Practice Management

What challenges should an MFM practice expect if transitioning from MFM care only, to providing full global obstetric care & MFM within the same practice (same NPI/Tax ID)? I understand it is relatively rare for an MFM practice to do this, but can someone explain why? Are there issues with payer contracts when it comes to global obstetric codes billed by an MFM (with a Maternal-Fetal taxonomy code)? Or perhaps the challenge is proving to each payer which patients received full obstetric care and which ones received MFM care only (ie- copious denials).

Any insight would be greatly appreciated.

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Julie Powers
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Hi Julie,

It probably makes sense to analyze the "before and after" to make sure how the transition will work for you and your practice. Some payers will only reimburse for global care, with additional visits above the allocated prenatal visits (12 or 14, etc.)  billed separately with -25 modifier to indicate these visits are not part of the global. It will really depend on your mix of patients, levels of complexity, and payer rules. I would recommend having a consultation with the SMFM PM consultant expert. Please see the related website: https://www.smfm.org/consulting

Best

Fadi

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Fadi BSAT, MD, FAIUM
Chair, SMFM Practice Management Committee
Past Chair, SMFM Coding Committee
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Original Message:
Sent: 08-08-2023 12:00
From: Julie Powers
Subject: Global Billing by MFM

What challenges should an MFM practice expect if transitioning from MFM care only, to providing full global obstetric care & MFM within the same practice (same NPI/Tax ID)? I understand it is relatively rare for an MFM practice to do this, but can someone explain why? Are there issues with payer contracts when it comes to global obstetric codes billed by an MFM (with a Maternal-Fetal taxonomy code)? Or perhaps the challenge is proving to each payer which patients received full obstetric care and which ones received MFM care only (ie- copious denials).

Any insight would be greatly appreciated.

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Julie Powers
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Julie,

If your current contracts are fee-for-service, you should not have any issues if you do not bill the global obstetric codes. My practice is a total care practice. Please feel free to reach out to me if you have additional questions.

Kind regards,

Heather

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Heather Hall
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Original Message:
Sent: 08-08-2023 12:00
From: Julie Powers
Subject: Global Billing by MFM

What challenges should an MFM practice expect if transitioning from MFM care only, to providing full global obstetric care & MFM within the same practice (same NPI/Tax ID)? I understand it is relatively rare for an MFM practice to do this, but can someone explain why? Are there issues with payer contracts when it comes to global obstetric codes billed by an MFM (with a Maternal-Fetal taxonomy code)? Or perhaps the challenge is proving to each payer which patients received full obstetric care and which ones received MFM care only (ie- copious denials).

Any insight would be greatly appreciated.

------------------------------
Julie Powers
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