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OB Care split billing within same practice

  1. #1
    Red face OB Care split billing within same practice
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    Okay, I know each practice probably has different ways of billing Global OB Care. I need several opinions and possible back-up on how to bill when the delivery doc is not the patient's OB/Gyn. But the delivery doc is in the same practice but was just the provider on-call when patient delivered. How do you split that up? I have some ideas but need some more speciality input.

  2. Default
    if they are in the same practice you cannot split bill.

  3. #3
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    Madison Area Chapter in Madison WI
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    Default
    I agree. I ran into this situation not too long ago. From a coding perspective, the services were provided by the same practice, same specialty, so the global service is billable.

    Many clinics pay their physicians based on the actual services they provided; therefore they would like to bill the services separately. This is an internal business issue for the clinic and doesn't change the coding rules.
    Happy Coding, Claudia


    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email]ccrsconsulting@tds.net
    ccrsconsulting.com - website

  4. #4
    Red face OB Care Split billing in same practice
    Okay, so I should tell the physician's that it is considered unbundling, which is what?...Fraudulent? I am having a hard time convincing them that this is incorrect coding. They "get paid". Which we all know does not mean correct coding. Any suggestions.

  5. Smile
    I have this scenario quite often. Our physicians agreed on a set fee they are reimbursed when they deliver another provider's patient while on call. This fee is collected internally and never billed to ins or pt. We have one set amount for vag.del and c/s. The global fee is billed to insurance and once they pay we adjust the amount due to the delivering dr from this charge and allocate that amount to an internal charge for the delivering physician. This system has worked quite well for us (15 ob/gyns) as well as giving us a tracking system to make sure the delivering physician is getting reimbursed for their services.

    Kari

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