Referral in the most basic understanding is a written order from the primary care specialist to see another specialist and get the patient certain medical services. In many Health Maintenance Organizations (HMOs), the patients need to get a referral before they can get medical care from anyone except their primary care doctor. If they don’t get a referral first, the plan may not pay for your services. Referrals are required by some insurance providers to ensure that the patient will receive accurate service from the right people.
Patient referral is a common and important medical practice. Sometimes, a patient’s condition is outside a physician’s area of expertise, and the physician needs to refer the patient to a specialist who is more knowledgeable about or experienced in treating the condition. In the United States, for example, doctors refer one in every three patients to a specialist each year. Every referral is meant to ensure the best outcome for the patient. How to Get a Physician Referral Historically, physicians have known that in reporting a consultation service, the three R’s must be documented: Request, Render, and Report. Starting in 2006, CPT requirements have included one more R requirement: a Reason. There must be a request for consulting services from another physician or health care provider, the suspected or known diagnosis requires determination by a specialist who renders his / her opinion, the referring physician and consultant specifies a reason for the consultation, the treatment is undetermined or may be known, and a written report to the requesting physician or referring source reiterating the reason for consultation plus the findings and opinions must be forwarded by the consultant. In most cases, a consultation is a one – time visit. A New Patient Referral usually has an identified problem which requires a specialist to provide care, and does not require that a written report be sent to the requesting physician or health care provider. The policy changes or clarifications also state that a transfer of care occurs when a physician requests another doctor to assume the care of the patient. Ongoing management of the patient by the consultant physician cannot be reported using a consultation service code. Therefore, a referral for evaluation and management (E/M) cannot be considered a consultation because there has been a transfer of care. There also has been concern regarding language that the consulting physician must document the request and reason for the consultation in the patient’s medical record. Without that documentation, the CPT code for a consultation could not be used. However, according to the E/M documentation guidelines, the consulting physician is not required to confirm that the requesting physician documents his / her request. The documentation criteria for a consultation service requires that the requesting physician and consulting physician both document the request for consultation in their medical records, but each physician is required to keep their own accurate records and code accordingly. In the revised Medicare Claims Processing Manual, the section which discusses consultation followed by treatment, there are also rules governing those occasions when it may be necessary for the consulting physician to assume ongoing care of the patient. It should be emphasized that the above guidelines differentiating a Consultation from a New Patient Referral apply primarily to Medicare patients. Currently it appears that non – Medicare payers have not yet implemented these regulations. Understanding each of these processes and how to determine what is required by the insurance is key to avoiding lost revenue and negatively impacting patients financially. Having knowledgeable support staff in the area of preservice is crucial to any organization. The return on investment in insurance reimbursement and patient experience alone is worth the cost of having this expertise at your institution. References and Useful Links Lori. (n.d.). New Patient Consultation and new patient referral – what is the difference. Medicare Payment, Reimbursement, CPT code, ICD, Denial Guidelines. Retrieved August 6, 2022, from https://medicarepaymentandreimbursement.com/2010/10/new-patient-consultation-and-new.html PatientPop. (2022, April 20). When and how to refer patients to a fellow physician. PatientPop. Retrieved August 6, 2022, from https://www.patientpop.com/blog/physician-to-physician-referrals-reducing-liability-and-improving-patient-care/ The Center of Medicaid and Medicare Services (CMS) form 1500 must be used to bill SFHP for medical services. The form is used by Physicians and Allied Health Professionals to submit claims for medical services. All items must be completed unless otherwise noted in these instructions. A CMS 1500 with field descriptions and instructions is included in the link below: https://www.sfhp.org/wp-content/files/providers/forms/Instructions_for_CMS_1500_Claim_Form.pdf Billing plays a vital role to keep your business running. It determines your capacity as a business owner to make your cash flow intact avoiding the business to collapse. While you continue to create greater impact, your business will continue to prosper if you know how to manage your finances carefully. From record keeping, cash in and cash out, invoice, giving statement and collection, billing takes place. It requires enough expertise to keep tracking all of these because inaccurate billing can cause serious problems. In the absence of accurate and reliable billing, major distractions to expected liquidity can ruin reinvestment plans, and in extreme cases put operations at risk.
