Wiki Professional charges for delivery billed by provider in a group, but not the OB of record, management thinks we should bill under delivering provider

[cubbiecatz]

Please help. We have always billed our global care CPT code under the OB of record when someone else in the same group, with the same TAX ID number delivers. This happens most often when the provider is covering for the group, or the doctor of record is already in the middle of a delivery or a surgery.
Management wants to streamline the OB/GYN department and are stating by billing this way it is incorrect and that we should bill under the delivering doctor so that it matches the facility record.
I have explained we are not billing for delivery only, but Global care but they are saying they want something in writing that says this is acceptable. I've also explained that we are billing it under the physician who is doing the majority of the OB care, since they will be providing antepartum and postpartum, the other doctor has only performed the delivery. I keep getting told the providers should match on the facility and the professional side. I thought the facility was billing for the hospital.

Does anyone have anything in writing that I can show them what we are doing is not, in their words, illegal?

Thank you,

Cathy Satkus

 

[Pam Warren]

It depends on a number of things.... I am assuming that your practice has an arrangement with the covering provider so that you pay him for his covering service. If that's the case, and he's not billing the delivery only under him/herself, then you still bill under your group, and then reimburse the covering doc for his time. If he's doing his own billing for the delivery, he carves that out and you bill antepartum and post partum care only. I wouldn't go so far as to say it's "illegal", but why would you give your revenue to the covering provider? Having said that, if your covering provider is credentialed as a provider within your practice and the global reimbursement is coming to your practice, then his name on the claim is moot.... the dollars are coming your way, and I am assuming he's being paid periodically for his covering service.

 

[cubbiecatz]

It depends on a number of things.... I am assuming that your practice has an arrangement with the covering provider so that you pay him for his covering service. If that's the case, and he's not billing the delivery only under him/herself, then you still bill under your group, and then reimburse the covering doc for his time. If he's doing his own billing for the delivery, he carves that out and you bill antepartum and post partum care only. I wouldn't go so far as to say it's "illegal", but why would you give your revenue to the covering provider? Having said that, if your covering provider is credentialed as a provider within your practice and the global reimbursement is coming to your practice, then his name on the claim is moot.... the dollars are coming your way, and I am assuming he's being paid periodically for his covering service.

This isn't an outside call covering group. I stated in the first sentence this is the same group, same tax ID number. It's our group of doctors. We have Dr. A, Dr.B, Dr. C Dr.A is the primary OB of record, Dr.A rendered all of the antepartum care. It's a Saturday and Dr.B is on call for the group. Dr.B delivers the baby for Dr.A. Dr. A will render the postpartum care. I bill the 59400 or 59510 under Dr. A. Management thinks that is wrong now and says we should be billing 59400 or 59510 under Dr. B because that is who will be on the facility record.

 

[Pam Warren]

Anthem has a nice grid that explains this. Federal (Medicare) guidance on obstetrics is spotty...not many over-65-year-olds are getting pregnant.

https://providers.bcbsal.org/portal/documents/10226/306297/Obstetrics+Coding+and+Documentation+Reference+Guide/8f5f1b65-1fd2-49a5-8708-6819a162098e#:~:text=Dr.,this%20scenario%20by%20either%20provider.

From Anthem: Maternity care provided by two different physicians practicing at the same location (group). When two different providers are practicing at the same location and are both providing maternity care services, a single claim should be filed with the appropriate global maternity CPT code. Two different claims should not be filed for the two providers since they are in the same location.

My experience (FWIW) is that the delivering doc is on the professional claim.

 

[cubbiecatz]

Anthem has a nice grid that explains this. Federal (Medicare) guidance on obstetrics is spotty...not many over-65-year-olds are getting pregnant.

https://providers.bcbsal.org/portal/documents/10226/306297/Obstetrics+Coding+and+Documentation+Reference+Guide/8f5f1b65-1fd2-49a5-8708-6819a162098e#:~:text=Dr.,this%20scenario%20by%20either%20provider.

From Anthem: Maternity care provided by two different physicians practicing at the same location (group). When two different providers are practicing at the same location and are both providing maternity care services, a single claim should be filed with the appropriate global maternity CPT code. Two different claims should not be filed for the two providers since they are in the same location.

My experience (FWIW) is that the delivering doc is on the professional claim.

Thank you, Pam. I wish they would have commented on which provider should bill the global maternity code. The doctors really like it submitted under the doctor of record, that started the OB care. We've heard starting in September, insurances are going to start denying charges if the hospital bills with a different provider than the delivering doctor.

 

[Cmama12]

Just to echo what Pam said, we always bill out under the delivering provider for global codes.

 

[cubbiecatz]

Just to echo what Pam said, we always bill out under the delivering provider for global codes.

Do you have a system where internally you give the OB of record RVU for antepartum and postpartum if they furnish it?

 

[Pam Warren]

Do you have a system where internally you give the OB of record RVU for antepartum and postpartum if they furnish it?

well, that's a business decision made by people with a bigger salary than me. Generally speaking, the RVUs directly associated with a provider are those that represent claims billed under their name. There would need to be some understanding by the business office that the standard billing practice for OB means we report under the delivering doc, even if the antepartum and post partum belongs to someone else (in the same practice, because we don't unbundle the codes if they're provided by physicians in the same group). It wouldn't surprise me if there's some data analysis being done behind the scenes that you might not be aware of, but in a small practice, it wouldn't hurt to ask.

 

[cubbiecatz]

well, that's a business decision made by people with a bigger salary than me. Generally speaking, the RVUs directly associated with a provider are those that represent claims billed under their name. There would need to be some understanding by the business office that the standard billing practice for OB means we report under the delivering doc, even if the antepartum and post partum belongs to someone else (in the same practice, because we don't unbundle the codes if they're provided by physicians in the same group). It wouldn't surprise me if there's some data analysis being done behind the scenes that you might not be aware of, but in a small practice, it wouldn't hurt to ask.

We are a larger office and we do this already, for example a patient was seen at one location but delivers at another, we do bill under the delivering since the original doctor doesn't practice at the delivering facility. I'm the one that completes the spreadsheet to turn into those groups with bigger salaries than me, lol. It will mean more work for me when we switch to this way of billing, as our doctors deliver for each other when the are the covering doctor. Mostly on the weekend, but we have around 15 OB providers.

Thanks for all your help, and Meg!

 

[csperoni]

We are a larger office and we do this already, for example a patient was seen at one location but delivers at another, we do bill under the delivering since the original doctor doesn't practice at the delivering facility. I'm the one that completes the spreadsheet to turn into those groups with bigger salaries than me, lol. It will mean more work for me when we switch to this way of billing, as our doctors deliver for each other when the are the covering doctor. Mostly on the weekend, but we have around 15 OB providers.

Thanks for all your help, and Meg!

There are lots of different arrangements that can take place with these types of situations. In my experience, if the physicians take equal call, then the assumption is that over time it balances out. Maybe this week, Dr. A delivers 2 patients of Dr. B and 4 of Dr. C, but next week Dr. B delivers 3 of Dr. A patients, etc. In my opinion, this doesn't work fairly if physicians do not take equal call, or most patients are going to a different hospital that not all physicians have privileges at, in which case I recommend some other system. Otherwise, it works itself out over the course of a few months, regardless of if you are universally billing under the delivering or universally billing under the physician providing the antepartum and postpartum.
Regarding "other systems" if you do need to right size for a variety of reasons, manual tracking/spreadsheets is not necessarily the most effective way. What some practices do is that the delivery gets credited to the "primary ob" even if they didn't deliver. But each physician gets a set small bonus per delivery, or other compensation for taking call shifts.