I spoke with the Maternity Care group that pays for AL Mediciad OB Global to ask how to bill them and was informed that the physician will have to bill the OB Global and the NP will need to be reimbursed from that office. I believe that we need to bill all payers this way.
We had an OB/GYN that left last July so all his patients had to transfer. I had to do a lot of antepartum billing for him. Certain payers such as BCBS denied the claims requiring me to list the Antepartum span dates from the First (New) OB visit to the last visit. Under this new set up, we will have overlapping dates of service between the two pactice locations. The NP will see the OB patients from the New OB until 20-24 weeks. The patient will go to the Physician’s office one time between 20-24 weeks then back to the NP. The patient will be treated by the NP until 35 weeks. At 35 weeks and after, they will go to the Physician’s office until delivery. Since we will have overlapping dates, I cannot enter these dates on the claim, since the claims will deny for overlapping services.
Originally, this was supposed to be Cash pay patients that only had Emergency Medicaid that would cover the delivery. We would charge a set cash price for each antepartum visit (at either office) and the physician would bill Mediciad for the Delivery. Our set up is fine in this situation.
Now, they are marketing to patient’s in the (rural) area that have insurnce and BCBS is a big provider in the area. This has now complicated the OB Global billing, since we have two separate locations under different NPI/Tax ID’s. Help!
I believe that all insurred patients should be billed by the physician and that office have a contract on what to reimburse the NP services for. I need confirmation for this, and I have a feeling that this type of set up has not been done before which makes setting up the charges and billing for this a bit challenging.
I appreciate any help I can get.
Rose Patterson :confused: