Medical billing is often full of complexities, and when it comes to tiny patients, the challenges can become even more pronounced. The smallest patients can present the most chaotic problems in medical billing.
This is especially true during neonatal procedures. This is because here multiple distinct services may be performed in a single visit. Most of the time, they are incorrectly bundled together during the billing process. Understanding the nuances of neonatal billing is important to ensure fair compensation for healthcare providers.
In this blog, we are going to explore the world of Neonatal Billing Services including the unique challenges and discuss some of the proven practices of medical billing and coding excellence in this specialty.
What is Neonatology
Neonatology constitutes a specialty in pediatrics that concentrates on the medical treatment of newborns. It particularly includes those who are ill or premature. It is a hospital-based specialty usually given in neonatal intensive care units (NICUs). The primary patients of neonatologists are newborns who are ill or require special medical care because of:
- Prematurity
- Low birth weight
- Congenital malformations and disabilities
- Sepsis
- Pulmonary Hypoplasia
- Birth asphyxia
A neonatologist oversees the survival and well-being of the smallest human beings, who present the most extensive and complex challenges. When you outsource your revenue cycle management operations to a team of specialists like Unify Healthcare Services, they take over the burden and simplify financial operations.
Case Study: Fever in a Neonatal Patient
Let's take a scenario. Consider that a neonatal patient presents with a fever. If you want to diagnose & treat this condition, a physician might perform a urine catheterization (CPT code 51701) and a spinal tap (CPT code 62270). This happens on a single office visit. While these procedures were performed at the same time, they serve different diagnostic purposes and should be billed separately from each other.
The Unique Challenges of Neonatal Billing
Neonatal billing demands a different approach because of the unique nature of neonatal care. These tiny patients often require multiple procedures that may look the same and related but should be billed separately. Incorrectly bundling these services not only affects reimbursement but can also lead to compliance issues.
Pediatric Billing and Coding: Hurdles and Best Practices
Confusing Billing, Codes and Growth ChartsOne thing about Neonatal Billing is that practices often deal with complex billing codes, growth charts, and various hectic assessments. Staying updated with the latest coding guidelines, which include ICD-10-CM and CPT codes, can’t be compromised to ensure a smooth billing process.
Best Practice:Make sure you are regularly training your staff in the latest coding guidelines. Consider using online resources and coding tools. Implement a comprehensive billing team, like Unify Healthcare Services, that includes Neonatal-specific coding to streamline the billing process.
Administrating and Managing Vaccine
In neonatal care, vaccines play an undeniable role. When it comes to inventory administration and management, it is quite challenging. If there is any mistake in the coding process, it can take you towards missed reimbursements and reduced chances of revenue.
Best Practice:Get a proper vaccine management system that helps you to track inventory and avoid challenges in billing. Instruct your staff to accurately code for vaccine administration and mention all the information clearly. It includes the vaccine’s National Drug Code (NDC) and lot number.
Visits are Frequent with a Consideration to Preventive Care
Neonatal patients demand frequent visits for preventive care. It includes well-child visits, screenings, and various immunizations. It can be quite a challenge to ensure correct medical billing for these services. The situation is even worse when you are coordinating with various insurance companies.
Best Practice: Before every visit, make sure that you are verifying insurance coverage for preventive care. It is crucial to maintain updated patient records. Train your staff to identify and use the correct billing codes for preventive care services.
Balances of Family and Case of Multiple Siblings
In neonatal practices, there is quite often a case where various siblings receive treatment under one account of the family. This can create havoc when billing and collecting payments from the families.
Best Practice:Get a practice management system that makes it easy to track accounts of the family. You must be clear with your communication, convey payment policies to families, and encourage them to use the best payment options.
Evolving Insurance Guidelines and Coordination of Benefits
Neonatal practices face frequent coverage changes because the ages are out of eligibility. There might be situations like changing jobs or divorces. Another important critical issue while dealing with insurance providers is Coordination of benefits (COB).
Getting Effective Neonatal Billing Service
Getting an effective billing service partner for neonatal billing is essential because the complexities related to the niche requires immense practice. The coders must be proficient in ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA. They must also be certified by the American Academy of Professional Coders (AAPC).
Best Practices:Physicians must include Newborn Care Services Codes to evaluate and manage the services provided to normal newborns during the initial days of life before hospital discharge.
The codes 99460-99463 deal with the billing of normal infants. This includes the birth center care per day depending on the health of the infant.
Codes 99478-99480 cover intensive care provided by the facility. This is used to evaluate and manage recovering low or very low birth weight infant. The code is decided upon the initial bodyweight of the infant.
Exceptional Service to Avoid Denials
Our trained employees at Unify Healthcare have excellence, knowledge, and accuracy in neonatal billing and coding services. We streamline your entire process including your specific requirements so that you can focus solely on providing excellent patient care.
We strive to create a smooth and friction-free coding, billing, claim submission and payment posting process. We ensure regular accounts receivable follow-ups and prior authorization, which plays a major role in preventing denials.
At Unify Healthcare we envision taking the burden of billing away from every healthcare provider, be it an individual or an organization. We take care of all your documentation needs, so you and your staff have all the time to provide patient care.
