The Heart of Maternity Care: The Global Package
Global OBGYN billing simplifies a complex journey—a nine-month-plus episode of care—into a single, bundled payment. This model, recognized by payers like CMS and commercial insurers, is designed for uncomplicated pregnancies. But what exactly is inside this package?
Antepartum Care (The Journey)
This includes all routine prenatal visits from the moment care begins until delivery. It follows a standard cadence: monthly visits up to 28 weeks, bi-weekly until 36 weeks, and weekly until the big day. It's the core of preventive care for mom and baby.
Delivery Services (The Destination)
This covers the management of labor, the delivery itself (whether vaginal or cesarean), and related hospital services like fetal monitoring and episiotomies. It represents the culmination of the pregnancy episode.
Postpartum Care (The Recovery)
The global package also includes routine care for the mother after delivery. This typically involves one or more follow-up visits to ensure she is recovering well physically and emotionally. This care is crucial for long-term maternal health.
Charge Capture: Why Every Click Counts
A common myth is that if a service is part of the global package, it doesn't need a charge. This is incorrect and risky. Accurately entering charges for every single encounter is vital for our non-profit mission. Here’s a deeper look at why.
Data Integrity & Financial Health 📊
Every charge you enter tells a story. It tracks provider productivity, measures patient acuity, and informs our quality improvement initiatives. This data is the bedrock of our financial forecasting and helps us justify resources for the OBGYN service line.
Billing for What's Outside the Box 📦
The global package has boundaries. Many common and necessary services fall outside of it. Only by capturing charges for every encounter can our billing experts identify and bill for these services separately, ensuring we are reimbursed fairly for all care provided.
Managing Complicated Scenarios 🔄
Pregnancies can be unpredictable. If a patient transfers care to or from our system, or if a different provider from another group performs the delivery, detailed charge capture is the only way to accurately bill for the portion of care we provided.
Resource for Audits and Compliance 🔍
Should a payer audit occur, a complete and detailed charge history for each patient provides a clear, defensible record of the care delivered. It demonstrates compliance and protects the organization from potential takebacks.
Outside the Global Package: Billable Services
It's crucial to identify what's *not* included in the standard package. Here are common examples of services that should always be charged separately. Your documentation must clearly support the distinct medical necessity of these services.
- The Initial Visit: The first visit to diagnose or confirm pregnancy is often billed separately.
- Complications & Unrelated Conditions: Treatment for issues like gestational diabetes, hypertension, pre-eclampsia, or even a simple UTI requires a distinct diagnosis and can be billed separately from routine care.
- High-Risk Care: If a patient's condition requires visits more frequently than the standard schedule, these additional visits may be billable.
- Key Procedures & Tests: Services like detailed ultrasounds, non-stress tests (NSTs), fetal biophysical profiles, and amniocentesis are not part of the global fee.
The Epic Charge Reconciliation Workflow
From your click to the final claim, here's how the charge reconciliation process works within our Epic system. Understanding this flow helps clarify your role in the revenue cycle.
- Charge Capture: You, the provider, document all services rendered in a progress note, delivery note, or flowsheet. This is the source of truth.
- "Dropping" the Charge: Based on your documentation, charges are entered. This can be automatic via SmartSets or flowsheets, or you can manually select them from a preference list. This is the moment a service becomes a potential billable line item.
- Charge Router Review: The charge travels to Epic's Charge Router, an automated checkpoint that applies system rules, checks for common errors, and ensures the charge is properly formatted.
- Billing Workqueue Triage: The charge lands in a workqueue for our expert billing specialists. They review the charge, attach modifiers if needed, and for global OB cases, they'll hold the main delivery CPT code (e.g., 59400) until after the postpartum period.
- Final Billing: Once the global period is complete, the comprehensive charge is released and submitted to the payer for reimbursement.
Key Resources & Further Reading
For those who want to dive deeper, these official sources are the gold standard for maternity care billing rules.
- ACOG Maternity Care Coding Guide: The American College of Obstetricians and Gynecologists provides the definitive clinical and coding perspective.
- CMS Medicare Coverage Database: Search for National Coverage Determinations (NCDs) related to maternity care to understand the baseline for federal payers.
- AMA CPT® Code Resources: The source for all CPT code descriptions and official guidelines.