Owning and billing for your own midwifery practice helps you and your practice in numerous ways. It gives you the opportunity to offer outstanding midwifery care, exactly how you envisioned your practice to be. It provides you the freedom and flexibility to manage your finances and cash flow. However, like most of us desire to simply manage the in and out of our practices’ revenue and profitability, reality hits that this is beyond what we envisioned. In reality, it is not easy to crawl down tracking all the records, keeping all the collections, updating codes and description, managing finances, and all other aspects that are involved in billing and coding. Not to mention you being busy as the expert of your own practice, your business will cripple if you can’t manage these factors properly. Time will surely come that you will question yourself how you may be able to get out of that duty. To prevent that from happening, you should know how to assess your business’ needs. Are you capable of doing billing tasks on your own? Or is it time to ask for help from the experts? Here’s what you need to do to assess your practice further. Assess Your Practice To find out what the best choice is for your business, ask yourself these questions about your billing process, staff, physical space, and plans for the future:
Assessing your own practice by answering this set of questions will help you understand the needs of your practice. If you answered YES to most of the questions, then outsourcing will be good for you. Outsourcing by means of hiring medical billers and bringing in their expertise to your practice. However, if you answered NO to most of the questions stated, then keeping your billing operations within your practice is the best choice for you. There are a lot of great benefits if you choose to hire an expert biller like Midwives Advantage but choosing to keep your billing procedures in-house is not a bad idea either. You have to simply weigh the needs of your practice. Reference To hire or not to hire billing service. (n.d.). Retrieved August 5, 2022, from https://www.kareo.com/documents/to-hire-or-not-to-hire-billing-service.pdf Healthcare system in the United States is very complex. Before the patient decides to see a specialist, the first question that needs to be answered is if he/she has health insurance. There’s a huge variety of group health insurance plans offered through employers, but the system also includes Medicare, Medicaid, the Veterans Health Administration system, and individual plans offered through the insurance markets set up by the Affordable Care Act. The kind of insurance that your patient has can directly influence how much your patient pays for healthcare and what doctors or specialists he/she is permitted to see. This is why health insurance providers are a lot more complicated than any other type of insurance. Over time it gets more complicated as new laws, regulations, court cases and differing opinions start to add complexity.
To ensure that a client's insurance provider will pay up all the required medication and treatment, doctors and other medical professionals require prior authorization to their clients. Under some medical and prescription drug plans, treatments and medications may need approval from the health insurance provider before you provide care. Prior authorization is usually required if your client needs a complex treatment or prescription. Coverage will not happen without it. One reason why health insurance providers require this type of document before proceeding with different medical procedures is that a less expensive treatment option may be sufficient rather than simply defaulting to the most expensive option. To make sure that reimbursement will not be denied and that you will receive proper compensation, this document must be secured prior to giving your client the required procedure. How to Get Prior Authorization? If you’re in-network to your patient’s insurance coverage, then you have to prepare the necessary documents for your patient. Prior-authorization procedures are different from every insurance provider. Submission of Prior Authorization Request You submit your pre-authorization request by mail or fax. Many authorization companies provide Prior Authorization Request Form (both offline and online) to submit written pre-authorization. Every insurance company has its own requirements for pre-authorization requests. However, you should include the following information in all types of requests.
How Long Do Prior Authorizations Take?
The process of obtaining and maintaining prior authorizations is vital to the success of any medical practice. Overall, the prior authorization process impacts almost every aspect of the revenue cycle and operations of your medical practice. HOW TO REQUEST A GAP EXCEPTION/ PRIOR AUTHORIZATION FOR OUT OF NETWORK CARE How to request a gap exception/ prior authorization for out of network ... (n.d.). Retrieved August 6, 2022, from https://favoredmedicalbilling.com/forms/GAP_Request_Guide_for_Midwives_and_Birth_Centers.pdf References Lower burden with outsource prior authorization: Drcatalyst. English. (n.d.). Retrieved August 6, 2022, from https://www.drcatalyst.com/importance-of-prior-authorization Prior authorization. Santa Clara Family Health Plan. (n.d.). Retrieved August 6, 2022, from https://www.scfhp.com/for-providers/provider-resources/prior-authorization/ Clements, J. (2022, July 14). What is prior authorization? when is it needed and not? Outsource Strategies International. Retrieved August 6, 2022, from https://www.outsourcestrategies.com/blog/what-is-prior-authorization-when-is-it-needed-and-not/ Each profession has its own jargon. The language used specifically in a communicative context and may not be well understood outside that context. Language that is understood by the people within specific areas of expertise. Medical codes are the universal language of understanding between payers and providers and hence used for communication and billing purposes. The financial criticality for both payers and providers mean that providers have to be compliant and accurate in coding for medical treatment provided.
