This flagship course is designed to take you from knowing nothing about insurance, to being able to bill your own claims for both professional and facility fees. Designed for midwives, it has also been helpful to professional billers who do not have experience with midwifery billing.
Check out the full details of the curriculum below, but here are the...
Learning Objectives:
1. Define what ICD, POS, and CPT codes are, and when they should be used.
2. Describe the structure of where payment comes from, in what timeframe.
3. Define what services are included in CPT 59400 and what services may be billed in addition to CPT 59400.
4. Explain the legalities of how to structure discounts in a manner that is consistent with Federal regulations.
5. Explain the pros and cons of in-network vs out-of-network coverage.
6. Demonstrate how to perform a VOB and calculate an estimated client responsibility.
7. Explain the legalities of balance billing.
8. Explain when and why GAP Exceptions may or may not be benefial.
9. Explain how Section 2706 of the ACA is helpful to midwives (yes, this is still in effect!).
10. Explain how other mandates may or may not be useful to midwives.
11. Demonstrate how to complete a CMS-1500.
This flagship course provides a HiveCE Certificate which may be used as Category 2 CE for CPM renewals with NARM.
This course was previously approved by MEAC for 14 hours of continuing education, approval number M1920-101-0501DE, and from May 2020 through May 31st, 2022.
This course was previously approved by MEAC for 10 hours of continuing education, approval number M1718-84-0425DE, from May 14th of 2018 to May 14th, 2020.
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Jesica Dolin Gutierrez, BSM
Instructor Bio:
Course curriculum
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01
Introduction and Overview
Show details- Links to Live Advanced Sessions
- Video: Intro and Overview
- Video: How To Get The Most Out Of This Class
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02
Billing Revolution
Show details- What is this?
- Video: The Three Problems
- Flat Fee vs Base Fee
- Video: What is a CPT code?
- Video: 59400 - Included or not?
- PDF: Inside and Outside Global Code 59400
- Video: Who pays what, when, and why?
- Do I have to charge my clients their portion?
- Video: The Solutions
- The Billing Revolution eBook
- BONUS SECTION: Basic Series Session #2 - Options and Legal Concerns for How to Structure Out-of-Network Insurance Reimbursement (with scenarios)
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03
Getting Started: Laying the Groundwork for Billing
Show details- Insurance Basics
- PDF: Glossary Of Insurance Definitions
- Resources Section for Health Care Sharing Ministries / Health Shares
- Resource Section for Health Saving Accounts and Flexible Spending Accounts
- Video: In or Out-Of-Network?
- Quiz: Ins and Outs
- Malpractice Insurance: Yay or Nay?
- Lawsuit Case Study #1
- Recommended Reading: How To Negotiate With A Liar
- IN Network Negotiation and RVUs
- NPI Q&A
- Fee Schedule Q&A
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04
Becoming In-Network (Bonus Section from our June 2018 Live Advanced Session)
Show details- Video: Is It Better To Be In or Out of Network? (same video as in Getting Started, Laying The Groundwork For Billing)
- Video: Live Session with Sizzly Auer on How to Become In-Net
- Common Requirements To Apply For Network Participation ("in-network")
- The Application Process
- Video: Q&A From The Live Session
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05
Before Services Are Rendered
Show details- Recommended Reading: How To Negotiate With A Liar
- Video: VOB Basics - To Make That Call
- PDF Worksheet: Verification Of Benefits For Out-Of-Network Coverage
- Video: Billing For Midwives How To Calculate A Client Portion
- PDF Worksheet: Calculating An Estimated Client Portion for Out-Of-Network Providers
- Quiz: Calculating a Client Portion ~ Practice Time!
- Video: Who Pays What, When and Why?
- Understanding Allowed Amounts And Third-Party Negotiations
- Should I Ask if There is a Homebirth Exclusion?
- Do I Have To Charge My Client Their Portion?
- HFMA's Best Practices for Financial Interactions In Advance of Service
- Financial Agreement, Consent to Care, and Payment Collection Tips
- Skip Ahead, Then Back...
- The Legalities of Balance Billing
- Additional Reading
- Downloadable Template: Client Invoice, Pages Version
- Downloadable Template: Client Invoice, Word Version
- Article: Out-of-network Referrals and Waivers of Patient Copayment and Deductibles: The battle between payors and providers endures and intensifies.
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06
How To Be Covered In-Network Without Being In-Network (aka: exception or gap exception)
Show details- New mini course alert!
- Mind The Gap! - Q&A From Discussion Area
- Articles & Request Letter Template
- PCP's Request for Exception
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07
Federal and State Mandates (aka: non-discrimination acts, aka: you gotta pay me, I'm licensed!)
