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.