To enter into the medical field, specifically midwifery, one must have enough knowledge and understanding with medical codes. Codes and descriptions that play a vital role in the billing procedures of all medical services rendered. Having the proper medical coding ensures that insurers have all the diagnostic codes required for appropriate payment. In this article, we will have a closer understanding in dealing with CPT codes, diagnostic codes and service locations. What is CPT Code? The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency. Administrative management purposes, such as claims processing and developing guidelines for medical care review, also use CPT codes. The CPT terminology is the most widely accepted medical nomenclature used across the country to report medical, surgical, radiology, laboratory, anesthesiology, genomic sequencing, evaluation and management (E/M) services under public and private health insurance programs. All CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have a common understanding across the clinical health care paradigm. What is Diagnostic Code? In healthcare, diagnosis codes are used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnostic coding is the translation of written descriptions of diseases, illnesses and injuries into codes from a particular classification. In medical classification, diagnosis codes are used as part of the clinical coding process alongside intervention codes. Both diagnosis and intervention codes are assigned by a health professional trained in medical classification such as a clinical coder. As the knowledge of health and medical advances arise, the diagnostic codes are generally revised and updated to match the most up to date current body of knowledge in the field of health. The codes may be quite frequently revised as new knowledge is attained. What are Service Locations? A service location is where services are rendered to a patient. This can be a hospital, the provider's office, or a nursing home, for example. In medical billing, service location is presented through the place of service (POS) dodes. Place of service codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintain POS codes used throughout the health care industry. Here’s the complete Place of Service (POS) Codes lists CPT Codes, diagnostic codes and service locations are three different coding classifications used in diverse areas. Healthcare is highly regulated, therefore understanding these three factors are very important. Although it may seem overwhelming with the number of codes you might need to use, the terminologies you might encounter every once in a while, when you have a basic understanding of them, you’ll have the foundation you need to start billing insurance in your private practice. Now you’ll have the opportunity to open up care to more clients, grow your practice and your impact. References Hazelwood, A (2005). ICD-9-CM Diagnostic Coding and Reimbursement for Physician Services 2006 Edition (PDF). United States of America: American Health Information Management Association. p. 2. Archived from the original (PDF) on 2013-07-18. Retrieved 2013-05-27. M, M. (2021, December 3). Revisiting the basics: Understanding medical coding. Medical Billing Wholesalers. Retrieved August 5, 2022, from https://www.medicalbillingwholesalers.com/the-revenue-cycle-blog/revisiting-the-basics-understanding-medical-coding#:~:text=Medical%20Codes%20are%20the%20universal,Coding%20for%20medical%20treatment%20provided. Place of service codes. CMS. (n.d.). Retrieved August 5, 2022, from https://www.cms.gov/Medicare/Coding/place-of-service-codes In this hastily developing healthcare setting around the US, employers need trained professionals to help them manage the inevitability of changes, maintain compliance, and preserve profitability. Billing is a complicated matter that only trained and skilled people can do. Its importance is often overlooked most especially in the healthcare industry as professionals in this field tend to focus on giving proper care and services to the patients that is why administrative tasks like this are not their priority. This happens most likely to midwives and other birth professionals. Some individual practice owners don’t have enough time to crawl out keeping track of all the records, collecting payments, managing cash flows. Hence, a medical biller is the one that can save the day.
