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nmarine

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I have a midwife provider that provides services at home. Her patient transferred in labor, and delivered at the hospital. The midwife does not have hospital privileges, but she still performed a newborn exam after delivery. Is there any way possible to bill for this service? I know the ICD codes, I know the CPT codes, the main problem is what POS code could I use?

I imagine that the hospital also billed for a newborn exam, but we are not affiliated with them in any way so I do not know.

Thoughts?

Thanks,
Nick
 
The only way you can bill is to bill the patient for fee for service. You can't bill the insurance for services when you don't have privileges to practice there or provide services in that facility. You also can't change the POS to anything else, the services were rendered in a hospital. The midwife knew she didn't have privileges at the hospital and never should have provided any services. She has opened herself up discipline actions if not legal actions from everyone from the patient, hospital, state, midwife board, etc. If you bill the insurance you will be committing Fraud. Good luck.
 
If the patient delivered at the hospital and that is where is post delivery exam took place then the POS must be the hospital. And since she does not have hospital privileges, it will most likely be denied.
 
Okay, thank you. That was my impression as well. I just wanted someone else to confirm this for me.
 
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