- September 25, 2024
- Posted by: Josh Knoll
- Category: Gynecology
Along with increasing financial pressures and skill shortages experienced in 2023, many healthcare facilities are continuing to face maternity services closure in 2024.
Regulatory changes, volatile economic conditions, and unexpected demand shifts have challenged gynecologists and obstetricians’ practices’ bottom line.
Pre-pandemic space was already grappling with numerous challenges, and even after a long time, the changes within the clinical and administrative protocols are still putting pressure on the providers.
The market is underserved due to skill shortages, and it is not limited to clinical services only. It is impacting the financial aspects of obstetric practices.
The healthcare professionals are not of course equipped with the skill set and knowledge of obstetrics billing services and therefore, the chances of errors in the billing and coding processes are heightening.
High claim rejection and denial rates are ultimately hurting your practice’s efficiency and draining revenue.
Furthermore, the frequent changes in CPT codes are adding another layer of complexity within obstetrics billing and revenue cycle management.
Well, in some cases rejections and denials are used interchangeably, but the main difference between these two is the time of occurrence. While rejection occurs before claim processing due to incorrect data, denial happens post-processing due to incorrect data.
Common Reasons for Rejections in Obstetrics Billing
- Duplicate claims
- Eligibility issues
- Invalid or missing NPI
- Payor ID errors
- Code issues
You need to gain a deeper insight into the coding process to minimize claim rejections and maximize reimbursements.
Also, do you know the frequent changes in CPT codes in the past few years have increased difficulties for the providers. The American Medical Association (AMA) has announced updates to the CPT codes in 2024. These updates include 230 new codes, the deletion of 49 codes and revision of 70 codes.
Understanding these changes is crucial to ensure accurate and timely reimbursements. A missing code, under coding or up coding can lead you to claim rejections.
Failure to keep up with the updates will cost your practice thousands of dollars. Hence collaborating with professional billers and coders is a better idea.
Consistent monitoring of the claims processing can reduce the claim rejection rates. However, it has been identified by the experts that 25% of the rejected claims are never followed up by the providers.
Implementing a systematic follow-up on the claim status can help you mitigate the risks of claim rejections. Compiling the lists of unpaid claims and initiating follow-up on a priority basis can be a good start.
Healthcare expenditure is rising forever in the US, and it is the most expensive healthcare system in the world.
The most costly healthcare system in the world is the one in the United States, and expenses are only going up. The amount spent on healthcare increased threefold from $1.4 trillion in 2000 to $4.5 trillion in 2022.
In fact costs grew at 7.5% to $4.8 trillion in 2023. Patients are also concerned regarding their financial responsibilities within the care process. More than 77% of healthcare professionals are concerned that patients may neglect to pay their medical expenses.
Healthcare professionals and leaders are quite concerned about payor reimbursement issues. In fact, more than 75% are concerned about nonpayment as a result of the constantly changing payor policies. On the other hand, the prior authorization intricacies are resulting in delayed care, reimbursements and disrupted functionality of the practices.
When the claim rejections increase, you need to work on that particular claim repetitively. This makes the process more redundant and increases your administrative burden even more. As a result, there is little room for effective patient care.
When is the Time to Outsource?
A minor error in your obstetrics billing process can lead you to claim rejection and denial. Given the high volumes of claims in OBGYN medical billing, sustaining the revenue is not an easy task.
If you observe signs like high claim rejection and denials, high staff turnover, disrupted operations, decreasing functionality and so on; then it is the right time to outsource your obstetrics billing services.
How Sunknowledge Can Help
Not only in obstetrics and gynecology billing, but we also specialized in 30+ more specialties.
From eligibility verification and prior authorization to denial management and payment posting, we offer end-to-end support to our clients.
We are the only RCM company working with both payors and providers for more than a decade with great versatility and references.
We operate as a genuine operational extension of your clinic, providing real-time dedicated medical billing and coding services.
We employ best practices and state-of-the-art technologies in your practice management to increase the effectiveness of your obstetrics and gynecology billing and maintain revenue over time.
Speak with one of our RCM specialists during a free consultation to learn why we are praised as the greatest in the business.