Wiki OB/GYN Question

[shellott]

I am wondering if any one has experianced a Health Insurer applying payer discount or denying a submitted code and then addding and paying on a similar code.

Example: Pt. changed insurance late in the pregnancy and we billed the new insurer for the delivery and postpartum care only and they denied the 59410 and added 59400 to our claim and paid that code.

I am wondering if this occurs alot with OB/GYN claims due to payer policies and if this happens to other procedures as I deal with multiple specialties. Any thought would be appriciated. Thanks Shellott

 

[amjordan]

Yes, this happens frequently. What will help is to contact your major companies and ask them for the following;

OB Global Policy
Multiple Delivery Policy
Split or Transfer of Care Billing Policy

Some of this information is actually posted online by some of the large companies. If not, contact your Provider Rep and ask for this information. This will provide you with a good base to work from and you will have the information in writing.

We recently has a case where the patient had an insurance change and had one antepartum visit on the new insurance and then delivered. We billed out 1 E/M and the then the delivery w/postpartum and they paid global. Upon calling the company, we learned that since the insurance change was due to her employer switching coverage the new insurance was covering the entire pregnancy. This is not the case for all carriers, so it helps to do a little work up front.