Birth centers and birth center workers play invaluable roles in the lives of women, children, and their families across this country. All women should have access to peaceful, safe birth settings outside of a hospital.
Insurance companies have not historically understood or acknowledged the nuances of birth center care and –as a result– birth center billing. At Larsen Billing, we know the value birth centers and midwives provide to individuals, communities, and our national well-being.
This article explores the importance of accurate and informed birth center billing, highlighting the nuances of care and codes. Read on to learn more about how Larsen Billing can empower you to receive the compensation you deserve for the vital services you provide.
A Lack of Education in Birth Center Billing
Many, if not most, insurance companies are unfamiliar with birth center billing. At Larsen Billing, we’re often in the unique position of educating insurance companies regarding the care we submit claims for, explaining what the care represents.
For example, a mom might be in labor for an extended period due to failure to progress or inadequate contractions. A midwife’s model of care includes monitoring the mother’s physical, psychological, and social well-being throughout the childbearing cycle. That means midwives remain with their moms during their full labor management time, ensuring both mom and baby are healthy and safe.
Birth center providers must understand how to bill for the care they provide correctly. Accurate billing ensures you, as the provider, maximize reimbursement and are paid appropriately for the high level of care you provide and for the use of your birth center.
Unfortunately, most payers don’t understand the nuances of birth center billing and how it differs from hospital births and OB/GYN care. They don’t realize midwives spend hours with their patients. As a result, you’re not compensated for that time, expertise, or care.
Larsen Billing has advocated for midwives and their teams for decades to ensure they’re paid for their services. We focus significant energy on payer education, teaching them the full spectrum of care midwives provide. There are currently very few codes approved for midwifery and birth center services, making fair compensation an uphill battle for the providers in this specialty. Larsen Billing works to educate payers regarding midwifery care to ensure all our midwives are paid appropriately.
Accurate Billing Leads to Increased Access
All women should have access to midwifery and birth center care. The battle to achieve fair access is, in part, getting insurance companies to recognize midwifery care as a valid choice for mothers nationwide.
Some states have insurance plans that cover laws mandating midwifery care and birth center care; most states do not. Many states don’t license midwives, meaning only certified nurse midwives (CNMs) are covered by most plans in those states. Furthermore, some states make the practice of midwifery by anyone other than a CNM illegal, making access to care an impossible hurdle to overcome.
Everyone involved in midwifery billing must understand these state-to-state nuances to bill care correctly, utilizing state laws to push insurance companies to pay claims. Keeping abreast of these laws and policies is a big task, as is billing correct claims to insurance payers who don’t understand the nuances of your services.
That’s where Larsen Billing shines. Our team of experts helps you manage the endless billing nuances for your birth center. We have experience billing for midwifery services in nearly every state. We submit claims correctly, advocate for you with payers, educate those payers regarding care claims, and help you get paid what you deserve. Ultimately, accurate billing services increase access to birth center care and midwifery services. When insurance companies recognize and understand your services, you are compensated, and mothers can utilize your care in the most critical time of their lives.
A Lack of Appropriate Billing Codes
The lack of midwifery and birth center-specific codes is problematic. As of today, no specific insurance codes exist for this specialty.
Midwifery care is billed using obstetric codes not designed to cover a midwife’s scope. Birth center care doesn’t have specific revenue codes that adequately represent the care provided to moms and babies during their time there. As a result, the provider and center aren’t being compensated fairly or accurately. At Larsen Billing, we use the closest codes we can while educating the payers on the scope of birth center care.
Most payers have hospital contracts for hospital providers but likely don’t have many birth center contracts. When setting up birth center contracts, the payer must understand that a mom and baby are both admitted to the birth center for a certain amount of time, then discharged. A facility fee is billed for the mom and baby (when the contract permits), which represents the time both are admitted to the birth center.
In this scenario, birth centers bill for the facility service fee, but currently, no code adequately represents or covers all that birth center care provides. Midwives and birth centers are often shortchanged due to a lack of appropriate and accurate billing codes. Many payers refuse to pay a newborn facility fee in addition to the maternal facility fee, which Larsen Billing continues to advocate for.
For over two decades, Larsen Billing has seen millions of dollars paid to our midwives and birthing center clients. We continuously and aggressively negotiate for midwives, ensuring they have the proper credentialing and contracts. We work to ensure you are paid what you deserve despite a lagging system that doesn’t yet formally recognize the value you bring to mothers and their families. Our services promote access to out-of-hospital births, paving the way for vital care and getting it covered by insurance.
