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.

2) Verify documentation before claim submission:

Most billing teams use a pre-submission checklist to review documentation and coding for multiple births, particularly twins, triplets, and higher-order multiples. This helps ensure that each newborn’s claim is separately supported, and that services are not inadvertently duplicated.

The billers reconcile the physician's documentation with the date/time of service and the hospital or NICU encounter. This is particularly important when several babies receive care from the same physician on the same day. The note is checked for an adequate description of the newborn's condition, assessment, treatment, and physician work supporting the selected code.

3) Assign codes based on individual issues:

Multiple births are generally billed by treating each newborn as a separate patient and claim. Clinical documentation is used to determine the services and diagnoses applicable to each individual infant.

For twins or triplets, an outsourced neonatology billing company verifies a separate account and claim for each newborn. The documentation is matched to the appropriate infant, including MRN, birth order, sex, weight, gestational age, and clinical course.

Review claims – The coders look for services that appear identical on the same date and ask whether they were actually performed for each distinct infant. They also check whether the CPT code is actually appropriate for each infant. This is particularly important with delivery-room services and neonatal critical care.

4) Follow-payer specific requirements:

Professional neonatology billing companies generally handle multiple births by combining payer-specific rules with infant-level claim tracking. Each infant has their own patient/medical-record identifier, insurance coverage, diagnosis coding, and claim. The billing company maps the clinical documentation to the specific infant rather than treating the delivery as one encounter.

Outsourced teams maintain payer-specific rules for different government and private insurance companies. These rules can differ regarding modifiers, units, duplicate claims, global or bundled services, and claim sequencing.

If Baby A's claim pays but Baby B's rejects as a duplicate, the billing company doesn't simply resubmit the same claim. It determines why the payer considered it duplicative and checks the payer's policy and documentation before correcting or appealing it.

In today's world of evolving technology, most outsourced firms implement the use of updated software and advanced billing tools. However, it is important to remember that outsourcing does not guarantee accuracy in neonatology reimbursement. What matters is choosing the right company with the right benefits. Thus, every provider must consider a few factors before partnering with a third-party firm.

Things to consider before hiring an efficient neonatology billing company

While submitting claims for multiple births can get tricky, choosing the right billing partner can equally be challenging. Neonatologists must consider several factors before partnering with a third-party service. There are some outsourced neonatology billing services that offer HIPAA-compliant services, real-time services, and CPC-certified coders. These factors must always be prioritized if providers aim to improve overall revenue cycle efficiency. One correct decision to outsource can result in multiple improvements in the neonatology reimbursement process.