Blog/ Hospital billing
How are hospital visits billed for a vaginal delivery?
Understand the CBHPM rules on paying for medical assessments in obstetric procedures and find out why the first day of the hospital stay follows different rules from those applied to elective surgical cases
- By
- Rivio, Editorial team
- Published
- Reading time
- 2 minutes
In hospital billing, charging for physician visits in vaginal deliveries follows specific rules defined by the Brazilian Hierarchical Classification of Medical Procedures (CBHPM).
In a vaginal delivery, because it is an emergency procedure, billing for the hospital visit on the first day of the hospital stay is allowed. In this situation, the CBHPM recognizes the need for the initial medical care to assess the patient and manage the delivery, authorizing separate payment for the physician visit.
From the second day of the hospital stay onward, physician visits are included in the procedure’s tier. This means that additional visits cannot be billed during the hospital follow-up period, since this care is already covered by the overall value of the procedure. According to the CBHPM, this coverage extends for up to 10 days after delivery, encompassing the post-procedure follow-up carried out during the hospital stay.
In cesarean deliveries, the interpretation is different. Because it is, as a rule, an elective and previously scheduled procedure, the hospital visit on the first day of the hospital stay cannot be billed separately. In this scenario, the initial medical care is already included in the surgical procedure package, and there is no regulatory provision for billing an additional visit.
According to the CBHPM:
Applying these rules correctly is essential to avoid denials, rework and financial losses. A careful review of the contract signed with the payer, as well as alignment with the CBHPM guidelines, is indispensable to ensure billing compliance and the sustainability of the hospital revenue cycle.
