Midwifery billing and coding are the backbone of midwifery care revenue cycle, ensuring payers and patients reimbursed providers for services delivered. With midwifery care on the rise in the United States, people are starting to hear about midwives and home birth. Midwifery offices receive money from private insurances providers and various healthcare programs, such as Medicare and Medicaid, which are provided by the government. Receiving proper funds allows the midwifery business office to stay open. With suboptimal reimbursement, it is difficult for them to provide stellar healthcare to patients.
Midwifery billing process is a series of steps completed by billing specialists to ensure that birth professionals are reimbursed for their services. Depending upon the circumstances, it can take a matter of days to complete, or may stretch over several weeks or months. While the process may differ slightly between birth centers, here is a general outline of a medical/midwife billing workflow.
1. Patient Registration
Patient registration is the first step on any billing flow chart. This is the collection of basic demographic information on a patient, including name, birth date, and the reason for a visit. Insurance information is collected, including the name of the insurance provider and the patient's policy number, and verified by billers. This information is used to set up a patient file that will be referred to during the billing process.
2. Financial Responsibility
The second step in the process is to determine financial responsibility for the visit. This means looking over the patient's insurance details to find out which procedures and services to be rendered during the visit are covered. If there are procedures or services that will not be covered, the patient is made aware that they will be financially responsible for those costs.
3. Superbill Creation
During check-in, the patient will be asked to complete forms for their file, or if it is a return visit, confirm or update information already on file. Identification will be requested, as well as a valid insurance card, and co-payments will be collected. Once the patient checks out, birth reports from the visit are translated into diagnosis and procedure codes by a coder. Then, a report called a “superbill” may be compiled from all the information gathered thus far. It will include provider and clinician information, the patient's demographic information and history, information on the procedures and services performed, and the applicable diagnosis and procedure codes.
4. Claims Generation
The biller will then use the superbill to prepare a claim to be submitted to the patient's insurance company. Once the claim is created, the biller must go over it carefully to confirm that it meets payer and HIPPA compliance standards, including standards for coding and format.
5. Claims Submission
Once the claim has been checked for accuracy and compliance, submission is the next step. In most cases, the claim will be electronically transmitted to a clearinghouse, which is a third-party company that acts as a liaison between healthcare providers and health insurers. The exception to this rule is high-volume payers, such as Medicaid, who will accept claims directly from healthcare providers.
6. Monitor Claim Adjudication
Adjudication is the process by which payers evaluate claims and determine whether they are valid and compliant, and if so, the amount of reimbursement the provider will receive. During this process, the claim may be accepted, rejected or denied. An accepted claim will be paid according to the insurer’s agreements with the provider. A rejected claim is one that has errors that must be corrected and the claim resubmitted. A denied claim is one that the payer refuses to reimburse.
7. Patient Statement Preparation
Once the claim has been processed, the patient is billed for any outstanding charges. The statement generally includes a detailed list of the procedures and services provided, their costs, the amount paid by insurance and the amount due from the patient.
8. Statement Follow-Up
The last step in the billing process is to make sure bills are paid. Billers must follow up with patients whose bills are delinquent, and, when necessary, send accounts to collection agencies.
Like many other complicated midwifery procedures, billing may take up so much time on your end as a midwife. Billing takes a huge part on the success of your midwifery business as it makes sure that cash flow is good, making your midwifery practice run smoothly.
Bryant & Stratton College Blog Staff. (n.d.). 10 steps in the medical billing process. Bryant & Stratton College. Retrieved June 18, 2022, from https://www.bryantstratton.edu/blog/2018/january/medical-billing-process