Transcript

SPEAKER_02
0:04

Hey Denise, how are you? Hi Ginger, here we are again. The possible midlives are back again. It's totally possible. Yeah, I keep believing that more and more every single day. Okay. Um, and you know, I think part of that is because I keep learning things all the time about how to approach things more with curiosity than with anger because it's real easy to get angry these days.

SPEAKER_03
0:32

Yes, yes, it is, it is. It's a good approach, Ginger. I mean, we keep learning, we have to keep learning. There's so many mysteries out there.

SPEAKER_02
0:40

Yeah. Well, you want to go into the big one? That's the new news for today.

SPEAKER_03
0:44

Well, this is what you love. So hit us with the news, Ginger.

SPEAKER_02
0:47

It is. I mean, I I have to admit, I I'm I'm a Facebook girl, you know. All of us I continue to refer to as the old folks, took over Facebook, and this was on Facebook all over social media yesterday. It could have come out before, but but I certainly caught ACOG's green color and meme. Um, and I didn't dig deeper because our guest uh does that for us, but here's the bolded statement. Okay. ACOG on the new maternity codes in the 2027 Medicare Physician Fee Schedule proposed rule. And I'm like, hmm, what is all this other stuff? And this is from their recent incoming president of ACOG, Dr. Claire. Okay. ACOG thanks CMS for their inclusion of the AMA new obstetric CPT codes in the 2027 fee schedule proposed rule. However, ACOG is concerned that CMS is also considering the creation of 15 new HCPCS G-codes for 2027 that would reflect the existing inadequate global coding and payment structure for maternity services. There's another sentence, but I'm just gonna stop there going, G codes. What the blank is a G code? You know, how do why do we have more codes? And 15 of them, which I'm not sure were ever brought up in prior discussions as they were evolving this major overhaul of reimbursement. Okay. Do you think our guests will have answers? I do. In that she'll know more than you and I do, but man, well, for sure.

SPEAKER_03
2:47

When I it's it's really creating a ripple in the clinical setting. People are anticipating how is this going to affect us? And there already there's a lot of fear. Um there is. There's a lot of fear, and then there's already talk about like WRVUs. Can we take those from you because you don't use WRVUs? I mean, we're experiencing that kind of thing in our practice. It's like, no, no, you can't take our WRVUs. I don't know how it will all affect us, but there's such great fear looming.

SPEAKER_02
3:15

So interestingly, as much as I think I hold some hesitancy about it all and not reimbursing low-risk patients at the same level as high risk, which I feel is a little discriminatory because everybody deserves excellent care from every provider. There are a lot of midwives I've seen posting, particularly on LinkedIn, that thinks this is the bee's niece. And I'm I'm sitting here going, I'm not sure we understand it's gonna be completely in our favor. Right. Uh, and it really hedged on better data collection and ways to do quality improvement by having codes that have maybe a more objective meaning than a subjective global bill that doesn't tell you much of anything.

SPEAKER_03
4:08

I get that. I get it. Um we gotta just get into the nuts and bolts of this, gender. Yeah. I don't know. I think it's yeah.

SPEAKER_02
4:18

You know, putting that on Facebook, thinking CMS gives a rat's ass. I'm sorry. I I I'm like this, make why would they put this on social media unless they want something to happen, which we're gonna talk about today?

SPEAKER_03
4:32

Would you like to introduce Arden? Oh, I I'll introduce Arden, but then you know, Arden's been with us before, um, and she's returning because of this timely discussion. Um, actually, I'm gonna let Arden introduce herself. She's gonna tell us um more about she knows more about who she is than I do, um, just because she lives with herself. So, Arden, please tell us who you are and why you're here today.

SPEAKER_00
4:58

Well, I'm Arden Schwenker. I'm CFO for Grow Midwives. I am a certified professional compliance officer, a certified OB coder. And most importantly, for today's discussion, I was part of the panel or the committee that was involved with introducing the new codes and developing the new codes. So that is my background as far as the new coding. And I've been billing, coding, um, full scope revenue cycle management for maternity care for almost 20 years. So a lot of experience in maternity care, billing and coding.

SPEAKER_03
5:46

Thank you. Thank you for being here, Arden.

SPEAKER_02
5:48

Yeah, thanks for coming back. Thanks for coming back. Yeah. You know, when I heard the G um the G word, I thought of all kinds of other G acronyms, and I didn't think of G codes, so I'll just stop there. But Arden, did any G codes come up in your conversations?

