1. Basics of Insurance Billing
(or How do I dip my toe into the turbulent waters)

2. Verification of Benefits
You will need
Your Tax ID and/or your NPI
Patient Name and dob
Patient ID number and group number (sometimes needed)
Phone number of insurance from back of Patients insurance card*

3. Verification of Benefits:
Co insurance
Deductible
How much has been met?
When does the plan reset?
In Network vs Out of Network
Plan Reset
Max out of Pocket (MOOP!)
Prenatal care preventative?
Newborn coverage
Prior authorization needed?
In Network exception possible? How?

4. If prenatal care is covered under preventative:
Does NOT fall under deductible
A general rule of thumb is 30% of full rate

5. Let’s do the math! Patient responsibility
Global rate – deductible= X X * patient coinsurance% = Y Deductible + Y = patient responsibility

6. Wait. What?
Global rate: $10,000 Deductible: $2,000 Co-insurance: 20% $10,000 - $2,000 = $8,000 $8,000 x .20 = $1,600 $1,600 + $2,000 = $3,600 patient responsibility

7. If prenatal care is preventative
Global rate – 30% of global = X X– deductible= Z Z * patient coinsurance% = Y Deductible + Y = patient responsibility

8. Let’s do that again. Global rate: $10,000
Deductible: $2, Co-insurance: 20%
$10,000 x .30 = $3,000
(global x pn care)
$10,000 - $3,000 = $7,000
(global – pn care)
$7,000 -$2,000= $5,000
(new starting charge – deductible)
$5,000 * .20 = $1,000
(remaining fee * co insurance)
$2,000 + $1,000 = $3,000 patient responsibility

9. Variables:
MOOP (max out of pocket)
Newborn care not covered

10. Superbill What is a superbill? What ISN’T a superbill? Ease of billing
For the provider or the biller to submit a claim
What ISN’T a superbill?
Something that you give to clients for them to submit to insurance

11. Billing Global Midwifery code 59400
*Global Obstetrical Care includes antepartum, labor & deliver, and postpartum
Antepartum care: includes initial and subsequent history, physical exams, recording of weight, blood pressure, fetal heart tones, routine chemical (dipstick) urinalysis. Monthly visits up to 28weeks gestation, biweekly visits between 28 and 36 weeks gestation, and weekly visits until delivery.
Delivery: includes admission to facility, admission history and physical exam, management of uncomplicated labor, vaginal delivery (with or without episiotomy, with or without forceps.)
Postpartum Care: includes office visits following vaginal or cesarean delivery for 6 weeks post delivery

12. To bill Global you have to have seen your patient for 7+ prenatal visits, delivered the baby, and provide postpartum care

13. Codes Codes Description Number of Visits 59400 Global OB Care 1 visit
59409
Vaginal Delivery Only
59410
Delivery & PP Care
59425/59426
Global AP Care
1 visit each
99203/99204/99205
Office Visit
20 visits each
99213/99214/99215
99354/99355
Prolonged Care
99232
Hospital Visit/Care
20 visits
99356/99357
99349/99350

14. Newborn Codes Codes Description Number of Visits 99463/99460
Newborn exam at Birthing Center
1 visit each
99464
Birth assistant
1 visit
99212/99213
Office Visit
20 visits each
99348/99349
Home Visit

15. Facility Codes Codes Description Number of Visits 0724 – UB-O4 Form
Maternal Facility Service Payment
2 visits
0724 – UB-04 Form
Newborn Facility Service Payment
59409 – CMS-1500 Form

16. Diagnosis Codes Maternal Newborn
Z34.00 – First time mom unspecified gestational age
Z34.80 – supervision other normal pregnancy unspecified gestational age
O09.40 – supervision of grand multiparity with unspecified gestational age
O80.00 – encounter for full term uncomplicated delivery
Newborn
Z38.0 – single liveborn infant, delivered vaginally

17. Place codes
OFFICE – 11
HOME – 12
BIRTH CENTER - 25

18. What needs to be given to client to submit?
Tax ID
NPI
Service Address
DX code
Rendering Provider
Itemized coding with charges
Place of service

19. What you do is important
What you do takes dedication and time away from your family
What you do took years of schooling and time away from your family
YOU DESERVE TO BE PAID