childbearing women;
• There were no adverse effects associated with midwife-led care but important advantages, so it is suggested that all women should be provided midwife-driven continuity models of care;
• Midwives can provide excellent quality of care, but socio-cultural, professional, and economic barriers have to be overcome to practice to their full potential.
• Case loading midwifery care is safe and cost-effective.

 
Ways To Increase Awareness

1. Get a proclamation acknowledging this day from the local officials or governor. Make preparations to pick up local assertions yourself or send a representative of your company or a group of midwifery supporters. Try to get media coverage.
2. Plan a potluck dinner, a picnic in the park, or a rally for the families you’ve served. Think about opening it to the public and media (“come talk with a few homebirth families” or”come see why these families used a midwife”).
3. Have an Open House in your workplace. Invite the mayor, governor, or your legislator to your occasion. Invite local physicians, nurses, hospital administrators, and health officials. Have a demonstration ready describing the benefits of midwifery care.
4. Participate in a TV or radio talk-show or interview.
5. Organize a church ceremony or plant a tree at a local park to commemorate the day.
6. Office supply stores now have stationery items like greeting cards and postcards, which feed through your printer.
7. Create and distribute flyers about International Midwives’ Day and midwifery. Send out to the general public, legislators, policymakers, insurance companies, etc. Send legislators a “new constituent birth announcement.”
8. Have a gathering of midwives. Send all of the midwives a copy of your proclamation in your community if you can copy it on special paper. Frame it and take the regional midwife out to lunch and present her statement as an award. Call some customers to join you and invite the media to an (inexpensive, easy to arrange ) Award Ceremony in honor of the day.
9. Wear lapel ribbons representing the day (in Michigan, they wear pink and blue ribbons). Let folks at other meetings you attend understand that International Midwives Day is coming up. Take some ribbons together, distribute them, and ask people to wear them on May 5.
10. Send out Public Service Announcements to TV and local radio.
11. Prepare to have a display or a booth in a health or shopping mall, women’s, or children’s fairs.
12. Give excellent gifts to infants born on International Midwives’ Day. Send their pictures to the newspaper with birth news.

 
Midwifery is proficient, educated, and compassionate care for childbearing women, newborn babies, and families throughout the pre-pregnancy, pregnancy, childbirth, postpartum, and the early weeks of life. Indeed, midwives are valuable sector of the society and that they need to receive the recognition they deserve.

Reference

Barker, J. (2021, February 13). Midwives do not get the recognition they deserve! Blog About Midwives & Doulas. Retrieved September 30, 2022, from https://www.fruitfulwombs.com/midwives-do-not-get-the-recognition-they-deserve/#:~:text=The%20Pros%20For%20Midwifery%3A&text=Quality%20midwifery%20care%20is%20essential,interchangeable%20with%20women%2Dcentered%20care.