SPEAKER_00
6:08

No, but that's because G codes are specific to Medicare. The only payer you can submit a HIC pick, which is HCPCS, a HIC pick G code too, is Medicare. Um, some state Medicaid plans here and there might allow it, but those are Medicare specific codes. And what CMS did yesterday was caved to someone, probably the insurance companies, and they are putting in the CMS final rule proposal. Now, this is just proposal to the final rule at this point. Um, the addition of 15G codes that not coincidentally, in my opinion, or ACOG's opinion, we are on the same page in this one, exactly mirror the 15 global codes that we fought so hard to have removed. Why? And well, I my opinion, because I my opinion is based on information I have heard from people that work directly for insurance companies, the insurance companies are stating that they do not have the budget to implement the new coding for 2027. So CMS is proposing this as a bridge where you can the G codes would only be theoretically for 2027. Nobody agrees with that, but it is a bridge where insurance companies can choose if you bill the global codes or if you bill the new codes. And it will in my opinion, in ACOG's opinion, what it's going to do is cause an even greater disruption in maternity care, in billing, in payment. It's going to cause even more confusion for Denise, you as a midwife, the rest of the midwives and OBs out there, and confusion for the billers. And in the end, it's going to cause confusion for the payers because they can't figure out how to pay maternity care right now, if more than one practitioner or provider sees somebody during the course of their pregnancy. If I start with ginger and transfer to Denise and you're at two different practices, insurance companies can't figure out how to pay those claims now. How are they going to do it in the future if they're choosing, do we use the old global codes or do we use the new per visit ENM codes, which are not new? It's the standard ENM codes, and then the new codes for labor management and delivery.

SPEAKER_03
9:23

And how will that, how do you think that's going to affect really just more of like high-risk patients? Um, like you're taking care of someone, but you need a consult with another provider for a high-risk issue. Again, confusion?

SPEAKER_00
9:38

Again, confusion. It's already confusion. If you are seeing someone and you need a consult with MFM, for example, and MFM is in the same practice. Well, they are including currently, typically including it in global. And if MFM's in a different practice, then they're supposed to pay both claims, but they may only pay the MFM and not the CNM or CM that referred to the MFM. So there's already confusion. I think it's going to add more confusion. There's already stress around the new codes. What do we do? How do we chart? How do we bill? And it's just going to add even more.

SPEAKER_03
10:31

Okay.

SPEAKER_02
10:32

What what you know, Arden has done a lot of work and research in the last 24 hours. And um my question is, what what does Denise do? What do midwives in active practice do when they read this in social media? You just sit there and go, how do I learn more about what is going on here? Uh, because as Isaac says, the trust me bro model doesn't always work very well.

SPEAKER_03
11:05

Right.

SPEAKER_00
11:06

Right. You think you have to advocate for yourself and for other midwives, and what do you do as far as the G codes is one part of it. Right. Right now, they're still nothing is finalized. They're being brought as um an option in the final rule, meaning it's open for commenting, so the general public can go and comment on these codes. I think that if they directly impact you in any way, that you go to CMS and you comment on the codes. I came up with a flyer with a QR code that tells you exactly what the codes mean, why you should be, why you should comment against them, why it would be in your best interest, and what to include in your comment, including basically writing out a lot of the comment or the initial part of what to include for people listening. And I think if it directly impacts you, you should definitely comment whether you use the suggestion that I have out there, ACOG suggestion, or your own words. It doesn't matter. Go comment on the final rule. Because if you don't comment, they'll pass the codes.

SPEAKER_03
12:35

So this handout is is available.

SPEAKER_00
12:38

Yes. It will be, we will, I don't know how we'll distribute those.

SPEAKER_02
12:45

We'll uh release it, Denise, on our podcast um Buzzsprout website. We will put it on the GM Grow Midwives website blog. And uh, I'm sure Denise Arden can help us get it out in the social media channels um as well.

SPEAKER_00
13:05

Yep, we will bless this everywhere.

SPEAKER_02
13:09

I I think it still sort of goes back. Uh Arden, I'm I'm gonna ask you to dumb it down even more. Good idea. Because the process that you all went through and and you sort of came in through A reaching out to ACNM, reaching out to us, and and then sort of got involved before all the final decisions were made. Like, how does this even happen in a formal process that ACOG, AMA, and CMS went through? And all of a sudden, the outliers who are the payers that don't want to participate in the sandbox get to disrupt the whole Apple cart? Like, is that because of the federal government allowing Medicaid and Medicare to yield their power or United or the Blues? Or like, how does the lobby industry for the insurance companies have this much power after all that work that was done over a couple years?

