Common Obstetrics Billing Mistakes and How to Avoid Them

In this dynamic landscape of healthcare managing billing in obstetrics practices is especially difficult, because most of the time they choose to handle it themselves. Now, providing accurate and quality patient care and handling daunting obstetrics billing and coding can be a nightmare. There are a number of common challenges like coding complexities, documentation requirements, and claim submission guidelines of different payors.    

In this blog, we have explored the dire mistakes in OBGYN medical billing and recommended some strategies that will help you sustain your practice’s financial and functional stability.      

4 Major Mistakes in Obstetrics Billing     

1. Missing information: Information is the key to obstetrics billing and coding. In the overall revenue cycle, if a minor information is missing like patients’ demographic information or a missing test, you will face claim denials and revenue loss.  

2. Inaccurate coding: Coding complexities are nothing new in obstetrics and gynecology billing. The coding requirements of OBGYN medical billing are particularly difficult because of the global codes used for the services. Often your staff is not well-aware of the coding processes. And being a gynecologist, it is not possible for you to consistently learn about the coding guidelines. Thus, there are higher chances of missing codes, upcoding, and under-coding. It can directly affect the bottom line of your practice.  

3. Missing denial management: Claim denials are quite a common challenge in obstetrics and gynecology practice. So if you do not maintain a continuous follow-up on the denied claims and lack monitoring of the process, you will leave an ample amount of revenue on the table.  

4. Lack of payment collection culture: Do you know more than 60% of OBGYN center miss out their payment? Missing out on the patient’s out-of-pocket payments like copays and deductibles are very common. If there is a lack of payment culture in your practice and you do not collect these payments up front then you will not get the correct reimbursements for the services, you rendered.  

Global Codes for OBGYN Medical Billing   

We have listed the global CPT codes of OBGYN practices to help you with obstetrics billing processes.    

OB global codes include 59400, 59510, 59610, and 59618. These codes indicate all care from antepartum to delivery and postpartum care.    

59400: Standard obstetric care, including antepartum and postoperative care, for vaginal deliveries (with or without an episiotomy and/or forceps).   

59510: This code is implemented when there are incidence of routine obstetrics care for cesarean section delivery, including antepartum and postpartum care. 

59610: This global code indicated routine obstetric care, including antepartum and postoperative care, for vaginal delivery following cesarean delivery (with or without an episiotomy and/or forceps).  

59618: Antepartum and postpartum care as part of routine obstetric treatment for cesarean birth after vaginal delivery attempt following prior cesarean delivery.   

It is important to note that if you are using global codes then you cannot bill for separate evaluation and management codes. However, you can bill separately if the mother’s insurance coverage changes during the pregnancy.    

Strategies to Enhance Obstetrics Billing Revenue   

Here are some strategies that can help you improve the obstetrics and gynecology billing revenue.  

Stay updated: Staying updated with the latest coding guidelines and regulations is a good way to start. Also, you need to understand the various payor guidelines when it comes to claim submission. Monitor the coding process and always recheck the codes implemented in the billing process.    

Detailed documentation: Documentation is a crucial and essential part of OBGYN medical billing. From patients’ demographic details to medical history and diagnosis to tests and procedures performed all should be present in the documentation. Also, never forget to provide medical proof of the procedures performed, so that you can ensure accurate and timely reimbursements for your practice.    

Maintain compliance: The healthcare industry is heavily regulated with strict guidelines and laws in clinical and administrative procedures. And obstetrics billing is no different. You need to make sure that you understand the regulations and implement them accordingly in your practice. A minor lack of compliance can lead you to not only claim denials but also, audits, penalties, and fines. It is not just about revenue loss but also, your reputation will be shattered otherwise.    

Ever Thought of Outsourcing? Sunknowledge is Here!   

Handling administrative tasks can be daunting irrespective of the size of your practice. Gynecology billing process entails several complexities. Furthermore, the consistent labor crunch and stratospheric wages in the healthcare industry, make it difficult for you to maintain an in-house billing team.  

If you partner with a reliable outsourced medical revenue cycle management organization like us, it will be more your practice will be more efficient and your productivity will also improve. 

Unlike other OBGYN medical billing agencies, we provide you with end-to-end support in your revenue cycle management.   

With real-time, dedicated medical billers and coders we work as an extension of your practice’s operations. As we work in your preferred time zone and as per your requirements, you have a defined workflow, and stakeholders have consistent communication with you.    

This makes care more accessible and efficient, and it directly reflects on your practice’s bottom line.    

With a 10% buffer in our team, we will never let you fall behind the productivity curve.   

While we take care of your obstetrics billing and revenue cycle management, you focus on care processes. As a result, you get accurate revenue and better patient health outcomes. So, it’s a win-win situation for you!   

To streamline your medical billing and coding processes, boost efficiency, and improve revenue partner with Sunknowledge Services Inc.