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Neonatal Billing & Coding Services

Providing neonatal billing & coding services is a critical process. Hospitals have to provide them smoothly. There is no room for error due to the sensitive nature of these services.

That’s why you should be perfectly aware of the ins and outs of this process. So, read further and learn how you can improve your cash flow by expertly providing its services. 

Overview of Neonatal Billing & Coding

Neonatal billing coding services are specialized to bill and code processes related to neonatal care. Neonatal care involves medical services provided to newborn infants. The timeline for neonatal care is usually within the first 28 days of life.

This gives an idea of the delicate nature of neonatal healthcare. You also have to face unique challenges while treating newborns. Their billing and coding processes need high levels of skills and expertise. Neonatal care involves a wide range of those services.

Neonatal Billing & Coding Services

They range from routine check-ups to intensive care. The patients also vary from premature to critically ill newborns. This can make neonatal healthcare complex. You must have a specialized understanding of its procedures.

Diagnostic tests and interventions are involved as well. They are specific to this population. Your billing and coding professionals should be well-versed in the relevant terms. Neonatal billing services need specialized training to get the necessary skills and knowledge.

How Neonatal Billing & Coding Help?

1. Facilitates Research

Neonatal billing and coding are good for research. Their accurate neonatal codes mean you have reliable data for research purposes. You can use it for key advancements in neonatology. And hospitals can ensure improved outcomes for newborns.

These services also record accurate documents. Such documents prepare reliable research datasets. You can use those datasets to analyze trends and outcomes. This way, the datasets can determine the effectiveness of your treatments.

Moreover, hospitals also use them to focus on their outcomes. Their researchers can study the long-term outcomes of your services. It enables those hospitals to develop new practices backed by research.

2. Prevents Fraud and Abuse

Placing strict coding standards can help prevent fraud and abuse. You must follow those regulations and conduct ethical billing. The standards ensure that you do not assign incorrect codes. Incorrect codes can either underbill or overbill your services.

In both cases, you are at a disadvantage. Neonatal billing maintains your integrity and saves you from fraudulent activities. Those activities can harm your medical system.

3. Facilitates Benchmarking

You can also use codes to compare your billing performance with that of the leading healthcare providers. Comparison gives you an idea about the common industry standards. This way, you can create an environment in which you continuously improve. It enables you to identify areas of improvement. Then, you can work on those areas with the help of neonatal coding.

4. Insurance Pre-authorizations

Neonatal coding helps hospitals get their pre-authorizations. Pre-authorizations are important for submitting claims to insurance companies. They improve the approval process for those claims. You can send clear and detailed documents to the insurers.

The documents easily justify the medical necessity of your services. As a result, you are able to get timely approvals. The documents have to be sent before you provide the services. This way, you can conduct the treatments without delays.

5. Supports Medical Education

The reliable data provided by neonatal billing & coding services can be used to improve educational efforts. You can conduct training programs and academic research through that data. Hospitals can use such educational programs to train their staff. The training can be about real-world scenarios and experiences.

This way, their staff can learn a lot about patients. Then, there is the aspect of academic research as well. You can support academic research as well. And improve your knowledge of neonatology. Hospitals can also develop new educational materials for their billing processes like provider credentialing.

Benefits Of Outsourcing Neonatal Billing & Coding Service

1. Neonatal Coding Expertise

Outsourcing companies focus on specialized knowledge for their neonatal services. They have experts who are specifically trained to handle those processes. They have tons of experience with real-life patient cases.

This expertise means that they assign accurate codes to your unique procedures. The experts take care of all the services associated with newborn care. As a result, you can see reduced errors in your documents.

2. Access to Latest Coding Updates

By outsourcing, hospitals are able to follow any medical coding changes. These changes are part of the regular standards set by regulatory authorities. Outsourcing companies have the necessary resources to regularly update their services.

These updates ensure that you have access to the latest coding updates. This approach is useful for maintaining compliance. You can also avoid the issues caused by outdated codes.

3. Service Flexibility

Outsourcing companies also have flexible services. They can tailor their billing neonatal services to match your needs. They have a lot of models. You can choose one that aligns with your specific neonatal care.

They can either scale their services up or down. It is based on your demand. They can only customize the level of support required and create a personalized approach. The approach is tailored to your neonatal billing & coding services.

4. Consistent Quality

Outsourcing companies have dedicated billing and coding teams. These teams are always determined to maintain consistent quality. They specialize in those processes and focus solely on them. You can work with them to ensure consistent and high-quality billing and coding.

They can make your neonatal documents accurate as well. All this enables you to thoroughly understand the field and its specific needs.

5. Improved Patient Satisfaction

Outsourcing your neonatal billing to medical billing companies is an effective way to improve your billing process. They can reduce the errors and issues that affect your patients. Patients experience positive interactions with your staff.

They do not face many billing-related problems. And have a more positive perception of the quality of care provided. They are satisfied with you and more likely to come again.

What Are the Guidelines for Outsourcing Neonatal Medical Billing Services?

1. Performance Monitoring and Reporting

Hospitals should set up systems to monitor the performance of outsourcing companies. Those systems should also report it back. This way, you can evaluate the effectiveness of your outsourcing partners.

This way, you can regularly assess if they are following the set standards. And maintaining accuracy while assigning codes and sending claims. These assessments enable you to identify areas of improvement.

You can do that by establishing key performance indicators for your neonatal billing. These indicators can include the rates of claim accuracy and submission. You can even schedule performance reviews and reports. They create an effective approach to highlight and address any issues promptly.

2. Risk Management Protocols

Healthcare providers can also establish risk management protocols. These protocols can manage the potential challenges that affect your billing processes. By doing this, you can prepare a quick and effective response to any issues.