SPEAKER_03
14:14

I think it can I add an additional like why I think it's money.

SPEAKER_00
14:22

I think it all goes back to money. And like I don't, I can't in all the research I've done in the last 24 hours since these codes were replaced. Not one thing I just want to put out there for not one thing directly ties it back to the insurance companies, and but they're the only ones that are set to gain from this. CMS isn't set to gain from it, Medicaid doesn't gain from it. AMA, I don't know. ACOG definitely doesn't, and CNMs or any midwife does not gain from these codes. A lot to dumb it down or take it back even further. The whole premise behind the new codes is that the old code set was based on one, you see one person throughout your whole pregnancy. That one person sees you on your first prenatal visit, they deliver your baby, they see you through six weeks postpartum, and they're paid one global fee. But as we all know, healthcare has changed, and you don't see one person through your whole pregnancy. Not typically, not real life, not real life. Real life, you'll see multiple people through your pregnancy. You might see somebody completely different for your delivery, you may see somebody different for postpartum care. That's what the new codes are intended to reflect is you bill for what you do, you bill per visit instead of globally, you get paid for labor management, you get paid for the del type of delivery that you do or assist with.

SPEAKER_02
16:16

Yeah, I I do think to give some of the people credit that I slightly was dissing, but not really. There is there is an ability to have more data on what's actually going on at points of care based on the codes they created. Um, and so that could potentially help, I think, Denise, in research and quality outcomes and um length of time that X, Y, and Z, you know, is going on.

SPEAKER_03
16:51

I mean, I do see some advantage when you talk about like things such as labor management and then somebody else comes in to do the delivery. Um, all that 36, 48 hours that you spent with that person not being reimbursed for that is really very painful. And they come in for two minutes and they get the whole reimbursement. My question now, like, there's gonna be like specifics, but how does that like involve just like postpartum visits, the in-hospital postpartum visits, et cetera? I mean, is everything really kind of broken down, all the parts um, from what you see?

SPEAKER_00
17:25

Um, so it'll everything will be based per encounter or per visit. It's it is um regular postpartum visits on the day of delivery are included in the code for delivery. Okay, but postpartum visit on the next day is becomes a billable, the discharge is no longer included in global, things like that will become billable, which increase increased revenues, and I've ran the numbers multiple different ways. The AMA's recommendation on number on how you bill is it pretty much on an NSVD, it's pretty much a wash. Like the RVUs are within 0.48 of each other based on the AMA's recommended RVU value, which they're not, they won't be finalized until November. But that's the based on the recommendation. But if you bill based on AMA's recommendation is 12 visits at a 99213. ACOG's recommendation is you bill based on medical decision making instead of time, and that bumps your RVUs up, that bumps your reimbursement up because it's a minimum of a 99214, and that equals higher reimbursement, higher RVUs. Plus, if you're using medical decision making for each prenatal visit, and you are charting and coding based on what happened during that visit, the recommendation is that it will give better data for maternal morbidity, maternal tracking, mortality tracking, but it will also give better data for evidence-based care.

SPEAKER_02
19:28

So let's just try this end run. Do midwives need to learn how to be more savvy in how they chart and bill for medical decision making?

SPEAKER_03
19:40

That's my question.

SPEAKER_00
19:41

Absolutely.

SPEAKER_03
19:42

Okay.

SPEAKER_00
19:43

Yes, yes, you need to be more savvy on how you chart and bill for medical decision making. Right now, a lot of practices are charting based on a prenatal flow. And every routine prenatal visit is billed with a Z34 code that it's routine prenatal and the number of weeks. When you're charting and coding based on medical decision making, you'll go back to a soap note. You will go back to using the O code, well, or not go back because the O codes weren't there previous, but you will code based on an O code, which are the maternity codes for a problem, and based on the problem at that visit. And that's one thing I encourage you to take trainings. Um, we will have some trainings available. Go absorb as much information as you can and ask your billers or your coders for information on the most common O codes for pregnancy. Because if you try to figure them out yourself, I pulled up my code book the other day. There are 25 pages of O codes. Nobody's gonna sit and sift through 25 pages of O codes. Okay, so try to figure out your common codes with your biller. We'll have some common code recommendations.

