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Thread: On call provider--not same practice

  1. #1
    Join Date
    Apr 2007

    Default On call provider--not same practice

    AAPC: Back to School
    Hi, am looking for guidance on billing the global delivery with an outside provider. Normally I work with physicians who all are in the same practice. Recently, we have an outside provider who is joining the on-call group.
    My questions:

    How do we bill if we deliver "his" baby?
    How do we bill if he delivers "our" baby?

    We would like to not split the global package, is this possible, legal?

    Any and all opinions are greatly appreciated!
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

  2. #2
    Join Date
    Apr 2007
    Grand Rapids


    For our OB providers we only bill for the services they provide (within our group) - if one of our patients happens to deliver with a provider that is not in our group then that provider is responsible to bill his charges and we only bill for the prenatal that we provided and the post partum (if/when the patient comes in for that). Unfortunately, in cases like these the billing does have to be split out.

  3. #3
    Join Date
    Apr 2007
    Portland Rose City Oregon Chapter


    Our office has this same arrangement with another office. We take call for a midwife group multiple times a month. When our doctors deliver one of their baby's, they bill out under their provider globally and our doctors are reimbursed on the back end. It is treated the same way in our office if one of our own doctors deliver another one of our providers patients. We bill globally under the patients provider and reimburse our other physician on the back side. It is something your office administrator will have to arrange with the outside provider/office.

    Hope this helps!
    Amber Ruiz, CPC
    Women's Health Today

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