Wiki OB PHYSICIAN SERVICES WITH MEDICARE AS PRIMARY PAYER

[baskiles]

Hello All, need some direction-- we have a new OB patient with Medicare as the primary payer. We will bill physician services for mom's antepartum, delievery and post partem follow up once baby is delivered - the global charge- 59400 and/or as appropriate for our services. We have had a hard time in the past getting our claims through Medicare--- how is this done? We are an FQHC facility as well. Any insight- has anyone billed Medicare for the physician's services of an OB global charge?

 

[Cmama12]

Hi, can you be more specific? Your charges are being denied? What do the denials say? We bill global if appropriate for Medicare.

 

[nielynco]

Hello All, need some direction-- we have a new OB patient with Medicare as the primary payer. We will bill physician services for mom's antepartum, delievery and post partem follow up once baby is delivered - the global charge- 59400 and/or as appropriate for our services. We have had a hard time in the past getting our claims through Medicare--- how is this done? We are an FQHC facility as well. Any insight- has anyone billed Medicare for the physician's services of an OB global charge?

You cannot bill an inpatient or outpatient hospital service under FQHC requirements - only face-to-face encounters and in billing under this system you must use the PPS G code that signifies the type of visit (new, established, preventive) followed by the CPT code for the services rendered at that visit. If the patient requires a "surgical" procedure, they must be referred out to an appropriate provider. If this patient has straight Medicare you would bill them using the global code only, but it would not be billed as an FQHC service. These are the instructions that were given to our FQHC in New Mexico and all deliveries must be referred out to providers who accept the sliding scale (we negotiate/contract with them to provide this service).