A Legal Analysis: The Changing Use of Billing “Incident To” in the provision of Midwifery Services
By: Joseph W. Booth, J.D., M.Div., AAML, FIAML;
Arden Schwenker, CPCO; and,
Ginger K Breedlove, CNM, PhD, FACNM, FAAN
Midwives are often unaware of their professional liabilities when employment contracts assign all billing rights to the employer. Midwives that own their own business often fail to understand compliant billing practices for services rendered by their employee’s. Billing within blended provider practice models requires awareness and understanding of frequently changing federal rules related to “incident to” regulatory compliance. This paper discusses the Centers for Medicare and Medicaid Services (CMS) policies regarding only Certified Nurse-Midwife (CNM) billing. Although Medicare pays for only a small portion of deliveries in the United States, CMS policies influence the policies of private payers and most state-specific Medicaid programs. According to the American College of Nurse-Midwife staff member providing comment at the time of this writing, Certified Midwives (CMs) are not reimbursed for Medicare services because they are not yet federally recognized.
As featured in: Primary Maternity Care/Purchaser Business Group on Health – Hospital Guide to Integrating the Freestanding Birth Center Model