Nuances in Birth Center Care vs. Hospital Care
Midwives and birth centers use the same billing codes as hospitals despite the vast differences in care and services. Here we break down nuances in birth center care and why traditional hospital birth care codes are not sufficient.
Global Fee Billing
Any provider billing for midwifery care must understand the global fee and what is and is omitted.
The global fee is CPT Code 59400. Any routine prenatal, delivery, and routine post-partum care provided to the mother is included in this code, which is also standard for hospital births. But because midwives tend to give more care than a typical OB, they need additional billing to represent the time spent with the mother accurately. Larsen Billing determines how to ensure midwives are paid for that extra care.
Many of the services midwives offer are not included in the CPT definition of the global fee. Care not included in the global fee should be billed with appropriate CPT/DX codes, and our billing service fights to ensure you get paid for that care.
Billing for Midwives
Incident-to-billing guidelines do not apply to midwives. OB/GYNs or doctors are allowed to supervise lower-level practitioners below them. CNMs are not allowed to do that because they’re designated as mid-level providers. If a licensed or certified professional midwife delivers the baby, we cannot bill that delivery under a CNM who wasn’t present. The birth must be billed under the provider who rendered care. In practices with multiple midwives, these restrictions pose significant issues. Some insurance plans only pay CNMs, meaning a group practice would need CNM coverage 24/7 for insurance to cover care; this is not always feasible. The national CNM shortage and billing constraints mean some births aren’t always covered by insurance, causing financial hardship if the mom has to pay out-of-pocket.
Birth Center Facility Fees
Birth center facility fees are billed on the UB-04 form (unless told otherwise by the insurance company). Some payers require certain parts of the UB-04 form to be filled out differently. Knowing the payer requirements is essential for the facility fees to be accepted by the payer and processed correctly. Billers must understand how to fill out the form correctly for each insurance plan so the claim isn’t denied.
Facility contracts often explain what is and is not included in the birth center facility fee. Knowing how to read and understand a facility contract is critical to ensuring that correct codes are being billed and that care included in the facility reimbursement is not being billed separately.
For example, a mother and her baby are two separate people. Newborn visits and newborn facility fees should be covered separately. This separation is vital for the birth center to receive fair compensation, a battle Larsen Billing constantly fights.
Understanding how to read your contract is crucial. Our Payer Relations team is adept at securing contracts for midwives and birthing centers at the highest possible rates. We educate the payer on why they should pay rates that birthing centers deserve and need to be paid. Ultimately, births at a birthing center are less expensive than hospital births. Contracting with a birthing center benefits the payer and regularly saves them thousands of dollars per birth. Our team educates payers so they can see that covering birthing centers and midwifery care results in better outcomes for everyone involved, including their bottom line.
Larsen Billing is Uniquely Equipped to Meet Birth Center Billing Needs
Information on billing for midwives and birth centers is not readily available online. Over the last two decades, the experts at Larsen Billing have learned and gathered valuable information concerning the correct way to bill for birth center deliveries. Our team has attended meetings and conferences and collaborated with our providers because they are a wealth of information concerning what we should bill and how far to fight.
Larsen Billing has been billing for birth center births since the company was founded in 2001. We have employees with various skills and backgrounds, including certified professional billers and coders; billers with years of billing experience; employees who know how to read through a contract and understand all the fine print; and a Payer Relations team that uses an organized system to ensure our providers are credentialed and contracted.
Larsen Billing arguably has the country’s most thorough and complete training for midwifery and birth center billing. We put all our billers through our meticulously curated training program before they bill these accounts. We’ve billed claims for midwives and birth centers in 46 states and have the broadest view of any company of how insurance companies respond to midwifery and birth center claims. Our team is exceptionally well-equipped to advocate for these services to be covered by insurance, allowing more women than ever to access this necessary type of care. Every woman should be able to choose to have an out-of-hospital birth, and it should be paid for by insurance.
Our team wants to see every midwifery practice succeed, even if you don’t choose to utilize our services. Over the years, Larsen Billing has developed a midwifery and birth center billing course that we sell to anyone who wants to learn how to bill for small midwives’ practices and birth centers with an in-house biller. We value your work, we care about your success, and we want to provide the resources you need to ensure you are billing correctly and getting compensated fairly.
Get Started with Birth Center Billing Today
You and your team provide invaluable care to mothers and their babies. We want women to have agency and choice in their birth experiences and to see every woman have access to birth center care through their insurance. This is why we fight, educate, and advocate for our midwives and birth centers.
Larsen Billing brings decades of expertise and passion for ensuring midwives are paid what they deserve. Reach out to learn more about how our billing experts can ensure every claim is optimized so you receive the appropriate compensation and you can continue serving women as they bring new life into this world.