SPEAKER_03
21:21

Okay, so it will, so if I'm hearing you're right, so learn the O codes, learn how to document differently. And in general, um, I mean, I think the most important thing that I think will very much excite people is learning how these are going to be split up, not in a global way, so that when you are in a group practice or you're, you know, co managing, that you can, you know, receive compensation for those individual parts. Exactly.

SPEAKER_00
21:53

And for practices like practice managers or owners or the C. Or whoever's behind the money in your practice per encounter billing is going to lead to eventually lead to faster reimbursement. You're not waiting for nine, 10 months to get paid. You're getting paid per visit, which means your cash flow will be more consistent, your revenue will be more consistent. All of those things matter in addition to it mattering to the individual midwife in a group practice, knowing you are getting paid for the work you do or reimbursed or credit.

SPEAKER_03
22:38

So for people who work on WRVUs, like for bonus purposes or or whatever, you're just taking, you know, you're you're looking at those things, what you do per year. It sounds like without the global, it will increase those numbers. Correct. I know you spoke about it a little bit, but yes.

SPEAKER_00
23:00

So the way the proposed RVU values are, um you will get your RVU credits for each prenatal visit, the RVUs for labor management, and the RVUs if you do the delivery for the delivery. But if you just are labor ring with somebody and somebody else does the delivery, you're still getting your RVUs for labor management, which you were getting nothing before, probably.

SPEAKER_03
23:32

I know you're repeating this, but I think it's because I just want to believe it. I just want to believe it.

SPEAKER_00
23:39

I will repeat it as many times as we need because it's important and it's important that everybody understands or at least knows about it enough to get more education on it so that you understand it.

SPEAKER_02
23:55

So let me let me ask you a question, Arden. My mind percolates as I listen to you talk. My apologies, a stranger came to the door and Ruby kind of lost her wits, but let's go back to the O-codes for a minute and watch Denise's face here. You know, I think AMA and ACOC say that every pregnant person is a high-risk person because pregnancy is a state of illness. So why can't every pregnant person be an O-code for every single prenatal visit?

SPEAKER_00
24:28

Well, there's not an Ocode just for being pregnant, but they also didn't say that every pregnant person is a high-risk pregnant. Of course not.

SPEAKER_02
24:38

I'm just telling you they believe it.

SPEAKER_00
24:41

Well, right. But what they're stating is pregnancy in and of itself is one element of medical decision making. And you need two to three, two of three elements to reach different levels of medical decision making.

SPEAKER_02
25:00

I would say, Denise, in my life experience, 80% of pregnant people have anemia at some point in their pregnancy. Sure do now, especially since we're using a lot of aspirin.

SPEAKER_03
25:11

Or BMI, or you name them, or just keep going.

SPEAKER_02
25:16

Hypertension.

SPEAKER_03
25:20

Or, and then obviously later, pre-eclampsia, gestational hypertension. I mean, more things now than I have ever seen in my 28 years of practice are becoming just a common thing. Um but they're low risk at the same time.

SPEAKER_02
25:37

Correct. Because that's what I'm trying to figure out, Denise. Can we make them high risk, but their care is low risk by a midwife? Well, I mean, those are risky things. Oh, come on. Just controlled diabetes, diet controlled diabetes, it's gonna make them high risk. We wouldn't risk them out of a birth center.

SPEAKER_03
25:59

No. Um, I mean, you know, levels.

SPEAKER_02
26:02

I'm trying to, I'm trying to play the game of getting the money. And sorry, I'm just questioning Arden.

SPEAKER_00
26:10

But you don't have to, the whole thing is you don't have to say they're high risk to bill a 99214. So AMA is saying you bill, AMA is saying you bill based on time. You spend 10 to 15 minutes with each pregnant person and you bill in 99213. Well, 15 minutes minimum, and you bill in 99213. That's what AMA is saying. They're looking at the OB model of care where you in and out. In and out. ACOG has fully supported midwives through this whole thing, which I was completely shocked about and super impressed by for the first time ever. Thank you. Thank you. Thanks, ACOG. Yes. Big shout out to ACOG for that. They're saying that uncomplicated antipartum visits best fit moderate decision making, which is a 99214. Okay. And in all of their trainings, they are stressing that you look at what's happening right now in that visit. So instead of making it high risk by adding history of pretend term later labor, history of gestation and diabetes, you look at what's happening in that visit right now. And it could be that their blood pressure is elevated right now. Well, there's an O code for elevated blood pressure that does not sedate, like happening right now, that isn't necessarily hypertension.

