Wiki billing for delivery DR didn't attend?

jesicat

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I am at an FQHC Indian Health Facility for general family practice. One of my new providers who will be providing OB care is wanting me to bill for a delivery that she was not present for. I have never done OB coding or billing before but it seems wrong to me. Apparently she is part of a group outside of our facility and one of her patients delivered while a different provider was on call. My provider wants me to bill for the other DR so that we can pay her? I am so confused by this. Can anyone help me?
 
OB billing

It may sound confusing to be billing for a physician that was being covered by another "on call". There are a lot of factors to be considered. Do they belong to the same group and the patient is of that group? How does the insurance company want it billed? What is their "on call" group coverage structure?
since OB deliveries are global fee structures, the majority of the payment is settled on the delivery and aftercare. If the insurance requires that you breakdown the charges you would have a charge for the prenatal care (59425 (4-6 visits) or 59426 (7 or more visits)). This would be charged by the physician that saw the patient only for prenatal visits. The physician that did the actual delivery would bill for the type of delivery and if appropriate, aftercare. If that physician does not provide the postpartum care there is another charge. It is a billing nightmare. So the insurance company accepts the global charge made by the physician that was seeing the patient but was not on call for the actual delivery. 59400, 59610, 59510 or 59618, etc. It is not fraudulent to bill this under the physician that was actually seeing the patient for the pregnancy. I have been billing OB/GYN services since 1982 and believe me trying to get paid for a complete breakdown by multiple providers in the same practice is not practical and the insurance companies feel that the physicians in the same practice and same specialty act as one in a case like yours.
Good luck.
 
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