Show details- Federal Mandate: Section 2706 of the Affordable Care Act (aka: ObamaCare)
- Class Action Lawsuit Against Healthnet
- Jesica's Request Letter During Pregnancy - Round 1
- Jesica's Request Letter - Round 2 - Success!
- Lauren's Successful 2706 (Post-Birth) Appeal Letter
- State Mandates: California, Florida, New Hampshire, New York, Vermont, and Washington (state).
- Federal Mandate: Newborns' and Mothers' Health Protection Act of 1996 (Newborn's Act)
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08
ICD-10 (Updated for 2022)
Show details- ICD-10 In A Nutshell
- ICD-10 for 2022
- CPT and ICD Grid
- PDF: Printable Quick Guide Z Codes Grid for Routine Pregnancy Care
- Predicting Trimester Specific Coding
- New Pregnancy Codes for 2019
- Non-Routine Pregnancy
- PDF: Printable Quick Guide Codes for Non-Routine Pregnancy Care
- The VBAC Dilemma
- Normal Birth, and General Birth Coding Rules
- Special Circumstances During Labor and Birth
- Article: Delivering Accurate Coding Remains A Challenge (Part II)
- Postpartum
- PDF: Printable Quick Guide Codes for Codes for Labor and Birth
- PDF: Printable Quick Guide Codes for Codes for Postpartum
- Newborns
- PDF: Printable Quick Guide Codes for Newborns
- ICD-10 Updates for 2020
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09
Place of Service (POS) Codes
Show details- Video: Place of Service (POS) Codes
- PDF: POS Chart
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10
CPT Codes
Show details- Video: What is a CPT code?
- CPT and ICD Grid 2019 (same file as in ICD section)
- Modifiers
- Modifiers
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11
Global Billing Using 59400 (This is what most of your billing will be!)
Show details- Video: What is included in the Global 59400? What is not?
- PDF: Inside and Outside Global Code 59400
- Quiz: 59400 ~ Included or not?
- Q&A From Real Students: Global Billing
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12
Billing Beyond The Global - Prenatal
Show details- Video: Visits In Addition To 59400
- Video: Time Based Billing
- Video: Venipuncture and Rh Immune Globulin
- Q&A: Troubleshooting Billing for RH Immune Globulin
- Video: ECV and NST
- PDF: Billing Beyond the Global: Pregnancy (eBook)
- Prenatal Care Q&A
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13
Billing Beyond The Global: Labor, Birth, and Postpartum
Show details- Video: Second Midwife/Routine Labor Assist
- Video: Second Midwife at a Shoulder Dystocia
- Video: Second Midwife at a Breech Birth
- The VBAC Dilemma (same video in ICD-10 section)
- Video: VBAC
- Looking for How To Bill for Intrapartum Care Prior to Transfer?
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14
Billing Beyond The Global: Newborn Care
Show details- Video: When can newborn care be billed in addition to 59400?
- Q&A: What about CPAP?
- Video: Routine Initial Stabilization by a Second Midwife
- Video: Newborn Resuscitation
- Video: Newborn Exam and Baby Visits
- Video: Routine Medications
- Video: Pulse Oximetry for cCHD Screening
- Video: Hearing Screen
- State-by-State Guide to Newborn Hearing Screening Regulations
- Newborn Metabolic Screening Tests
- Billing Beyond the Global: Newborn Care Services
- Newborn Care Q&A
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15
An (Un)Bundle Of Joy (bonus section)
Show details- Video from our September 2018 Live Advanced Session
- Logic Path Cheat Sheet (printable PDF)
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16
In Case Of Transport
Show details- In Case Of Transport: Billing for Routine Visits
- Looking for How To Bill for Intrapartum Care Prior to Transfer?
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17
Annual Gyn Visits, Preconception Counseling, Birth Control, etc (Bonus Section from our Oct 2018 Live Advanced Session)
Show details- Intro and General Guidelines
- Guide to Modifiers 26 and TC from the AAPC
- PAPs/Annual Gyn Exam
- Preconception/Infertility
- ICI & IUI Insemination
- Birth Control
- Words of Wisdom for Billing Gyn
- Sample Gyn Superbill
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18
Submitting Claims Using a CMS-1500 (the form formerly known as HCFA)
Show details- Video: All About the CMS-1500
- Video: How To Complete A CMS 1500
- Red CMS-1500 Form (HCFA)
- Video: What About Box 27? Should I "Accept Assignment?"