SPEAKER_03
27:51

Right, an isolated case.

SPEAKER_00
27:53

An isolated case. So it's just drilling down the decision making at each visit, the medical decision making, and then working with your biller encoder to find the appropriate codes.

SPEAKER_03
28:10

So let's say you're look, you're seeing somebody, and you typically go through, especially like Epic has a problem list, right? And you're reviewing the problem list to make sure you haven't missed anything for that visit. And they deal with such things as maybe, you know, a chronic hypertension or all the things, anemia, um, those should be detailed in your discussion each visit, right? In your soap note, Denise? In your soap note, in your note, which should now always be a soap note, because we don't always do a soap note, but it sounds like we should always do a soap note now. So if you have a template that you're writing, change it each time and review each individual problem.

SPEAKER_00
28:52

Yes. Correct. And ACOG's working with Epic and the other large EMRs on dot phrases, templates to help make medical decision making easier in your charting.

SPEAKER_03
29:09

I mean, because some of the time is related to documentation.

SPEAKER_00
29:12

So some of the time is related to documentation. And the other thing too is when you're when you're charting based on medical decision making, so your uncomplicated antipartum fits your diagnosis for or your for a 99214. Typically, you're reviewing a test or a document, or you're interpreting something, or you're discussing with another person. You need one of those three things for your reviewing data. You're going to always review something in a visit. And then your risk is other risk factors. So this is where prescription drug management, or are they, I don't know, were they in a car accident? Did they have minor surgery? Um, or the big hot topic, this is where social determinant of health comes in, is in your medical decision making. But social determinant of health does no not make them high risk as AMA originally wanted. Right. Now it falls under moderate risk.

SPEAKER_02
30:35

Yeah. That's good. Okay. Yes. It's important. Okay. Yes.

SPEAKER_03
30:42

A lot of changes, Denise. I know. I'm I'm also curious, just another, you know, another hot topic area always is like Obi Triage. Um same thing, I imagine. You're just going to have a very detailed note.

SPEAKER_00
30:56

Um I don't think Obi triage will change. Those codes were not any of the codes that changed. Obi triage has always been you bill an emergency code if it's in the OBED. Um, you bill a hospital observation code if they're admitted. I don't think any of that is changing necessarily unless you're admitting them in active labor, and then OB triage becomes labor management. Okay. And you would bill the labor management code instead of the OB triage code. And some of this has not entirely been defined or trained on yet. The like the definitions or the rules regarding what payers will pay hasn't all clearly been defined. There, I know ACOG is working on it. They've done a few trainings. I've attended the trainings they've done so far, but the big trainings they're doing later on through the year as they write more of the maternity policies. Because historically, their maternity policies are what the payers follow. They follow their policy on global, on ultrasounds, on you gotta have a standard.

SPEAKER_02
32:27

Yes, you gotta have a standard.

SPEAKER_00
32:28

And so they follow ACOG standards because it's easier than writing their own. And as a biller, it's easier for me if they're if everybody's following ACOG standards, it's so much easier to know what to bill for.

SPEAKER_02
32:44

You know what might be a good thing, Denise, that that we ask clients all the time that we could challenge our listeners to do. There's a lot of midwife, midwife practices that cover OB, ED, and triage, and those services are never billed for now.

SPEAKER_03
33:03

I I'm always astounded by that.

SPEAKER_00
33:06

Me too.

SPEAKER_03
33:07

Would you agree, Arthur? Yeah, I'm always astounded by it too. Like it's so time intensive. It's it's I it's unbelievable to me. Um, we have a dedicated person that does Obi Triage, it's not the OBED, but Obi Triage every day. So it's like you're paying out salaries, etc. How would you not recoup those costs?

SPEAKER_00
33:29

I know, and it's I think it's because people don't know. Like nobody has ever told them to drop charges for what you're doing or doc. I mean, document it, you should be charting it. But sometimes the billers, Ginger, we've talked to billers and coders that came from urology and had no idea how to code or bill for OB triage.

SPEAKER_03
33:56

It's the hardest part of our practice, I believe, is triage. It it takes the more experienced providers to do, you know. I mean, everybody can do it, but that's that's always the most difficult area. So I have no idea.