A medical biller is a trained professional who submits bills to patients and/or health insurance companies and follows up to make sure the healthcare provider receives payment for the services. When the medical biller receives a claim for the healthcare services, it’s represented by a code, and it’s the medical biller who translates it into a claim. It’s the medical biller’s responsibility to follow up on the bill until the provider has the final reimbursement. Like any other profession, Medical Billers are compensated well. As they perform crucial tasks, they are paid more. On average, medical coders (certified and non-certified) make $54,797 annually. Medical billers and coders without certification earn approximately $47,200 per year while certified coding and billing specialists make an average annual salary of $60,097 — 27% more than their non-certified colleagues. The Medical Coding and Billing Salary Survey demonstrates once again that certification pays. The average salary for professional coders with two credentials rises to $64,712. Billing and coding specialists with three or more credentials earn approximately $69,942 per year. In addition to competitive salaries and standard employment benefits, many employers also offer paid professional association dues and paid continuing education. Full or partial coverage of continuing education is particularly valuable, given the correlation between salary and medical coding credentials. Other variables that weigh into the salary equation include experience, specialty/medical field, employer type, and location. The price you pay for a biller varies greatly from hourly rate, commission, scope of work specific charges, or salaried. When determining if the price is fair for the services, determine the return on investment that cost if bringing in to your practice. If this biller is really good and brings you in far more money for a quicker reimbursement time, paying them more makes a lot of sense to do. Hiring the experts and the national bests will costs you more, but get you far better results in the end. References Aapc. (2022, February 9). Medical coding salary survey. AAPC. Retrieved August 5, 2022, from https://www.aapc.com/resources/research/medical-coding-salary-survey/ Pettigrew. (2021, May 7). The growing importance and value of medical billing services. PETTIGREW. Retrieved August 5, 2022, from https://www.pettigrewmedical.com/the-growing-importance-and-value-of-medical-billing-services/ What is a medical biller? The Best Health Degrees. (2022, April 25). Retrieved August 6, 2022, from https://www.besthealthdegrees.com/faq/what-is-a-medical-biller/ Medical billing is a series of complicated matters that requires enormous amounts of effort and understanding to perform. It contains different codes and descriptions that are intended to determine and facilitate payment and collection to keep your practice operational.
If you're aiming to dig into medical billing, whether you want to add it onto your skills or if you decide to hire an expert in medical billing, it is important to understand the nature of the job in different types of facilities. In the medical and midwifery world, codes work differently. Countless codes that need to be updated from time to time. There are ICD Codes, CPT Codes, HCPCS Codes, DRG Codes, Modifiers, etc. Each code has different usage and transcriptions that are used and designed within specific diagnostics. In this article, we will be discussing how professional fee and facility CPT codes differ from each other. Professional and facility coding describe two very diverse aspects of the healthcare industry. Simply speaking, professional fee coding is the billing for the physicians and the experts. The facility coding is billing for the facility and the equipment. Professional codes primarily capture the complexity and intensity of provider care provided during a visit, facility codes detail the volume and intensity of hospital or health system resources used to deliver patient care, such as the use of medical equipment, medication, and nursing staff. What is a Professional Fee Code? Professional fee, refers to coding and billing the physician side of a patient encounter. Professional fee coding covers the work performed by the provider and the reimbursement they will receive for the medical services performed. In general, midwives and midwife-led birth centers offer standard pregnancy care packages. This package covers the professional fee, all prenatal visits, labor and delivery care in a birth center, at home, or in a hospital, birth kits, newborn care and assessment, postnatal visits at two and six weeks postpartum, and phone consultations. On average, a midwife's basic maternity care package ranges from $3,000 to $6,000 for normal low-risk pregnancies. This can vary depending on the location or state where your practice is located. The basic package cost usually comprises prenatal visits, labor and delivery care, and postnatal visits. To know more about midwifery reimbursement rates, here is a sample professional fee for CNMs and CMS MEDICAID FEE-FOR-SERVICE REIMBURSEMENT RATES FOR CNMs and CMs as of September 2013 What is the Facility Fee Code? A facility fee is a charge that you may have to pay when you see a physician or a midwife at a clinic that is not owned by that physician or midwife. Facility fees are charged in addition to any other charges for the visit. Facility fees are often charged at clinics that are owned by hospitals to cover the costs of maintaining that facility Hospitals, hospital-based facilities (such as outpatient clinics owned by a hospital), and various other medical facilities often charge a facility fee as well as the provider's professional fees. CMS regulations do not establish a general definition of “facility fee,” but CMS sets reimbursement rates for these fees subject to various requirements