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Billing Global

The Global obstetrical package (OB Package) includes Prenatal Visits, Delivery Services, and Postpartum Services. See below for more details:

Prenatal Visits: includes initial and subsequent history, physical exams, recording of weight, blood pressure, fetal heart tones, and routine urine dipstick analysis.  There is no definition regarding the minimum number of prenatal visits to bill globally, however each payor has their own requirements.  Contact the payor directly for their specific guidelines.  In some cases we can bill the global delivery code with as few as 4 prenatal visits.  If the client has seen another provider during their prenatal care we may not be able to bill the global fee regardless of how many visits you do; again, this varies by payor.  We will still bill out the care that you provide, but will submit different procedure codes if we are unable to bill the global fee.  By definition, routine prenatal care is considered:

• Weekly visits from 36 weeks through delivery
• Bi-weekly visits from 29 – 36 weeks

If a patient presents with signs or symptoms of pregnancy and the patient is there to confirm pregnancy, this visit may be reported with the appropriate level of E/M as long as the OB Record is NOT initiated at this visit. If the OB Record is initiated at this visit, then the visit becomes part of the OB Package and is not billed.

Delivery Services: Includes management of uncomplicated labor, the delivery itself, induction of labor, artificial rupture of membranes, and delivery of placenta.

Postpartum Services: Includes routine home and office visits during the global delivery period. If there is a medical condition, those could possibly be billed separately.

• The postpartum period is usually 6 weeks (42 days) following the delivery (again some payors might have slightly different guidelines)

• The initial pregnancy test
• Routine Venipuncture
• Administration of RH immune globulin
• Ultrasound testing
• Fetal biophysical profiles, non-stress tests, and fetal echocardiography
• Office or home visits for complications of the pregnancy or medical issues unrelated to the pregnancy

Appeals

Your billing team is well trained in creating and sending appeals to the insurance companies and will do this as a natural process in obtaining optimum reimbursement on your claims.

There are times when an insurance company will not allow anyone other than the member to appeal claims. Other times, we come across insurance company policy where they insist on having signed consent forms from the member stating that we can act in their behalf. Larsen Billing Service provides the templates necessary for meeting such demands. Learn more about templates for parents »