Fix Neonatology Billing issues for twins and multiple births

The task of managing neonatology reimbursement is challenging for many providers. Newborns face complex health issues which make their treatment even more complicated. The reimbursement process of multiple births involves additional complexities because each newborn is typically billed as an individual patient. Separate patient records and billing considerations often apply, despite infants being delivered during the same pregnancy. These complications lead to several hindrances in neonatology billing that give rise to claim denials, payment delays, and revenue loss.

The in-house billers are often overburdened with other administrative tasks. Hiring a third-party neonatology billing company helps overcome challenges in the reimbursement for twins and multiple births.

The hidden reasons behind the complexity of twins and multiple births reimbursement

When twins are born, physicians take additional care to ensure proper treatment for both the newborns. This involves multiple imaging tests, procedures, and medications. However, the reimbursement process becomes complicated for in-house neonatology billing teams due to the following reasons:

1) Separate patient identities:

Each newborn is a separate patient with a separate medical record, diagnosis set, and claim. Billing systems must correctly link each baby to the mother and distinguish Twin A, Twin B, etc.

2) Global maternity vs. newborn services:

The obstetric provider's global maternity reimbursement generally covers the mother's care, while neonatal services are billed separately for the newborns. Confusion can occur when payer edits or claim systems incorrectly associate newborn services with the maternal or global claim.

3) Same-day services:

Twins may receive similar evaluations, resuscitation, procedures, or critical-care services on the same date. Automated payer edits may flag identical CPT/HCPCS code combinations as duplicate services. Clear claim details showing that the services provided to different patients can help prevent this edit.

4) Different levels of neonatal care:

One twin may require NICU care while another may only need routine newborn care. Even though the babies share a delivery, their medical necessity, acuity, procedures, and length of stay can be very different.

5) Modifier requirements:

Certain neonatal procedures performed for multiple infants may require modifiers such as 59, XU, or other payer-specific modifiers to indicate that the services were distinct and provided to different patients. Improper modifier selection or application may result in claim denials.

6) Shared delivery-room services:

Neonatologists may attend the same delivery for multiple babies, but the clinical work can differ substantially between infants. Documentation needs to establish what was actually performed for each newborn.

Most of these issues arise due to a lack of expertise in billing. While in-house staff can manage the complexities of single born reimbursement, they often struggle to ensure billing accuracy for twins or multiple births. This is when hiring an outsourced neonatology billing company becomes necessary for most practitioners.

How can outsourcing fix neonatology billing issues?

Handling the complex task of newborn care reimbursement takes more than just knowledge about coding and payer policies. It also requires experience and the ability to handle billing complexities of multiple births. Professional neonatology billing services implement the following methods to reduce claim denials in multiple births:

1) Maintain separate patient records:

The outsourced companies have a billing system that creates a distinct patient account or medical-record number for Twin A, Twin B, etc. CMS treats patients’ financial records separately from their medical or health records and requires claims to include patient-identifying information.

Each infant gets his or her own dates of service, diagnoses, procedures, providers, charges, payments, and claim history. Thus, if the neonatologist examines both twins, the services are entered against the appropriate infant's encounter rather than treating the twins as one patient.