set forth below. The facility fee covers overhead costs, such as equipment, space, and support staff. This fee is sometimes referred to as the technical component of the bill. Under the CMS “provider-based status” rules, Medicare will reimburse for facility fees at a hospital-based facility (such a group practice owned by the hospital) meeting certain requirements but not at providers' offices not affiliated with a hospital. A facility or practice has provider-based status and thus can bill for facility fees it if has a relationship with the main provider (i.e., the hospital) concerning a range of issues, such as licensure, clinical and financial integration with the hospital, public awareness, and billing practices. The regulations specify payment recovery procedures if a hospital inappropriately treats a facility as provider-based. Facility Claim A single facility claim is submitted for all services provided to the patient on that date. ● Condition code is submitted in the claim header, letting the payer know that the evaluation and management (E/M) codes are distinct, potentially reimbursable services, and not duplicates. ● The occurrence code and occurrence date at the header level indicates some of the services were related to an accident, which lets the payer know other medical coverage may apply for the services on the claim. ● Revenue codes indicate the facility department or area ● HCPCS Level II/CPT® codes ● Diagnosis codes appear at the header level, not tied to a particular line In order to bill the facility fees, the hospital or facility like a birth center should already have criteria for the codes they use. The Centers for Medicare and Medicaid Services does not specify these criteria, but expects them to form a bell-shaped curve. If the hospital has not established these guidelines, they could use and modify the suggestions published by the American College of Emergency Physicians, available at https://www.acep.org/administration/reimbursement/ed-facility-level-coding-guidelines/ Also visit https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/ambulatory-care/Facility-Billing.pdf Your practice will rely mainly on your cash flow. Professional fees and facility fees are the top two revenue streams of your business. Your clients must pay you with your expertise same with the facility you have been using to provide quality of service. As a practice owner, if you happen to create a unique system that collects these two types of fees and utilize it methodically, then you are on the right track and that is for sure. References Renee Dustman. (2015, February 1). Compare and contrast physician and outpatient facility coding. AAPC Knowledge Center. Retrieved August 6, 2022, from https://www.aapc.com/blog/29346-compare-and-contrast-physician-and-outpatient-facility-coding/ James Orlando, A. A. (n.d.). Facility fees and Accountable Care Organizations. Retrieved August 6, 2022, from https://www.cga.ct.gov/2014/rpt/2014-R-0238.htm Understanding facility fees - the Alliance. (n.d.). Retrieved August 6, 2022, from https://the-alliance.org/wp-content/uploads/2021/05/TheAlliance_FacilityFees2021_EE_UnderstadningFees_6152021.pdf One of the most common mistakes in medical billing is the failure of accurate verification of insurance claims. Insurance verification is the topmost significant step in the medical billing and coding process. Before you provide midwifery care to your clients, you have to verify if the patient’s healthcare benefits will cover up all the medical procedures needed. Presently, the healthcare industry continues to shift into many complex settings that require closer attention in validating insurance coverage, patient benefits, deductibles and copayments.
Every successful billing merely depends on the success of eligibility verification. In a brief summary, health insurance verification is the process of checking a patient’s active coverage with the insurance company. It also verifies the eligibility of a patient's insurance claims. Checking your patient's insurance benefits BEFORE the patient is seen should be a fundamental part of your practice's administrative process. Otherwise, you run the risk of claims being denied and left unpaid. You don't always have the right to appeal or bill your patient which is why it is so important to know the patient's insurance benefits before treatment begins. When checking benefits, be sure to ask the right questions. 1. What is the patient's financial responsibility?
2. Does this patient have visit limits?
3. "Is this a plan year or calendar year?"
4. "Is a referral or authorization required?"
If your administrative process does not include checking patient benefits before the patient is seen, your revenue cycle management is hindered from the start. Accurate insurance verification ensures a higher number of clean claims which speeds up approval and results in a faster billing cycle. Inadequate verification of eligibility and plan-specific benefits puts healthcare organizations at risk for claim rejections, denials, and bad debt. Always pay attention to the documents submitted and be scrupulous in receiving the data needed for your service reimbursement. Reference Ramsey, D. (n.d.). The 5 most important questions to ask when checking benefits. Account Matters Blog. Retrieved August 5, 2022, from https://blog.accountmattersma.com/5-important-questions-to-ask-when-checking-benefits If you are a midwife running a private practice, you know that billing and insurance claims can be a major hassle. Not only is it time-consuming, but it can also be very confusing. It can even distract you from patient care. This is why many medical practices are outsourcing their medical billing. Outsourcing can save you time and money, and it can also help improve your bottom line. In this blog post, we will discuss 15 reasons why you should outsource your medical billing.
