1. OB Billing: Package v. Visit Billing OB services in the FQHC environment can be tricky as payers choose their payment methodology.

2. Objectives for this Session Explain OB Package Billing Discuss timing of posting the package Explain per visit OB Billing Partial Package billing and when its appropriate Best Practices Forms and Tools for OB Services

3. OB Package Billing Billing OB services in a package is the more traditional way of billing. Private practices OB clinics use this method (almost) exclusively. FQHC payment methodology creates options for CHCs.

4. How do I know? Private Insurances usually pay package Medicare ONLY pays package Medicaid varies state to state  If you are in a state with high managed care for Medicaid recipients, carriers may follow different models  Changes in patient eligibility may mean changes in methodology Patients can be billed package or per visit as long as you have FQHC status.

5. CHC Research Research o Who are your largest OB payers? o What method does each payer require? o Be prepared for payers to “misuse” CPT codes! Understand payers’ coding. o Payer rules will override CPT coding rules!

6. Payer Questionnaire

7. CHC Decisions Decisions o If your payers require a mix of methodologies, how will you bill your self pay and sliding fee patient populations? o Will your SFS differ for OB patients? o Later we’ll get to the decision of adding the package to your AR earlier or later in the process.

8. Pricing & Sliding OB Pricing: Delivery is 60% of the work in a package Price using usual method Test with other OB clinics in your area Partial package w/o del=40% of pkg Sliding: Slide the same as other medical services? Slide a max of 50% Set a nominal fee for the package

9. What is included in the package? Monthly visits to week 32 Bi-weekly visits from weeks 32 to 38 Weekly visits from weeks 38 to delivery Delivery Discharge from hospital Post partum visits –Two for vaginal delivery –Three for cesarean section delivery

10. What is NOT included in the package? Pregnancy test Lab work: hcg quants, glucose, triple test, genetic testing, Rh injection Ultrasounds Office visits for illness or injury not related to pregnancy Hospital visits for illness, injury, threatened or premature labor, or additional days stayed

11. Billing OB Packages Package cannot be billed until delivery – when majority of services are complete Enter a dummy code for initial billing of the package o OBSTD – for vaginal delivery o OBCSD – for planned cesarean delivery No charge visits for OV Bill charges for services not in package Decision: o Post package at beginning of services, AR ages throughout o Post package at delivery, AR ages from delivery

12. Pros and Cons of OB Package Posting at Start of Services Pros Patients can pay toward their package or portion Easy to track your OB business Better patient compliance with visits Cons Inflates AR for services in the future Mistaken filing prior to delivery Adjustments will be necessary if delivery method changes from what is initially billed

13. Pros and Cons of OB Package Posting at Delivery Pros Posted when majority of charges are due/delivered No adjustments for different delivery method Cons Patients often have ‘sticker shock’ No collections from patients throughout service delivery

14. OB per Visit Billing Billing per visit is an option because of the FQHC payment methodology Just as it sounds, you bill for each service provided Some payers require this type of billing Patients billed this method tend to attend fewer OB visits

15. Adding OB AR

16. When a Partial Package is Appropriate If your clinic doesn’t have doctors doing delivery at a hospital If the patient terminates, miscarries or is lost to follow up during care If you do prenatal and post partum services, don’t forget to bill for the post partum care.

17. Adjusting OB Billing Patient is self pay through OB care and gets e-med for delivery Patient is presumptive Medicaid eligibility at start of care Patient gets or loses insurance during pregnancy Be familiar with billing/coding: ie. laceration repair, placenta delivery only, precipitous nurse delivery, etc

18. Codes to Consider Building 99212OB, 99212OB NC, 99213OB, 99213OBNC 99212PP, 99212PPNC, 99213PP, 99213PPNC 59409, 59409NC 59514, 59514NC OBSTD, OBCSD For billing charge and no charge OB visits For billing charge and no charge Post Partum visits Both vag and c/s charge and no charge del Dummy code for package pmts

19. Additional Codes & Recap Vaginal Delivery Package 59400 C/S Delivery Package 59510 1-3 visits, post each visit (E/M) 4-6 visits, post 59425 7 or more visits, post 59426 These slides are in no way an exhaustive list of codes used for OB services. Please consult current CPT resources for additional codes relating to these services and other types of delivery.

20. Best Practices Educate patients – create materials and present to every OB patient Patient payment agreements on OB care – include allowing patients to pay toward OB directly (as opposed to oldest due) Build a case for delivery – UDS information

21. More Best Practices Staff (OB Specialist) follow OB patient from positive pregnancy test through outcome of delivery, PP care –Education - explain services, explain costs –Accountability – is patient making visits, payments, need additional care –Follow up – outcome of delivery, transfers, lost to follow up, UDS data capture

22. Forms and Tools Form to explain the package OB Payment Agreement Estimation tool to help staff estimate costs and payments Greatest tool is to have an OB Specialist build a relationship with the OB patients http://www.acog.org/

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