Midwife Billing Service versus In House Billing

Midwife Billing Service versus In House Billing

Biggest challenge midwives have is to pick which part of services to keep in house versus out source. Do you do breastfeeding support within practice or refer patients to Lactation Consultant down the street? Do you offer doula services or have that part of what birth assistant will do for your clients? Will your insurance processing be done by an established midwifery billing service or be done by your practice directly?

You can hire a billing specialist that can do double role of receptionist. Depending on how busy your practice will become, that might be a nice option initially. I find it more has to do with the skill of the midwife or midwife team with billing and coding that determines if a billing company should be hired. Solo midwife practices can do their own billing, but time spent focusing on this “headache of a process” can be spent focusing on patients. There is lots of time spent learning billing and coding, keeping up with standards in coding, know all insurance companies specific rules, and have time to follow up with claims and invoices.

Outsourcing a billing service like Larsen Billing or Midwives Advantage are great resources for smaller midwifery practices (less than 3). It is typically 6-10% charge for claims. Some bill flat monthly service plus commission from funds received. Some charge based on commission of what should be collected whether patient pays or not. Are they billing claims under your specific name, business name, or their billing system name using your provider name (subcontractor role of larger entity). Please make sure you understand their specific contract before signing up with any billing company. If a claim is ever questioned, you want to make sure who is ultimately responsible for codes and services rendered on teh claims. Most of the time, it is your license and business in question when a billing service submits a claim. Claims should be only submitted for care you directly provided, most billing companies will ask for copy of charted notes or access to your EMR system to view those documents.

As your practice grows, it isn’t cost effective having a billing company doing your claim processing. Having someone directly in house as a hourly rate or flat salary is usually best option once midwife business is greater than 4 midwives and midwife team understands billing and coding. If you aren’t sure what to bill or what codes are available to bill, there is lots of risk with insurance fraud and loss of immense revenue with missing important codes. It isn’t just about knowing how to bill maternity care. One must know when to bill a problem visit with maternity care, which supply code can be billed outside of a facility during a home birth, and preventative counseling like tobacco use to be successful.

For a midwife business to be successful long term, financial revenue collection is key to success. Collection is from cash, co-payments, co-insurance, deductibles, non-covered services, and insurance payments.

I rarely outsourced my billing, because I am very comfortable with insurance billing system. I like using EMR systems that have billing services part of it. I can submit my claims, but have a back door customer support team to help with claims getting stuck or rejected and automatically collect patient payments and send balances out after claims are submitted. It is a nice balance between outsourcing, but paying a lower commission to have a charting system do everything all in one.

I use Athena Health and it works great for having a midwifery practice that does obstetrics and gynecology services. I would just paper chart at home births or birth center deliveries and upload those documents into the patient’s charts later. Rest of care was placed directly in the EMR system that had option after check out to submit patient’s claim to insurance company. I could then do verification of benefits prior to visits, see regularly patient’s balance and where claims were at after delivery.

As a new graduate, most midwives just need to focus on caring for mothers and babies while leaving the experts in their fields like insurance billing to that aspect of their practice. Starting your own midwifery practice can seem overwhelming and daunting. Just take each start up or expansion task one step at a time. Hire the right team and you will excel! You don’t have to be an expert at everything, you just need to know how to find the right team members to make your midwifery business perform optimally.