1. Time SavingsOne of the biggest reasons to outsource your medical billing is time. When you outsource your medical billing, you can free up time that you would normally spend on billing and insurance claims. This extra time can be used to see more patients, work on other aspects of your practice, or take a much-needed break! 2. Money SavingsAnother great reason to outsource your medical billing is for the money savings. When you outsource your medical billing, you can save money on office staff costs, office space, and supplies. You can also save money on medical billing software and hardware because the medical billing company will take care of that. Outsourcing medical billing services can also help you save money on collections. When you outsource your medical billing, you can have a team of experts from the medical billing company working on collecting so that you can focus on seeing patients. 3. Improved Bottom LineOutsourcing medical billing services can improve your financial performance. This is because a medical billing service can help you save money on in house employees and overhead expenses. In addition to these reduced costs, outsourcing medical billing can help you get paid faster! How? When you hire medical billing services, you can take advantage of the latest technology and software and their revenue cycle management expertise. This means that your claims will be processed faster, you will get paid sooner, and your cash flow will be stable. 4. Reduced StressOne of the best reasons to hire medical billing services is for the reduced stress. When you outsource your medical billing, you can rest assured that your billing and insurance claims are being handled by a team of professionals from a medical billing company. This can take a lot of the stress off of you and allow you to focus on seeing clients. 5. Increased AccuracyUsing an in house billing team can result in more billing errors because your staff may not be as experienced or may not have the time to focus on billing. When you outsource your medical billing, you can increase the accuracy of your billing and insurance claims. This is because you will have a team of experts from the medical billing company working on your claims. They will make sure that all of the information is correct and that your claims are filed correctly. This can help you avoid billing errors and save you a lot of time and money in the long run. 6. TimelinessAnother great reason to outsource your medical billing is for the timeliness. Medical billing services use the latest technology and software, so choosing to outsource billing means that your claims will be processed faster and you will get paid in a timely manner. 7. Easier Access to Billing and Insurance InformationWhen you outsource your medical billing, you will have easier access to billing and insurance information. This is because the team of medical billing services experts will be handling all of the claims and paperwork for you. This can save you a lot of time when you need to access this information. 8. Reduced Chance of Fraudulent ActivityOutsourced billing services can reduce the chance of fraudulent activity. This is because the outsourced billing team is made up of experts who know the ins and outs of the medical billing process. This outsourced billing team will be handling all of the claims and paperwork for you. They will be able to spot any red flags or suspicious activity. 9. Stay Up-to-Date EffortlesslyOne of the many things that can affect reimbursement is changes in coding. By outsourcing medical billing services, you can be sure that the team of experts from the medical billing company will stay updated on the latest coding changes. This way, you can be assured that your claims will be processed correctly. 10. Continued Support and TrainingOutsourcing medical billing will also allow you to receive support and training. This is because the team of experts will be available to answer any questions that you have on the medical billing process. They will also provide ongoing training so that you can stay updated on the latest changes in the industry. 11. Higher Staff MoraleYour own team can be bogged down by the mundane tasks of billing and insurance claims. This can lead to low morale among your in house staff. When you outsource your medical billing, you can free up your in house team to focus on more important tasks. This can lead to higher morale among your staff and a more positive work environment. 12. More Time to Focus on PatientsWhen you outsource your medical billing, you can focus on providing the best possible care for your patients. This is because outsourced medical billing services will allow you to have more time to spend on patient care and less time spent on billing. This is why medical billing services play such an important role in any midwifery practice 13. Higher Patient SatisfactionPatient satisfaction is important for any healthcare organization. When you outsource your medical billing, you can focus on providing the best possible care for your patients. This can lead to improved patient satisfaction and a better reputation for your organization. 14. Better Use of Your TimeAs a busy midwife, you likely do not have the time to focus on billing and insurance claims. When you outsource your medical billing, you can use your time more efficiently by focusing on other aspects of your practice. Not having to worry about your billing needs can give you more time to focus on your practice’s growth strategy, such as how to gain more revenue, improve your services, and your organization’s success. This can improve your decision making process so you can focus on your key performance indicators and set up your medical practice for success. 15. Increased Income Due to Proper Follow-Ups40% of many midwives' income is due to proper follow-up with the insurance companies. Getting the correct payments is crucial when it comes to billing and your income. Just by simply following proper follow-up procedures you can insure that you will receive the right amount that are due. ConclusionHealthcare is an ever changing industry with increasing demands. Medical billing companies can help you achieve success as you look out for your patients’ interests. There are many reasons why you should outsource your medical billing. Outsourced medical billing can save you time and money so you can focus on treating patients. In this blog post, we discussed reasons why you should outsource your medical billing. It is important to find the right medical billing company that will understand your organization’s specific needs so they can provide a customized solution. Our team of billing experts has the experience and know-how to help you outsource your medical billing so you can focus on what’s important — patient care. If you are considering hiring medical billing services, we encourage you to contact us today! We would be happy to discuss how we can help you save time, save money AND make you more money. https://medicalbillingauthority.com/15-reasons-why-you-should-outsource-your-medical-billing/ Stacy Carruth, CPM delivered her first child in a hospital in 1983 and had the rest of her children at home with midwives. She started her midwifery education in 1992. Stacy has been the administrator of two state-licensed birth centers and attended well over a thousand deliveries over the last 30 years.
