Billing Model Transition Notice | Effective April 1, 2026

Over the past several years, maternity reimbursement structures have shifted significantly, particularly with the transition away from global maternity billing toward individual claim billing models. These changes increase claim volume, payment posting complexity, statement processing, and secondary insurance coordination.

To ensure long-term sustainability, regulatory clarity, and fair alignment between administrative workload and compensation, I will be transitioning from a percentage-based billing model to an episode-based billing structure effective April 1, 2026.

This change allows compensation to reflect the actual administrative work required to manage maternity care, regardless of payer mix, deductible levels, coinsurance structures, or reimbursement timing.

What Is Changing

Beginning April 1, 2026, compensation will be structured as follows:

Professional Services

• Completed Maternity Episode (delivery billed by practice):$450 per completed maternity episode

• Incomplete Maternity Episode (≥4 prenatal visits, delivery not billed due to transfer):$300 per incomplete episode

• Early-Exit Prenatal (≤3 visits) and All Other Non-Maternity Encounters:$30 per encounter billed

Birth Center Facility Billing

• Completed Facility Birth:$175 per facility delivery claim submitted

Monthly Administrative Minimum

• A $75 monthly minimum administrative fee will apply to all accounts. Episode and encounter fees will be applied toward this minimum.

  
  

How Current Claims Will Be Handled

To ensure a smooth and fair transition:

1. All percentage-based billing will conclude for payments received on or before March 31, 2026.

2. A “Claims at Insurance” report will be generated as of March 31, 2026, identifying claims submitted but not yet reimbursed.

3. Claims submitted prior to April 1, 2026 but not yet paid will transition into the new episode model.

4. For clients currently mid-episode under individual billing:

   • Any commission already paid on individual claims will be credited toward the applicable episode fee.

   • Upon delivery or formal transfer, the episode fee will be reconciled accordingly.

5. For “global” clients not yet billed for a maternity case:

   • All cases delivering on or after April 1, 2026 will fall under the new episode model.

This approach ensures no duplication of billing and no loss of compensation for work already performed.

Why This Change Is Necessary

The transition to individual maternity billing significantly increases:

• Number of claims submitted

• Remittance processing

• Secondary insurance billing

• Patient statement cycles

• Administrative oversight

A percentage-based model tied solely to payments no longer accurately reflects the administrative workload required to manage maternity revenue cycles.

The episode-based model provides:

• Stability and predictability

• Fair compensation for incomplete or transferred cases

• Protection against reimbursement volatility

• Alignment with evolving payer structures

  
  

I remain committed to providing consistent, thorough, and compliant revenue cycle management for your practice. This updated structure ensures that services remain sustainable while continuing to support your patients and your business.