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Thread: Docs changing tax id and Global OB

  1. #1
    Join Date
    Apr 2007
    Location
    Norfolk, NE
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    8

    Default Docs changing tax id and Global OB

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    We have a group of OB/GYN docs that will be joining the multi-specialty group that I work for. Their old tax id will be termed when they join our group. How should we handle the current pregnancies they have been managing? My first thought was that we should still bill global, but some of the insurance companies are saying that we should split the global, due to IRS purposes. What does this group think?

  2. #2
    Join Date
    Apr 2007
    Location
    Greater Orlando
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    Default Work out an arrangement with the insurers

    Daniele23,

    How has the group being merged in reported the pregancies "in process" to the various insurers up to now? And, ignoring the merger aspect for a moment, how do insurers pay for the global, all at the end or incrementally over the pregnancy?

    The accountant in me would argue for working out an arrangement with the insurers. If you're proactive, you probably can get them to agree to a single, unified plan. You want to avoid having to craft "n" plans one for each of the "n" different insurers where your OB patients have coverage.



    Such an arrangement might include the following points for allocation of billings.
    • Allocate between the two organizations using the RVUs of CPTs as follows:
    • 59425, 59409, & 59426 to split the billing of 59400 (vaginal delivery global) and
    • 59425, 59514, & 59426 to split the billing of 59510 (cesarean delivery global).
    To the extent antepartum or postpartum care period of a pregnancy overlaps the merger date, I would use the relative amounts of time each group handled care in the period to further refine the allocations for that period.

    Using this methodology, the insurers will pay no more than if only one group had handled a pregnancy.

    And giving the insurers each a copy of the Excel worksheet with the allocation computations and underlying data on it should make this smooth for everyone.

    Finally, I'd have each organizatio bill for its share of the total. This should satisfy the insurer's concern about keeping the IRS happy (no artifical shifting of income between separate tax entities, and each side gets its fair share). And the insurers should also be happy. And, it probably will satisfy the doctors of each group, as well.

    I hope this helps you.
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  3. #3
    Join Date
    Apr 2007
    Location
    Tacoma, WA
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    Default

    Quote Originally Posted by daniele23 View Post
    We have a group of OB/GYN docs that will be joining the multi-specialty group that I work for. Their old tax id will be termed when they join our group. How should we handle the current pregnancies they have been managing? My first thought was that we should still bill global, but some of the insurance companies are saying that we should split the global, due to IRS purposes. What does this group think?
    I just handled this exact scenario for my OB/Gyn provider group that merged with a large hospital corporation. I billed out all care that had been received under the old tax ID right before we made the switch. The new corporation will bill the remaining OB care and deliveries under the new tax ID number. It is no different than a transfer of care, or a change of insurance....have to split the billing so the appropriate parties get credit for the work they did.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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