OB GYN contracting information: Urgent help please

Hi,

My provider is an OB/GYN specialist, she is contracted with most of the PPO in California. till last month she was working with a group but as of Sept. 1 she has opened her own practice and here is the problem arise.

Now she has a new Tax ID no. and her old patients are coming to her new clinic and claims are being billed with new Tax ID but problem is with OB care patients, my provider has given pregnancy care to many patients at old location and claims were billed with old tax ID but now delivery or continuity of care will be billed with new Tax ID so there are chances that insurance will pay us for only delivery.
so what is the right procedure we should follow in this case to insure full payment for full OB care. please advise!!!

OB/GYN contractrat Help:Urgent

[Hi,

My provider is an OB/GYN specialist, she is contracted with most of the PPO in California. till last month she was working with a group but as of Sept. 1 she has opened her own practice and here is the problem arise.

Now she has a new Tax ID no. and her old patients are coming to her new clinic and claims are being billed with new Tax ID but problem is with OB care patients, my provider has given pregnancy care to many patients at old location and claims were billed with old tax ID but now delivery or continuity of care will be billed with new Tax ID so there are chances that insurance will pay us for only delivery.
so what is the right procedure we should follow in this case to insure full payment for full OB care. please advise!!!]

She may need to bill under the new tax id no and get it updated with insurance co

The provider that you work for has to bill under her new tax id # , so she get paid directly. If she was part of a medical group (for example)and she had their tax id # for instance, she could be missing out on money that supposed to go to her directly. So please advise her to use the new tax id # and to update her new tax id # as known as EIN# for tax purposes as well. She need to contact the contract providers with her new information of her tax id #. Because by her using the old, the payments may be listed with her old tax#, and the address in the insurance provider system has to match up with the provider. So this might stop her from being paid. Good luck.

OB visits, two groups

Your physician cannot bill for services provided under the old tax ID, as if she did them now. That group will bill for services performed when she was affiliated with them, and you will bill for services now that she is in her own practice. The only way around this is if you made an agreement with the old practice to pay them for the work done while she was there.

Look at this article from ACOG

http://www.acog.org/departments/dept_notice.cfm?recno=6&bulletin=4666

You need to break out the global OB codes, as described in the bottom of the article.

ob delivery billing

how do we deal with OB patients where this EIN change was made in the middle of the pregnancy? does it effect the delivery billing at all?

OB Billing / Tax ID

All services performed under old tax id must be billed under that tax id. If doc was with group the group needs to bill antepartum and the doc can bill OB and delivery if she in fact does the remainder of the ob visits and the delivery. If she only did 1-3 visits I would send with a letter explaining that she only did those visits in her office and bill as office visits, send with notes and visit history showing the ob visits. I have had very good luck with this.