I have several scenarios where the insurance of an OB patient changes during their antepartum care while the provider stays the same.
I understand the billing scenario of "transfer of care". My question is: How do I bill for total care when I have a private payer (or OHC) and MediCaid...in this case Medi-Cal.
If the patient starts out on MediCal and then goes to the Private Payer, I think I would bill the "per-visit" OB codes to Medi-Cal and then bill the private payer according to how many antepartum visits were performed in addition to delivery, postpartum care.
If there were 4 or more antepartum visits, V delivery and PP care, I would bill a Global OB to the private payer...59400.
Someone has suggested to me that this is fraud....billing for a limited number of antepartum visits to the one payer and then billing a global delivery to the other payer . Is it?
I have researched and find nothing to address this issue of 2 different responsible payers for one OB provider and patient .
Thank you
I understand the billing scenario of "transfer of care". My question is: How do I bill for total care when I have a private payer (or OHC) and MediCaid...in this case Medi-Cal.
If the patient starts out on MediCal and then goes to the Private Payer, I think I would bill the "per-visit" OB codes to Medi-Cal and then bill the private payer according to how many antepartum visits were performed in addition to delivery, postpartum care.
If there were 4 or more antepartum visits, V delivery and PP care, I would bill a Global OB to the private payer...59400.
Someone has suggested to me that this is fraud....billing for a limited number of antepartum visits to the one payer and then billing a global delivery to the other payer . Is it?
I have researched and find nothing to address this issue of 2 different responsible payers for one OB provider and patient .
Thank you