- CMS-1500 Q&A
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19
Birth Center Facility Fee Billing
Show details- Facility Fee Basics
- Facility Fee Research - The Journey Begins
- A Surprising Discovery with State Regulations
- State-by-State Birth Center Regulations and Resources
- Birth Center Stay Client Survey Results
- Can I charge a facility fee for a homebirth?
- Video: What Is and Where Can I Obtain a CMS-1450/UB-04?
- Printable PDF: CMS-1450 w/Required Fields Marked
- CMS-1450 (UB-04) Walkthrough - Inpatient
- CMS-1450 (UB-04) Walkthrough - Outpatient
- Video: Choosing Your Type of Bill (Field 4 on the UB-04)
- Open Model Birth Center Q&A
- Library of CMS-1450/UB-04 Instructions and Downloadable Forms
- Bonus Section: Interview w/Desiree LeFave, Co-Owner of Bella Vie Gentle Birth Center
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20
Electronic Claims Submission (EDI)
Show details- List of EDI Companies
- Recording of Live Zoom with Sizzly Auer on EDI ~ April 2018
- Availity Walkthrough
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21
It's a bird, it's a plane, nope...it's a Superbill!
Show details- Q&A: Superbill ~ What It Is and When To Use It
- PDF Form: Superbill for Homebirth
- PDF Form: Superbill for Birth Center
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22
Using a Professional Billing Service
Show details- Questions To Ask Professional Billers
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23
Claim Follow-Up: The Good, The Bad, and The Ugly
Show details- Transport Billing Denied Due To Place Of Service Code
- Success story: "Sure, I'd be happy bill unbundled."
- Handout For Clients Regarding Insurance Checks (Be sure to edit to be applicable for your practice!)
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24
Bonus Section: Special Circumstances for Billing During Covid-19 Pandemic
Show details- About This Section
- New ICD-10 Codes for Covid-19
- Telehealth and Other Special Circumstances for Billing During Covid-19 Pandemic
- Coding for Telemedicine
- HIPAA Exceptions During Covid-19
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25
NEW! State Specific Medicaid (Bonus Section)
Show details- Alaska Medicaid
- Alaska Medicaid Slides w/Links to Useful Documents and Websites
- California: Medi-Cal Basics for Licensed Midwives
- California Medicaid (Medi-Cal): Useful Documents and Other Links
- Connecticut Medicaid Links
- New York Medicaid Links
- Washington Medicaid
- Washington Medicaid: Washington State Health Care Authority's Agreement to Pay for Healthcare Services (Printable Form)
- Washington Medicaid: Useful Links
- Washington: ProviderOne Walkthrough of Coverage Verification and Claims Submission
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26
Libraries of Rules For Billing
Show details- Insurance Companies
- States
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27
Post-Test and CE Certificate
Show details- Evaluation Questions
- Post-Test
With Guest Speakers...
Sizzly Auer, LM, CPM, CPB, CPC is both a licensed midwife in Florida and a certified biller and coder.
Angela Stanton of River City Billing brings her experience of midwifery and medical office billing, including billing Medicaid in Washington State.
Madeleine Wisner, LM, draws from her background in public health, and her experience as a licensed midwife and Medi-Cal provider in California.
Emily Pasternak of My AK Billing provides billing service to homebirth practices and birth centers in Alaska. Her detail oriented methods provide maximum reimbursement while following "all the rules."
Due to the frequently changing nature of insurance information, Billing for Midwives is updated on a continuing basis. For this reason, we recommend you enroll through Extended Access, which will include all current Billing for Midwives courses and mini-courses, and also provide access to future mini-courses as they are created.
Choose the enrollment method that best meets your needs:
1. À la carte: Standalone enrollment in this mini-course, which expires after 60 days.
~ or ~
2. Billing for Midwives Extended Access. BfM Extended Access members will enjoy the following benefits:
- Monthly opportunity to schedule a 30-minute private consultation at no additional cost
- Ongoing access to the flagship course, Billing for Midwives, for reference and/or CE*
- Ongoing access to BfM's mini-course Setting Your Fees: Finding That Sweet Spot, for reference and/or MEAC CE
- Ongoing access to BfM's Community Birth Billing Practices and Reimbursement Survey Results
- Ongoing access to BfM's mini-course Safe(r) Discounts, for reference and/or MEAC CE
- Access to new BfM's mini-courses as they are released
*Upon course completion, a HiveCE CE Certificate will be issued, which may be used as Category 2 CE for CPM renewals through NARM.
Billing for Midwives
60-Day Access, Flagship Course Only
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Enroll
$99.00
À la carte price (USD)