NICU revenue streams

Posted by Kate Tingley on Aug 8, 2019 12:45:28 PM

Closeup portrait female health care professional, doctor, nurse with stethoscope holding piggy bank, dollar bill, isolated red background. Medical insurance, medicare reimbursement, reform conceptToday on the blog, Lynne Westergaard - our NICU revenue cycle expert, is sharing 4 potential revenue streams your NICU professional billing team may be missing. Before we get to Lynne's tips, we've made a couple of assumptions:

 

  1. The group is an independent contracted service to the hospital and does fee for service billing 
  2. The group does not participate in a resident program; i.e. there are no residents providing services for neonatology

Based on these assumptions, here are the tips:

  • Labor and Delivery is a good revenue stream for the practices I work with. In our experience, Neonatology attends between 45% and 55% of all deliveries. The Medicare allowable for 99464 in the “Rest of California” geographical area is $77.29. the Medicare allowable for 99465 is $150.65. Contracts may/may not be based on Medicare allowable, but the commercial payers (Aetna, BCBS, Cigna, UnitedHealthcare, etc.) would typically pay higher with negotiated rates. Labor and Delivery records were not included in this review.
  • Procedures performed in the delivery room prior to NICU admission (intubation, surfactant administration, etc.) can be billed in addition to 99464 and 99465. The procedures need to be clearly identified/documented. Use of appropriate modifiers can differentiate the L&D codes, (L&D location) procedure codes, and NICU admission codes so that each is reimbursed appropriately.
  • There are some codes that can be billed in the NICU in addition to the NICU global codes. The ones I typically see (not often, but on occasion) are chest tubes (32551 and 32554) and transfusions (36450 and 36456). Appropriate use of modifiers would differentiate these from the global day and the procedure should be a clearly documented note.
  • One other source of revenue is routine well-baby exams. One of the practices we work with routinely performs well-baby exams for several of the pediatric practices in the area, another practice only does this occasionally, and a third is staffed to do all wellbaby exams in the hospital. The reimbursement for these exams can be significant source of revenue and shouldn’t be overlooked even if it is only occasional. Here we've used California as an example:
    • 99460 initial exam Medicare allowable $98.94, 
    • 99462 interim exam Medicare allowable $43.62 
    • 99438/99439 discharge Medicare allowable $75.58 / $110.98). Time must be documented for the discharge codes.

We hope this has given you food for thought when it comes to NICU reimbursement.

If NICU billing is a struggle for your hospital or practice, schedule a call with Lynne to learn how Coronis can help improve your revenue cycle and more importantly your collections.

Topics: NICU billing, NICU, NICU Revenue Cycle, hospital coding, hospital revenue cycle management, hospital revenue cycle

Coronis Health strives to provide valuable healthcare billing, revenue cycle and practice management information to practices and hospitals. Our blog is one of the many ways we serve as a resource to the healthcare community. Here you'll find articles on:

  • Reimbursement and coding changes
  • Tips and tricks for specialty practices
  • Resources for revenue cycle success

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