Becoming a business owner while doing what you love is everyone’s pie in the sky. Not everyone can achieve it and only few have enough courage to do it. If you’re employed, it takes enough courage to be out of the shadows of big hospitals and other health companies. Starting your own practice is never an easy task as it takes plenty of groundwork. It needs your expertise in midwifery but that’s not all. You must learn proper ways to introduce and market your practice, maintain good leadership and management talents within your chosen team, manage your finances which is vital for your practice to cultivate and continue operating, and many aspects that you must learn first-hand so you can avoid relying to other people’s expertise making your business vulnerable.
Financial revenue and collection are crucial for a midwife business’s long-term success and probability. Collection comes from cash, co-payments, co-insurance, deductibles, non-covered services, and insurance payments. Midwives are valuable assets our health care system — all the quality and personalized care provided needs to be counted for with insurance reimbursement charges. Billing and coding are not part of midwifery education; however, running a successful private midwifery practice in today’s ever-changing environment requires understanding billing and coding.
Billing plays a vital part in your midwifery practice. Midwife billing and coding is defined as the process of determining diagnoses, medical testing, procedures, and treatments found in clinical documentation and then transcribing the patient’s data into standardized codes to bill government and commercial payers for midwife reimbursement. Keeping up with coding standards, knowing specific insurance company rules, following up with claims, and invoices take time.
Lack of proper knowledge how you will bill your patients for the services that you give is a no-no to your practice. Your revenue is your fuel for your business to operate so you must learn how to properly bill your patients. Below are some medical billing tips that is essential and applicable for your practice:
1. Get Paid for Care What Your Services are Worth
Midwives are great at catching babies, but terrible at personally valuing what those services are financially worth. Make sure your fee schedule is accurately representing your time, overhead expenses, emergency accounts, and future expansion opportunities. Many midwives do just collect cash for care, but we do challenge each midwife to work closely with a billing service to get insurance plans to pay for their midwifery care (get paid more while families are obligated to pay less).
2. Establish a Clear Collection Process
All providers need a collections process to ensure the financial health of their practice. Establishing a step-by-step approach clarifies the procedures for all involved, and it can greatly improve revenue cycles by ensuring patients are properly and thoroughly informed of their responsibilities.
3. Manage Claims Properly
Approximately 80% of all medical bills contain errors, and because of how strict insurance companies are about correct medical billing and coding practices, they’ll likely be rejected. The cycle of submission, rejection, editing, and resubmission can take weeks, often resulting in providers waiting for months before receiving payment for their services.
Because of the wasted time and effort involved in editing and resubmitting claims, it’s important that claims are accurate and complete the first time. This involves inputting the information correctly and double-checking claims for any possible errors before submitting them.
To minimize billing problems, be sure to double-check claims before submitting them and communicate with the rendering provider if any information is inconsistent, incomplete, or unclear. After submitting the claim, follow up with a representative of the insurance company and keep up-to-date on any errors they may have encountered.
When resubmitting a denied claim, make sure to check the attached Explanation of Benefits (EOB) in addition to the possible errors listed above. It’s possible that an insurance company will return a claim without an EOB or denial code attached, which makes it more difficult to identify and correct any errors. If this occurs, contact a representative of the company to ask if they can clarify which portions of the claim were problematic or if they can send the EOB.
4. Minimize Documentation & Coding Errors
Make sure all the care you are providing is being clearly documented. When an insurance plan requests additional information or audits your chart, many midwives do the care that is being billed out and not really noting it in any of the documentation, thus requiring funds needs to be given back to the insurance plans.
Within a claim, medical coders describe the performed procedures using standardized codes, making the claims easier to decipher and process. These codes can use ICD-10-CM, CPT and HCPCS Level II classification systems.
While this provides a standard method of describing procedures, errors can still occur. The most common errors, such as incorrect, mismatched, or missing codes, are often caught by clearinghouses before they become an issue. However, some common errors are more difficult to catch.
5. Promptly Handle Denied or Rejected Claims
To discuss this topic in detail, it’s important to establish the differences between a rejected claim and a denied claim. A rejected claim is one that hasn’t been processed yet due to the discovery of one or more errors. It’s preventing the insurance company from paying the bill as it’s written. A denied claim, on the other hand, is a claim that the insurance company has processed and has deemed unpayable due to a discovered violation of the payer-patient contract, or some vital error caught after processing. In both of these cases, the payer will return the claim to the biller with an explanation of the problem. A rejected claim can be corrected and resubmitted, but a denied claim must be appealed before resubmission, a much more costly and time-consuming process.
Checking for errors in a claim can minimize the occurrence of rejections and denials, but if they do occur, be sure to handle them as quickly as possible. Keep in touch with a representative of the payer — they can help clarify problems with the original claim and provide information on current claims as they are processed. All of this can help expedite the claim editing process and minimize appeal and resubmission times.
6. Look for Ways to Improve
The midwifery care world is constantly changing, and practices should follow suit if they want to maximize efficiency and revenue. By tracking performance and keeping current on the latest healthcare regulations, practices can identify problem areas and implement new ways of addressing them.
7. Know When to Outsource
Midwife practices must constantly worry about their patients, current trends in medicine and proper staff management. They must also stay current with the most recent rules about coding standards, insurance companies, and billing regulations. With so much to keep up with, details can slip through the cracks, resulting in rejections, denials, and underpayments that cost medical practices time and money.
Despite their best efforts to implement proactive billing practices, many healthcare providers still find themselves lagging behind. This is often due to the costly time and labor involved in tracking down debtors, submitting and editing claims, and staying on top of current regulation — duties often piled on top of the existing responsibilities of medical office staff.
In response to the multiplying rules and regulations and in an effort to cut labor costs, many practices have outsourced their medical billing and coding to third party specialists. For many, letting another party manage their medical billing is an effective way to increase revenue and regain control.
Billing & coding course. MIDWIFERY BUSINESS CONSULTATION. (2022, April 12). Retrieved May 6, 2022, from https://midwiferybusinessconsultation.com/billing-coding-course/
Rakow, D. J. (2022, March 8). 6 proactive medical billing tips to maximize revenue: HAP. Healthcare Administrative Partners. Retrieved May 6, 2022, from https://www.hapusa.com/6-proactive-medical-billing-tips/