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This manual is designed to provide certified nurse-midwives (CNMs), certified midwives (CMs), and their billing staff basic guidance on reimbursement for midwifery services. Understanding the billing and coding process as well as the laws and regulations that govern payment under public and private health plans or insurers is critical to this process.
This manual provides information on billing, coding, and reimbursement issues that are universal to all health care professionals as well as specific requirements and issues that uniquely affect CNMs/CMs. This edition contains updated information on Medicaid, Medicare, managed care, and midwifery regulations. Chapter 1 provides a general introduction to the material in this manual. Chapter 2 addresses billing and payment under federal health programs. Chapter 3 addresses these issues under private payers. Chapter 4 focuses on fraudulent billing. Although it is not intended as legal advice, this manual should provide midwives with essential background information in these vital areas. Chapter 5 provides information on contracting. Chapter 6 addresses coding. Finally, Chapter 7 describes the steps in the life cycle of a claim.