It can reduce their impact on your financial health. For this, you can define and document any risk scenarios related to your billing. These scenarios can include coding errors and delays in claims processing.

Another scenario includes the changes in regulations made by regulatory authorities. You must work with your outsourcing partner to develop plans to oversee this. You can also develop response strategies with them. A tip is to regularly review and update these protocols.

3. Understanding NICU Billing

Neonatal Intensive Care Unit billing includes a lot of specialized services. It is important that your outsourcing partner understands how to conduct it. This way, they can ensure that your bills accurately align with the NICU services provided. Moreover, you should also check that the outsourcing staff is specifically trained for NICU billing.

You can conduct training sessions with them to keep the team updated. These sessions can be vital in case of new procedures or coding changes introduced. Another measure includes setting up an open communication with them. It gives both parties a chance to address each other’s questions.

4. HIPAA Compliance

Your outsourcing company should strictly follow the HIPAA regulations. This guideline is non-negotiable for neonatal outsourcing. You should especially ensure this as you work with sensitive patient information. Security measures must be in place as well.

They should protect the privacy and confidentiality of that data. You can do that by verifying the security protocols of your outsourcing partner. They should follow HIPAA and uphold encryption and access controls.

The most important thing is data transmission. It should be secure. And you can ensure that through audits. You can audit the security measures of your outsourcing company. It will confirm whether your outsourced billing processes like charge entry follow the relevant standards.

5. Documentation Transparency

Outsourcing companies should also maintain transparent documentation. They should provide clear and detailed documents to you. This is a key step as you are billing neonatal care. Those documents can include reports. Others can explain the codes assigned to your treatments.

They are related to procedures conducted on newborns. Some modifications can be made as well. They are mostly done to your billing records. Transparent documentation can maintain accountability between you and outsourcing companies. It is also important for internal audits and compliance verification.

How Health Quest Can Help Your Neonatal Billing Process

Health Quest Billing has skilled coders who specialize in neonatal coding. They can assign accurate codes to your services. This way, we reduce errors in your neonatal billing & coding services. Our billers and coders are also updated with the latest changes in neonatal billing guidelines.

That helps us generate precise bills for your patients. And our compliant practices ensure that you do not experience any billing problems. We are also experts at enhancing the claims submission process for hospitals.

Health Quest Billing ensures that your claims are accurately and timely submitted. This improves the reimbursement process. Insurance companies are likely to approve those claims. Ultimately, this increases your hospital’s revenue.

Apart from that, our comprehensive pediatrics billing services guide offers invaluable insights, tips, and solutions to optimize your revenue cycle management effortlessly.

What Are The Neonatal Billing CPT Codes?

There are three categories of CPT codes for neonatal services. They include Pediatric Critical Care Patient Transport and Inpatient Neonatal and Pediatric Critical Care. The other one is Initial and Continuing Intensive Care Services. Let’s take a look at some of their codes:

1. Pediatric Critical Care Patient Transport

One of the most important CPT codes is 99466. It is assigned whenever a provider has to handle a critically ill or injured child. The child has to be two years of age or younger. This code is used during transporting the child between facilities.

Another key CPT code is 99485. It is assigned whenever a provider handles the transport of a critically ill or injured child between facilities. The child has to be 24 months of age or younger. The maximum duration of the transport can be 30 minutes.

The provider has to communicate with the transport team at all times. This includes before and during transport. They also have to communicate upon arrival at the receiving facility. During this communication, they interpret the patient data provided by the transport team.

2. Inpatient Neonatal and Pediatric Critical Care

This category includes three main CPT codes. The first one is 99468, which is assigned when a provider provides initial care. They have to evaluate and manage a newborn or infant. The child has to be less than 28 days of age. This care is provided in a critical care setting.

The second important CPT code is 99471. You have to assign this whenever your provider handles a critically ill infant or young child in an inpatient setting. They have to conduct an initial evaluation and management of the child. The age of the child should be 29 days through 24 months.

3. Initial and Continuing Intensive Care Services

The CPT code 99476 is assigned when a provider provides follow-up care. They have to handle a critically ill child. The ages of such children should be between two to five years. And the care is provided in an inpatient setting.

The Bottom Line

Neonatal billing & coding services include processes provided only for neonatal care. Accurate coding is good for research and prevents fraud. By outsourcing billing processes, you can enjoy flexible services and consistent quality.

Some outsourcing guidelines include performance monitoring, risk management, and HIPAA compliance. Health Quest Billing is the best at neonatal coding. We can increase your revenue with better compliance and claims submission.

So, contact us  today and get access to top-quality services that can upscale your cash flow!

Contact Us For Neonatal Billing & Coding Services

Ready to upscale your Neonatal Billing & Coding Services ? Schedule an appointment with Health Quest Billing today and let our experts guide you towards a more efficient and profitable billing future.

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Frequently Asked Questions (FAQs)

When billing for a newborn, the patient should be identified as either baby boy or baby girl. The bill should also contain the appropriate date of birth.

The billing code for neonatal intensive care is CPT 99468. It falls under Inpatient Neonatal and Pediatric Critical Care.

Code 99477 is used for the initial hospital care of a neonate (28 days or younger) who is not critically ill. Although, they require intensive observation, frequent interventions, and other intensive care services.

NICU care levels are represented by unique revenue codes: Level 1 (0171), Level 2 (0172), Level 3 (0173), and Level 4 (0174). Any inpatient revenue codes not billed as levels 2-4 are recognized as level 1.

The coding standards for a birth episode in a newborn record assign a code from category Z38. This includes liveborn infants according to place of birth and type of delivery.