SPEAKER_00
34:09

And there's little things that get left on the table. Like you might, I've seen where the biller has billed for the visit itself, but missed billing the professional component of the NST. So, Denise, if you're in there reading the NST, you can bill for the professional component, not the technical, because the hospital owns the machine or whatever, but the professional, you're reading the strip. Right. You're so that's billable. And right, right, it gets missed all the time.

SPEAKER_03
34:46

For those people who often use Obi Triage as their prenatal care, I mean, those providers are really losing out because that happens so often for lack of care, barriers to care, all the things. Um, that's just amazing.

SPEAKER_02
35:01

Well, Arden, you did um a webinar. You've done a couple, one in December and another one, I think was it in when was it? February or March? I or more recent. I can't remember. Let me just say that Arden's recordings that you can find on our YouTube channel are the most highly watched uh webinars that we've ever produced over nine years. Uh, and I think the good news here is people are starting to realize it's an important component of professional responsibility to understand the fiscal shenanigans that are going on and how to protect themselves, but be informed and be able to be part of the discussion. Which leads me to the question I have right now, because you did a remarkable um presentation, your last one, not the podcast, but it was a webinar on antipartum new codes and how people could begin to prepare now. And then all of a sudden, yesterday, the G code drops in our laps, and it could be an either-or option. Do you think people should pause, or what would be your advice in the last 24 hours?

SPEAKER_00
36:16

I think that you should still move forward because something is I feel like something is going to change. It has to change. The current system is broken, and if it doesn't change, it's really scary as far as financially what it does, what it will do to practices, even to the individual consumer. So I feel like it has to change. I feel like people still need to move forward and learn the new codes, learn how to correctly, accurately chart for the new coding. Um, how to build the billers need to learn how to bill for it because again, something has to change.

SPEAKER_02
37:05

Yeah. When, you know, let's talk about Denise's practice, high volume, very busy. I don't know, you know, how many patients you all see in an hour based on on their on their needs. But even the idea of scheduling, does that need to be thought about so that people have an opportunity to really learn this without a full practice day being loaded on top of learning all of this? Do schedules need to change?

SPEAKER_00
37:35

I don't know. I I've never scheduled a practice, so I don't really know, but I know that you can there can be trainings done just on the little tweaks or changes you need to make in charting in a couple of hours. Or you could take it different chunks of time. Like, for example, I'm training with one of our billing service clients, and they already chart based on soap notes. They just have never changed it. So our training is going to take an hour, probably, just to add in like what additional documentation do you need to add to support Ocodes and how to make that change? And we're focusing right now. I think the focus currently needs to be on prenatal care charting because the guidance isn't out there quite yet on labor management. How you chart a delivery is not going to change. It's going to be how you chart your prenatal care, how you chart labor management, and eventually how you chart your postpartum care. But everybody, and I think you need to learn the changes for prenatal care in this year, prior to January, because if the codes change January 1st, you want to be able to hit the ground running.

SPEAKER_03
39:03

Okay. That makes sense to me because I think prenatal visits are often not necessarily soap notes. And yeah, and that's where we spend most of our time.

SPEAKER_00
39:14

And ideally, I would learn how to chart it before. I mean, the guidance right now is that anybody who enters care September 1st on will be billed per visit. Okay.

SPEAKER_03
39:34

Even though it doesn't start till January, it'll be even though it doesn't start because they'll deliver theoretically.

SPEAKER_00
39:40

And they won't have enough visits to bill a current global code. So if the current global codes really do go away, there won't, if you're newly pregnant September 1st or in September, you won't have four prenatal visits by January 1st, theoretically.

SPEAKER_03
40:00

Would that billing be delayed then till January? And then broken up individually, do you think?

SPEAKER_00
40:07

Um we're going to try, we're going to test it and build some with the new TH modifier showing that it's a maternity code. And we're going to start September 1st and see what happens.

SPEAKER_02
40:24

You go, Arden.

SPEAKER_00
40:25

That's impressive. Your pilot test. Yeah. We're going to use some of our practices and pilot test it.

SPEAKER_03
40:32

Cool. So you'll have to let us know what you find out. Well, I don't know. I don't I feel overall optimistic about this. I'm not really sure why. Um I feel optimistic. Maybe it's because I have to, but also I just I just keep thinking about a lot of the services that we don't get reimbursed for um when we do have to transfer somebody. So I'm maybe thinking too small, not not having a more global view, but no, I think you're right.

