Understanding the Impact of Medicare Carve Out Rule on OB/GYN Providers

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Understanding the Impact of Medicare Carve Out
Rule on OB/GYN Providers
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Understanding the Impact of Medicare Carve Out
Rule on OB/GYN Providers
As a healthcare provider, you know that
navigating Medicare regulations can be complex
and time-consuming. One such regulation that you
may have heard of is the Medicare Carve Out
rule. The Medicare Carve Out rule can have a
significant impact on OB/GYN providers, as many
of the services they provide are eligible for
carve-out under Medicare regulations. In this
article, we will discuss what is Medicare Carve
Out Rule, how the Medicare Carve Out rule affects
OB/GYN providers and how OB/GYN providers can
ensure accurate billing. What is the Medicare
Carve Out Rule? The Medicare Carve Out rule, also
known as the carve-out exception, is a
provision within the Medicare program that allows
for certain services to be excluded from a
bundled payment. Bundled payments are a form of
payment in which multiple services provided
during a single episode of care are combined into
one payment. The purpose of bundled payments is
to encourage providers to work together to
coordinate care and reduce costs. However, not
all services are eligible for bundled payments.
The Medicare Carve Out rule allows for certain
services to be excluded from the bundled payment
and billed separately. This is typically done
when a service is provided by a specialist who is
not part of the primary care team responsible for
the bundled payment. Examples of services that
may be carved out include anesthesia services,
radiology services, and certain types of therapy.
In these cases, the specialist providing the
service bills Medicare separately and is
reimbursed at the Medicare fee schedule rate.
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Understanding the Impact of Medicare Carve Out
Rule on OB/GYN Providers

• How Does the Medicare Carve Out Rule Affect
  OB/GYN Providers?
• OB/GYN providers often provide a variety of
  services to their patients, many of which may be
  eligible for carve-out under Medicare
  regulations. Some examples of services that may
  be carved out include
• Ultrasound services OB/GYN providers often
  perform ultrasound services as part of routine
  prenatal care. These services may be carved out
  if they are provided by a radiologist or other
  specialist.
• Anesthesia services OB/GYN providers may require
  anesthesia services during certain procedures,
  such as cesarean sections. If the anesthesia
  services are provided by an anesthesiologist or
  other specialist, they may be eligible for
  carve-out.
• Pathology services OB/GYN providers may perform
  certain pathology services, such as cervical
  cancer screenings. However, if the pathology
  services are performed by a pathologist or other
  specialist, they may be eligible for carve-out.
• These are just a few examples of services that
  may be eligible for carve-out for OB/GYN
  providers. The Medicare Carve Out rule ensures
  that specialists who provide these services
  receive fair reimbursement for their services.
• Ensuring Accurate Billing
• To ensure accurate billing for carved-out
  services, OB/GYN providers should work closely
  with a medical billing company that has
  experience billing for these services. The
  medical billing company should have a thorough
  understanding of the Medicare Carve Out rule and
  be able to accurately bill for services that are
  carved out.

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Understanding the Impact of Medicare Carve Out
Rule on OB/GYN Providers
Additionally, OB/GYN providers should ensure that
they have accurate documentation of the services
they provide and the time spent providing those
services. This will help to ensure that billing
is accurate and that providers receive fair
reimbursement for their services. Finally, OB/GYN
providers should be prepared to work closely with
Medicare to resolve any billing issues that may
arise. This may involve submitting additional
documentation or working with Medicare to resolve
disputes over reimbursement. To summarize, the
Medicare Carve Out rule can have a significant
impact on OB/GYN providers, as many of the
services they provide may be eligible for
carve-out under Medicare regulations. OB/GYN
providers should work closely with a medical
billing company that has experience billing for
carved-out services, ensure accurate
documentation of the services they provide, and
be prepared to work closely with Medicare to
resolve any billing issues that may arise. By
doing so, OB/GYN providers can ensure that they
receive fair reimbursement for their services and
provide the best possible care to their
patients. Legion Healthcare Solutions is a
medical billing company with extensive experience
in accurately billing for OB/GYN services and
ensuring compliance with Medicares laws and
regulations. Our team of billing experts has a
deep understanding of the Medicare Carve Out rule
and can accurately bill for services that may be
eligible for carve-out. We work closely with
OB/GYN providers to ensure accurate documentation
of the services they provide and the time spent
providing those services.
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Understanding the Impact of Medicare Carve Out
Rule on OB/GYN Providers
Our team is well-versed in Medicares laws and
regulations and can ensure compliance with all
relevant rules and requirements. Overall, working
with Legion Healthcare Solutions can help OB/GYN
providers to navigate the complex world of
medical billing and ensure that they receive fair
reimbursement for their services while remaining
in compliance with all relevant regulations. To
know more about our OB/GYN billing services,
contact us at 727-475-1834 or email us at
info_at_legionhealthcaresolutions.com
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