Making sure a midwife is getting paid for her services is vital to a successful business. Whether you are paid cash or insurance payments, having good written policies to improve communication among staff and clients will create strength to your billing processes.
Make sure an attorney looks over your financial contracts before implementing them into the business. Any legal binding document for your practice should be looked at by an attorney prior to use like HIPAA documents, financial agreements, risk out criteria, scope of a midwife, charting forms, transport records given to hospitals, and anything that family will sign during your care.
Midwife Billing System
Have an internal trained biller or professional midwife billing system to process your insurance claims. Know which insurance plans you will bill in network and get credentialed. If choosing to be out of network with an insurance plan, make sure clients understands your business network status and estimated responsibility for costs of care. Last thing a midwife wants is postpartum frustration between mothers and midwife, because she didn’t understand what your care would really costs her.
Creating fee schedules that are competitive, cover your overhead operating expenses while leaving room for profits, and covers all the codes your practice will offer for care. Learn what each insurance plans in network contracted rate for services is before becoming in network. Last thing you want is to be stuck to a low reimbursement rate by contract that doesn’t cover your overhead business costs.
Remember, private practice midwives offer higher quality care (not based on high volume assembly line), so your costs will be higher than a hospital large practice. Make sure the business marketing is promoting quality and families will expect to pay for more individualized prenatal care and birth experience.
Billing and Financial Discussions
How your staff talks about billing and financial questions with customers should be discussed in staff meetings, initial staff training orientation, and written policies for future reference. Receptionist shouldn’t be having a discussion with mothers during check in about their financial responsibilities on insurance claims.
Their skill set and job description doesn’t cover that part of the practice flow. Have all financial questions be directed to Office Manager or Biller directly if one is present in office. Midwives during prenatal visits and care shouldn’t be having the financial discussions. Most midwives are not trained in billing and shouldn’t be explaining your practice’s billing expectations. It is nice to have a meeting with Biller at initial prenatal visit after the midwife has her appointment completed.
It is a good idea to have co-payments and estimated financial responsibility for care paid prior to the birth. Many private medical practices are going to pay for services prior to administration to help with lost revenue when insurance claims are done processing. Birth charges can take up to a year to process. Many families, especially if it is their last child, will have little incentive to pay their remaining balance to the practice for outstanding balances. You can hire a debt collection service, but medical outstanding balances do not harm a patient’s credit score or anything if not paid. There is very little incentive to pay besides legal fees if taken to court for payment collection.
Lower your Liability Risk
If your family finds the funds to pay for your care prior to birth, your quality of care is more in demand. For example, someone that doesn’t pay anything for care out of pocket directly or funds will be collected after birth occurs, there is no “financial investment” present with patient being a team in the cost of this birth and care experience. Families that search out your services, choose to pay out of pocket for care versus an in network provider, or drive a far distance to come see you are much less likely to sue you later.
Record keeping for billing can be automated through an EMR system like Athena Health (my favorite) or on a simple excel spreadsheet. Create a system that works best for your style and size of the practice. Small practices doing paper charting have an easier time using invoice templates with automated algorithms to calculate costs and patient responsibility. As practice grows, having an EMR system that doesn’t much of the practice tasks automatically like billing claims and sending statements to patients will really help create high reimbursement from insurance plans and patients.
It is really vital that midwives invest time in advance of start up and regular intervals keeping an eye on billing laws, insurance claim process, coding changes, patient balances on file, and staff education about financial etiquette discussions. With health care costs rising and private practice closing daily, make sure your midwife practice is profitable and successful long term.