SPEAKER_00
41:05

Initially, I was really scared about the new codes and was super on the fence about whether or not they would provide higher reimbursement. But then when I saw the projected RVUs, I'm like, okay, well, this maybe isn't as bad as I thought.

SPEAKER_02
41:24

But Arden, we've we've heard the conversation. The pie is only so big.

SPEAKER_00
41:30

The pie is only so big. That's true.

SPEAKER_02
41:33

So who gets the money? The higher okay, thank you. I I still think there's an enormous risk going on here.

SPEAKER_03
41:41

Uh that's what we're talking about.

SPEAKER_00
41:43

The pie is only so big, and I think that's another factor in the G codes. Yeah. And I also think that insurance companies stating that they don't have the budget to implement the new codes by January 1st, when one major insurance company showed a $3 billion profit last quarter.

SPEAKER_03
42:06

Therein lies the problem. Therein lies the problem. The corruption of insurance companies. Yeah. Who's getting the money? Not the people providing the care.

SPEAKER_02
42:17

So let's let's talk just for a minute. We don't have to talk a long time, but I think it's it's worth it. We have a big audience, you know. I think it's growing. Uh, we focused a little bit on Denise and hospital-based practices. What about community birth and smaller midwifery practices that may not be um in a collaborative model? I mean, they may own their own business, right? How might any of this impact the small business owners?

SPEAKER_00
42:47

I think for the small business owners that are billing insurance, first of all, let's talk about them. It will impact your cash flow, but I think it will impact it in a positive way. My only reason I say think is because anytime there's a coding change, it takes insurance companies a little bit of time to catch up. So you always want to have something in reserve for that delay in payment. But once you're billing per visit, it's faster cash flow, it's more consistent based on the prenatal visits you're doing each month. And it allows for better budgeting. You will have to make if you're using an in-house biller, make sure your in-house biller is trained on how to bill code and bill appropriately. If your billing is outsourced, you want to make sure that whoever, whatever billing service you're using is trained and knowledgeable on the new codes. How do you how do you make sure of that, Arden? You attend trainings. Like I, for us and our clients, I personally am attending every Webinar I can find, but we also will have webinars that we will do. We will have a training available later in the year. I'm going to go to ACOG's large full-day payment in practice, where we are coding and billing real life scenarios for an entire day and bring that back to everyone, anyone who wants to attend that. But just getting the knowledge out there.

SPEAKER_03
44:29

So then it's Yeah. So for the provider that is like doing all the care, um you you yourself are being very diligent about training and knowing how to bill, but how do they know that their biller knows what they're doing? How do they know that?

SPEAKER_00
44:46

I mean, aside from training. I would ask my biller what trainings, what trainings have you attended, and what trainings can you offer to me?

SPEAKER_03
44:58

Okay.

SPEAKER_00
44:58

It's a good question.

SPEAKER_03
44:59

I just I just think we have to I just think providers in those settings really have to be just much more aware of what their biller is doing. So that it's done um it's done legally and correctly and comprehensively and bringing everything to the table that that provider is working so hard to do.

SPEAKER_00
45:19

And I would even go so far as to ask my biller, are you familiar with the changes in the maternity codes for 2027? And if they say no, that is a ginormously huge red flux.

SPEAKER_02
45:32

Well, that's that's a question they can ask today. That that's a question you can ask today.

SPEAKER_03
45:36

Yeah. Yes, and because we've all heard of it, or many have heard of it as providers.

SPEAKER_00
45:41

Exactly. And if they say yes, then say what trainings will you have available to me and when will they be available?

SPEAKER_03
45:50

Yeah. Okay, I'm feeling very strongly about this topic, as you can tell.

SPEAKER_00
45:56

You and me both.

SPEAKER_03
45:58

Oh, thank you so much. Thank you.

SPEAKER_00
46:03

Um and I just have one other thing about the small independent practices. Even if you're not billing insurance, you still have to use the new codes. Okay. Because the global codes, the the proposal is that the global codes will completely go away. So you will have to use the new codes.

SPEAKER_02
46:27

So if someone's handing their client a super bill to submit to an insurance company, it's gotta be done right.

SPEAKER_00
46:34

It has to be done right. It has to have the new codes. So you should also train. Yeah. It's some sort of training.

SPEAKER_02
46:45

So, Arden, why don't you tell our listeners where you're gonna be in the next, you know, few months and what's what what they need to stay tuned about in terms of all these trainings and opportunities to hear you speak?

