Wiki Global OB when outside provider delivers

[debellis59]

Hi Everyone:

We are opening a new OBGYN clinic and there are only two providers at this time. There is also another OBGYN clinic that is on campus but not under our Tax ID. Occasionally we will be doing deliveries for them, or them for us. My superiors believe we (or they) can bill the OB globals even if they aren't the delivering provider. I'm thinking we have to break out / unbundle the billing if this happens. That if we deliver for them, we would bill the delivery and they would bill ante- and post-partum care. Or conversely, if they deliver for us, we would bill only the ante- and post-partum care and they would bill the delivery. Is there anything showing how this should be done for the sake of compliance? I have a meeting tomorrow and anything you can help with would be so appreciated!

Thank you,

Deb

 

[csperoni]

Many of the smaller ob practices in my area do have reciprocal arrangements to cover each other's deliveries. From what I have seen, most do not split the billing, even when the other group delivers. From a logistics standpoint, it's certainly easier to simply provide the medical services and not have to register the patient (name, address, DOB, insurance, etc), enter billing charges, and follow up on those claims for patients that never even set foot in your door. Some do split the billing. Your covering arrangement should specify this. My understanding is that either way is compliant, as long as it's clear and you don't wind up with both practices billing the same services.
Here is a reference from CGS Medicare about billing reciprocal coverage: https://www.cgsmedicare.com/pdf/Reciprocal_Billing_Arrangements.pdf

 

[debellis59]

Many of the smaller ob practices in my area do have reciprocal arrangements to cover each other's deliveries. From what I have seen, most do not split the billing, even when the other group delivers. From a logistics standpoint, it's certainly easier to simply provide the medical services and not have to register the patient (name, address, DOB, insurance, etc), enter billing charges, and follow up on those claims for patients that never even set foot in your door. Some do split the billing. Your covering arrangement should specify this. My understanding is that either way is compliant, as long as it's clear and you don't wind up with both practices billing the same services.
Here is a reference from CGS Medicare about billing reciprocal coverage: https://www.cgsmedicare.com/pdf/Reciprocal_Billing_Arrangements.pdf

Thank you so much!