Obstetrics And Gynecology (OB/GYN) Medical Billing Services

As an obstetrics and gynecology (OBGYN) specialist, you spend your time providing the best OBGYN care possible for your patients. However, one question that arises when you are running a practice is that when was the last time you took a deep insight into your practice’s financial health?

The coding and billing process for healthcare providers in different specialities have never been simple. It has even become even more complicated over time. There are different codes, requirements, and regulations involved in the process. This creates a lot of scope for hangups and slowdown the entire process of receiving reimbursements. Certainly, managing medical coding for any specialty is quite daunting, and if there are mistakes in the process, it can lead to long delays in receiving payments.

This fact is very true for obstetrics and gynecology (OBGYN) specialists. OBGYN medicine is one of the most sensitive practices. And what makes the situation worse is the constantly changing Current Procedural Terminology (CPT) codes, because of which it becomes difficult to keep track of how to regularly get paid.

However, you don’t have to worry, as thankfully, there are medical billing companies like Eminence RCM that provide Obstetrics and Gynecology (OB/GYN) Medical Billing Services to keep codes up to date. The team of professional billers and coders ensures regulatory compliance, which makes billing for OBGYN-related services easy and accurate.

In this blog we will discuss different challenges that arise in Obstetrics and Gynecology (OB/GYN) Medical Billing Services and different tips to tackle them effectively. But before that let’s discuss the workflow steps in OBGYN Billing.

Workflow Steps for OBGYN Billing Services

While you are imparting GYN medical billing services, the foremost and the most important thing is to establish an efficient workflow. Your medical billing workflow in OBGYN must be an understandable and a step-by-step procedure. When you are familiar with the correct order of operations and understands the importance of every step, it is helpful for the billing professionals to remember the workflow and avoid errors.

Step 1: Pre-Authorization and Verification of Insurance Eligibility

Pre-authorization and verification decide if the healthcare provider will receive reimbursement for rendered services. In the case of pre-authorization, healthcare providers must check with the insurance provider. This is essential to know the details of the insurance plan and coverage.

The billing teams in OBGYN teams must complete the verification process. This should be done before admitting patients to the hospital or providing them with any medical services. If services are provided without verification, it can lead to future billing problems for patients and healthcare practitioners.

Step 2: Give Services and Capture Charges

Giving quality services to patients is up to the doctor and other medical professionals. Every service has its own CPT code. Charge capture is the process of entering those codes into the appropriate system to begin the claims and billing process.

It is important to input the correct code for each specific service rendered while capturing charges. Just like medical professionals have to get the treatments right, in the same manner, billing professionals like Eminence RCM avoid mistakes such as undercoding.

Step 3: Submission of claims

Claim submissions is not just about sending an insurance claim. One important part is that every billing professional must consider is to first calculate the net reimbursement the provider will receive once the insurer clears all the dues.

When the minimal time is spent in confirming AR, the claims submitted are considered as “clean claims. These kinds of claims result in faster reimbursements. The effectiveness of a billing professional is often evaluated by their percentage of clean claims. This is because faster payouts result in profitable revenue cycles.

Step 4: Receiving payment

The most important point to consider while receiving payments is to ensure that the amount received is correct. The amount should neither be under or over the required amount. Every payment must be accurately logged and tracked. Comprehensive medical billing company like Eminence RCM helps log and track payment data while avoiding data inaccuracies.

Step 5: Reporting data

Let’s not forget the fact that data is the most valuable byproduct of a billing process even after the payment. Efficiency and productivity across an entire OBGYN practice can be significantly improved by this collected data. This data can be used for analytics and business intelligence. It is a hectic process to do data entry on your own. The process is time consuming and prone to errors. A dedicated medical billing company is always a good idea to handle billing, payment, and data collection.

Challenges of OBGYN Medical Billing

In OBGYN medical billing, if you want to submit clean claims and make sure payments come in quickly, it requires precision and patience. Sadly, for the past few years, revenue in OBGYN have dropped. The below-listed obstacles are the reasons:

Keeping up with Current Procedural Terminology (CPT) Codes:

There are numerous codes in OBGYN medical billing. These codes are updated on a regular basis. Even if you enter the wrong code once, it can result in long delays. This emphasizes the need to properly verify the information to avoid inaccuracies.

Insufficient OBGYN medical billing professionals:

Today, because of an aging workforce, burnout, and lack of teaching faculty there is a personnel shortage across the medical industry.

It was already uncommon to find AAPC-certified billing staff with subspecialities in OBGYN practices and versed in ICD-10-CM codes. The shortages are increasing, and this is only exacerbating the problem.

Complex processes for appealing claims:

Another problem that arises quite frequently in the billing departments is that they often find it problematic to find a clear way to appeal when an insurer denies a claim. This not only slows down the claim submission but the overall billing process.

Difficulty in tracking down the underpaying insurers

When collecting on underpayments, healthcare practices often have trouble dealing with obscure or smaller insurers. This is one of the major issue practices face which results in revenue leakages.

Complex multiple procedures & billing regulations

Different OBGYN procedures require different codes. There are even different billing procedures which makes it harder to submit clean claims.

All these issues contribute to making the coding and billing process for OBGYN practices more complex. But you don’t have to worry as we are going to discuss the tips to overcome these challenges.

Tips for Streamlining OBGYN Medical Billing

Understand the entire coding system

It must be evident till now that OBGYN medical billing requires a strong understanding of the coding system. This includes the CPT Codes and International Classification of Diseases (ICD) codes. It is important for the medical coders to confirm they are using the correct codes for the services that they are offering. It results in ensuring the fastest and maximum reimbursement.

It is always better to double-check every code that you have entered. A medical billing expert like Eminence RCM can keep codes up to date.

Verify Insurance Coverage

Before providing any services, make sure you verify every patient’s insurance coverage and benefits. It is helpful to find what the patient owes except from their insurance. It is very obvious that the insurers are quick to refuse payments they’re not actually required to make. Therefore, it is important to make the patient aware of their responsibility for out-of-pocket expenses.

If you mistakenly go to billing insurance companies for the fees that their customers owe, it will result in delayed payments for the practice. Additionally, it will cause unwanted stress for the patient.

Accurate documentation

It is vital to ensure that all documentation related to the patient’s medical history, examination, and treatment is accurate and complete. Keeping track of all diagnosis codes, CPT codes, and modifiers should be included.

When the documentation is correct, it ensures clean claims and result in faster and more accurate payouts. A right medical billing company billing distinguish themselves by their accuracy and precision, which automatically results in speed.

Timely submission of claims

As you are working with insurance companies, it is essential to be aware of their payment policies. One thing to keep in mind is that your payment can be entirely refused if you submit claims after a certain timeframe from when the procedure was performed.

When you have a right medical billing partner, it ensures that you stay on top of deadlines. This means that all your claims are submitted within the required time frame which minimize chances of unpaid claims.

A Reliable and efficient medical billing company such as Eminence RCM can significantly affect your productivity and revenue. We follow efficient and healthy billing procedures in OBGYN and maintain patient confidentiality of their billing records.