SPEAKER_00
46:58

Um, so I will be at ACNM in October in Kansas City. Um, the agenda's been released, so my presentation's at 8 a.m. Saturday morning. I think that's October 10th. Um, we I will be attending ACOG's payment in practice full day training in November. We will have a train uh training webinar after that available.

SPEAKER_02
47:30

And I think we're going to New Mexico.

SPEAKER_00
47:34

We're going to New Mexico in December. Um we'll have some more webinars.

SPEAKER_02
47:43

I think we're gonna have some more webinars. Yeah, that may be different than trainings. I think, you know, one of the things we're trying to figure out, we have a lot of people asking how to get resources, is how to create like a curriculum, a training program that would include all the educational information and case studies and resource sheets. And as you know, Arden and our team are thinking about all of this, it's a lot to to synthesize, especially since nothing's final.

SPEAKER_03
48:17

Arden, how about a manual? Um, is that something that you will be able to create for practices A that want to just look it up? They're not maybe auditory learners, they want to be able to have it on in their fingers, in their hands to to look at, or at least a PDF.

SPEAKER_00
48:35

Um, I think a manual and some individual PDFs. So, like a PDF of common O codes, for example, or a PDF of the codes and their definitions, or maybe how to code and chart based on medical decision making. I don't know, just some things rambling around in my brain right now. Yeah. But I think a manual's also a good idea, but I think that we release something like that after the CMS final rule is published so that we are releasing the final information.

SPEAKER_03
49:18

Great idea.

SPEAKER_00
49:19

Great idea. Okay. Sounds good. And I think that's when we release our training webinar or like our final webinar training on this is after the CMS final rule. But in the meantime, I feel like we should do a webinar on labor management and um the delivery codes.

SPEAKER_02
49:39

Yeah. Okay. That's in the plans. We don't have dates, but in the meantime, they can go to the YouTube channel and watch watch your presentation on Anapartum and get started now talking with their colleagues about all of this if they're still behind the eight ball a little bit on trying to catch up.

SPEAKER_00
50:00

And that I think that webinar was in June.

SPEAKER_02
50:03

Yeah, I think you're right. Oh, June, June 11th. You're right. Yep, yep, you're right. Oh, time, time machine. Well, why don't we do why don't we do our call to action?

SPEAKER_03
50:17

Okay, I'm gonna do mine first. Okay. I just feel like exploding on this one, but I I really I want to, for my practices and similar practices, really be able to bring the information to the table. So um, so I'm calling myself out action um to just keep keep learning and really know. I want to be on the cutting edge. So that's what I'm gonna do. I'm gonna just be on the cutting edge, listening, going back to listen to the webinars. I'm gonna listen to this podcast again, not because I want to hear myself, but I just I need to hear Arden. So I gotta write these things down. So that's my that's my call. Great, Arden. Do you have do you have a recommendation?

SPEAKER_00
51:01

Yeah, mine is to get the information out there on how to go comment on the CMS final rule. Okay, great. Regarding the G codes, because I think that that is highly important for everyone.

SPEAKER_02
51:17

Current news. Yeah, new news. Um, and and I'm gonna end with um as you continue to think, those of you in active practice and even students who are trying to figure out what we're talking about, start writing your questions down and send them to us so that as these teaching products are designed, that Arden and her team are able to sort of take it from novice to seasoned practitioner in a way that the questions are going to be different, right, Denise? I I think I think that it's gonna be important to speak to a very large audience with a blended panel of patients in different settings. And if you would, you know, feel comfortable sending your questions, uh, you can send them to the podcast platform on Buzzsprout, you can send them to Grow Midwives. We'll have Arden's email up as well. You can send them to her directly. But we would love for you to get engaged in helping design the teaching materials.

SPEAKER_00
52:25

I agree. Can I add just one thing when they're sending that? If you have a scenario that you think should be part of the charting and coding final webinar um course that we're doing, send that too because I am more than happy to use that in teaching how to chart and code for that.

SPEAKER_02
52:52

Great idea. Great idea. Well, Denise, we're wrapping up another another podcast. It's a wrap, Ginger. Thanks, Arden, so much. Thank you. It's always a pleasure. So exciting.

SPEAKER_03
53:04

We need to keep valuing ourselves, right?

SPEAKER_02
53:07

So and we have such a such a special gift with Arden being so dedicated to midwifery. Thank you. All right, ladies, have a great day. Thank you. Bye. Till the next time.

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