Wiki Billing: Full Coverage for Prenatal Services, Partial for Delivery

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nmarine

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Good morning,

While verifying benefits for a patient yesterday, I found out that her insurance policy covers prenatal services at 100% and delivery services at 80%.

How would complete maternity care with this patient be coded and billed? It seems to me like I would have to do itemized billing for prenatal appts, delivery, and postpartum appts, instead of the usual Global OB code. Is this correct?

This leads me to my next question regarding preventive prenatal services. If the Affordable Care Act has mandated that routine prenatal and postpartum appointments are considered "Preventive Services" and therefore must be covered at 100% (with no cost-share) by all insurance companies, then must we bill itemized for the prenatals, the delivery, and the postpartums (because the delivery would incur cost-share)? Or do we still bill globally but the insurance company somehow splits up the bill?

I apologize for the very newbie questions. I am quite new to this!

Thank you for any suggestions you may have
 
If it were me I would ask the payer how they want it billed since they have such a strange benefit for OB. Could be they don't recognize global billing therefore each service is billed individually. That's rare but it does happen.

You might ask them about the Obamacare rule you referenced while you have them on the phone.
 
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