by Christine Romney

Billing Facility Fee for Homebirths

Dear Midwives,

I have recently heard about other billing services that are promising and getting facility fees paid for home birth midwives. My first thought was, “Thank goodness, now maybe I can get some compensation for that CCHD pulse ox I had to buy last year, and that Doppler I dropped in the birth tub last week!” We all know the burden of hauling bags of equipment and supplies from place to place, and the heartbreak of tossing expensive expired medications that we rarely use, but must have at the ready for every client.

I immediately brought this to the attention of Christine and our senior coders.

Larsen Billing Service has investigated all of the possible codes for facility and supplies, and I feel moved to share with you what we have discovered:

  • Facility Service Payments are not payable under CPT or Revenue codes for births that occur at home. Billing a facility code when there is no facility cost, like rent, utilities, insurance etc., constitutes fraudulent billing according to every resource that we can find.
  • Even midwives who own or have privileges at birth centers or hospitals are not eligible for this kind of compensation when the labor and birth happens at home.
  • Billing under a birth center for services that do not occur there is insurance fraud.
    Of course this is confusing, because if the claims are paying, what is the problem, right? Well, here is what else you need to know:
  • Coding is not universal, and there is certainly the possibility that there is a midwife out there with a contract with some insurance plan, whom may be allowed to bill a facility code for homebirth supplies. We have never seen one, but anything is possible. However, that does not mean that this is applicable to any other midwife practice or any other insurance plan. That’s one of the problems with most of the billing resources floating around the internet and within the midwife community. What works for one practice does not apply to anyone else, and may inadvertently be fraud, despite the author’s best intentions.
  • You, the provider, are responsible for coding. Billing services, even this one, give advice and make suggestions on coding all the time, but if you cannot find evidence in the code books for the advice as it pertains to your services, you should not allow them to bill on your behalf. So even if your billing service picks your codes, you have ultimate responsibility for all of them.
  • States vary, but there is no overall statute of limitations on take backs, audits, or insurance fraud. That means that even if a code pays for ten years, it could be audited or investigated by the insurance company or local authorities, and you will be held liable to pay back, usually with interest, all funds that were improperly coded. A good billing service stands by their billing and coding and will help you gather the needed information in the case of an audit.

All of that is pretty scary. Believe me, even with my years of experience at LBS, the nuances of billing and coding for my practice have kept me awake at night. The fact of the matter is that coding and insurance billing is not a system built around the midwifery model of care, our business models, or our traditions. Sadly, in order to play the insurance game, we have to work within their system, not ours. For most of us that means we have to know more and participate more in the flawed western medical and bureaucratic medical insurance systems, way more than we ever wanted to in order to do the work we have been called to do.

I can promise you this:

  • Larsen Billing Service is constantly surveying contracts, State and Federal actions, and case law in regard to coding practices and standards.
  • LBS is committed to finding all of the legitimate codes for midwifery and birth center services and maximizing reimbursement to your practice and your clients.
  • We change how and what we bill in response to these findings, and we utilize multiple outlets to inform our customers of best billing practices.

In the meantime, donate those expired supplies, document the cost of that pulse oximeter, and write off every single business expense that you can.

If we ever find a code for that water-logged Doppler, I promise that you will be the first to know.

Nicole Wocelka, CPM
Licensed Midwife and Chief Operating Officer at Larsen Billing Service