Stacy used several highly recommended third-party billers to file insurance claims, and the results were the same: "Homebirth or birth centers are not a covered service. Midwives are not recognized as healthcare providers." The list of reasons to deny claims goes on. It wasn't fair that insurance would pay for a hospital birth but refused to pay for birth centers or home births. Stacy had personal experience with the injustice of insurance and homebirth. Her husband was a federal employee, and they had excellent insurance. If she had delivered in a hospital, her co-pay was $200. Since she delivered at home, Stacy paid thousands to her midwives, and the insurance paid nothing. Someone had to conquer this injustice; as a mother and a midwife, Stacy was the perfect person for this mission. In 2009, Stacy was introduced to an attorney that won a $180M settlement from United Healthcare and a $120M settlement from Aetna for underpaying out-of-network claims. After that, physicians wanted him to terminate their in-network contracts because of the low-paying fee schedules. He formed Edge Medical Solutions, Inc. to submit out-of-network insurance claims for orthopedic surgeons, obstetricians, physical therapists, surgical first assistants, and family practice doctors. Shortly after they met, he told her about an upcoming meeting to negotiate out-of-network agreements for Edge Medical Solutions with several hundred insurance companies. Stacy knew this was something she needed to be a part of and was the first midwife to join Edge Medical Solutions. Stacy had tried everything else to get claims paid; this was worth a try. The attorney didn't have high expectations for the claims, even with his Edge Medical agreements. She filed several claims for deliveries, and to their surprise, big checks started rolling in. After seeing the money Stacy was making, the attorney asked her how many midwives attended home and birth center deliveries. He was surprised when Stacy told him there are thousands of midwives, and out-of-hospital births are very popular. The attorney had a brilliant idea for a new company, and National Birth Centers, Inc. was born. They incorporated his knowledge from years of experience as an attorney and Stacy's knowledge from years of experience as a midwife. They formed a nationwide business that focused solely on getting birth centers and home birth midwives paid by insurance companies. Through their system, midwives become contracted providers of National Birth Centers. They submitted claims to the insurance company with the midwife as the attending provider, and these claims were paid under the company's established agreements. They built National Birth Centers, Inc from 2009 until 2011. In the Fall of 2011, the attorney called Stacy into his office and told her he wasn't making the money he had anticipated with the midwifery billing venture, and he was closing the business. They had come so far in billing for midwives, and Stacy knew more midwives needed this service. She couldn't let the momentum die. With his blessing, Stacy continued the business, and she has continued to a unique realm of billing for midwives. Today, Stacy Carruth, CPM is proud to say that midwives in 38 states have realized the benefits of getting paid the Midwives Advantage way! Empowering Midwifery Education has an amazing online course for midwives around all the billable services to process with insurance companies. The midwifery billing and coding course is packed with over twelve hours of videos, resources, and tools to help any midwife with setting up billing insurance plan with their private practices. We start with basics of billing and coding like ICD 10 codes, CPT codes, and POS codes typically billed by midwives to insurance companies. There are hours of content about billing in or out of network coverage to plan, how to negotiate with insurance companies, creating financial policies, and outstanding patient balances. So much is covered in this affordable, valuable resource to any midwifery practice. Be one step ahead of the insurance billing curve and take this course to advance your practice to the next level of success!
There are over 15hrs of content available! Enjoy the lifetime access to dive deep into specific professional services that midwives can bill for part of their scope of practice (maternity care, newborn care, gynecological services, well women care, contraception, primary care, & telemedicine). This is by far the most comprehensive billing and coding training for midwives out there! Comprehensive Billing and Coding for Midwives | Empowering Midwifery (teachable.com) |
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