Work out an arrangement with the insurers
Daniele23,
How has the group being merged in reported the pregancies "in process" to the various insurers up to now? And, ignoring the merger aspect for a moment, how do insurers pay for the global, all at the end or incrementally over the pregnancy?
The accountant in me would argue for working out an arrangement with the insurers. If you're proactive, you probably can get them to agree to a single, unified plan. You want to avoid having to craft "n" plans one for each of the "n" different insurers where your OB patients have coverage.
Such an arrangement might include the following points for allocation of billings.
- Allocate between the two organizations using the RVUs of CPTs as follows:
- 59425, 59409, & 59426 to split the billing of 59400 (vaginal delivery global) and
- 59425, 59514, & 59426 to split the billing of 59510 (cesarean delivery global).
To the extent antepartum or postpartum care period of a pregnancy overlaps the merger date, I would use the relative amounts of time each group handled care in the period to further refine the allocations for that period.
Using this methodology, the insurers will pay no more than if only one group had handled a pregnancy.
And giving the insurers each a copy of the Excel worksheet with the allocation computations and underlying data on it should make this smooth for everyone.
Finally, I'd have each organizatio bill for its share of the total. This should satisfy the insurer's concern about keeping the IRS happy (no artifical shifting of income between separate tax entities, and each side gets its fair share). And the insurers should also be happy. And, it probably will satisfy the doctors of each group, as well.
I hope this helps you.
