A Must Read Guide to OB/GYN Billing Services

OB/GYN billing services include quite sensitive procedures for any hospital. It has immense value for providing top-quality care and increasing revenue.

ByadminonJanuary 10, 2024

This blog will cover various aspects of these services in detail. Continue reading further to learn how you can increase revenue through them.

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Overview of OB/GYN Billing

OB/GYN billing submits claims and receives payments for obstetrics and gynecology services. It involves key processes like coding, insurance verification, and compliance. Medical coders have to assign correct codes for obstetrics and gynecology services. OB/GYN billing teams verify patients’ insurance coverage. They verify before hospitals provide those services.

This way, you can avoid claim denials from insurance companies. Your patients can have multiple insurance plans. In this case, you have to identify the primary and secondary plans. You also have to submit accurate reimbursement claims. OB/GYN services have sensitive processes. So, you have to follow several state and federal regulations.


OB/GYN Billing Services

You can work with some experienced billing partners. Such collaborations can improve your billing process. They also reduce errors and ensure compliance. OB GYN billing involves key elements of women’s care. Pregnancy and childbirth are important medical cases.

You also have to diagnose and treat the diseases of female reproductive organs. OB/GYN billing includes other medical issues as well. You have to manage surgeries, health screenings, and pre and postpartum healthcare for women.

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How OB/GYN Billing Services Help?

OB/GYN Billing Services

    1. Insurance Eligibility Verification

Insurance eligibility verification is a key service in OB/GYN billing. It verifies whether your patients are eligible for your OB/GYN services. You have to check their insurance policy.

Some hospitals also check if their patients fulfill the pre-authorization requirements. Calculating the relevant deductibles and copayments is the next step. This way, OB/GYN billing improves your cash flow. It also increases the rate of your reimbursements.

    2. Demographic and Charge Entry

Charge entry is another step in OB/GYN billing that can help you. It calculates the total amount charged for obstetrics and gynecology services. You just have to enter your charges into your patient’s account.

The demographic entry process requires a team of its own. It records the personal and medical details of patients. These details are helpful in managing the OB/GYN services of those patients. You must enter high-quality and error-free details into your system.

    3. Reporting and Analytics

Our OBGYN medical billing team reviews sources in patient files. They include doctor’s transcription and imaging reports. These sources verify the services performed. They also assign appropriate codes.

Incorrect code submission causes continuous claim denials. They also lead to underpayments. Such difficulties create unnecessary claim-related burdens. They can make OB/GYN billing difficult.

    4. Accounts Receivable Management

You have to follow up on their accounts receivables. It can be time-consuming and difficult. Billing teams pursue unpaid OB/GYN claims. They reduce accounts receivable as much as possible.

They also appeal any refused or underpaid claims. You must ensure that those claims are reimbursed in a timely manner.

    5. Claim Denial Management

Claim denials can result in significant losses for hospitals. So you must keep track of them. An OB/GYN billing team determines the reasons for denials. They also fix any errors. Then, timely resubmit those denied claims.

Insurance companies can deny claims due to lack of information. You must address the gaps as soon as possible. Your OB/GYN billing team should assist you.

They can keep track of your denials. They should also analyze the causes to improve the process. This way, you can reduce the number of denials.

    6. Payment Posting

Payment posting is the first line of defense against billing issues. It identifies denials for medical necessity. You can also manage non-covered services and prior authorization with it. You can assign them to your OB/GYN revenue team.

They can scan your Explanation of Benefits. Scanning ensures you have entered all payment details into your system. Then, you can update the data into the patient accounts.

    7. Provider Credentialing

Provider credentialing is important for a revenue cycle. It links OB/GYN doctors with payers. Your patients can use their insurance cards to pay for your services. This way, you can receive timely payments for those OB/GYN services.

A billing team processes faster payments. It gets more referrals and reduces revenue leakage. You can also reduce denials and identify provider trends.

    8. Medical Billing Software

Billing software is also key for revenue cycle management. OB/GYN medical billing is an administrative process. It can get time-consuming and paper-intensive. An OB/GYN billing software increases the efficiency of billers. It is helpful for coding, filing, and tracking claims.

You need to understand patient needs. Use that information to provide top-quality OB/GYN billing services. Your team should have the necessary expertise. They should know how to work on the necessary tools.

Workflow of OB/GYN Billing

OB/GYN Billing Services

    1. Pre-Authorization

You can begin the billing process with pre-authorization. The first step is to determine the validity of your patient’s insurance policy. It should cover all the required treatments. It is an important step.

Most claim denials happen when someone fails to verify benefit information. This verification process should be completed before admitting patients. You should also not provide your OB/GYN services before.

Doing so without insurance coverage causes future billing problems. It is a problem for both patients and doctors.

    2. Capturing Medical Charges

Rendering patient services is up to the OB/GYN doctors. Each service has its own claim code. Charge capture enters the codes of OB/GYN services into your system.

You can use them to begin the claims and billing process. Your billing team should input correct codes for the services rendered.

Medical professionals have to get their treatments right. You should also avoid mistakes such as under-coding. Under-coding leaves out some of the relevant codes.

    3. Claims Submission

Claims submission is not simple. You do not just send an insurance claim. You first calculate your net reimbursement. You will receive it once all dues are cleared.  

OBGYN billing teams often submit clean claims. They spend minimal time confirming their reimbursement amounts by accounts receivable. These claims result in faster payouts.

You can test your effectiveness with the percentage of your clean claims. Faster payouts result in profitable revenue cycles.

    4. Receiving Payments

You must ensure the received payments are correct. They should neither be under nor over the required amount. Insurers always collect overpayments.  

It is better to log and track all payments. You can use a software to log and track your payment data. It can avoid data silos.

    5. Data Reporting

Data is an important product of the OB/GYN billing process. You can collect data for analytics. It leads to various improvements. Your billing can become more efficient and productive for any practice.  

Manually entering data is a time-consuming process. It is also prone to error. In this case, you can use a dedicated software. It can easily handle billing, payment, and data collection.

Challenges of OB/GYN Billing Services

OB/GYN Billing Services

    1. New Cpt Codes

It is difficult to keep up with current procedural terminology codes. There are too many codes for OB/GYN services. They are also regularly updated.

Entering a wrong code even once can cause payment delays. Insurers have to verify inaccurate information. After that, they release those payments.

    2. Professional Scarcity

OB/GYN billing professionals are quite rare. The workforce is aging due to burnout. There is also a lack of teaching faculties. It results in personnel shortages across the medical industry. They include nurses and billing experts.

Certified billing staff with subspecialities in OB/GYN practices is scarce. Professionals versed in ICD-10-CM codes are already uncommon. This shortage intensifies the problem.

    3. Difficult Appealing Process

Appealing claims is a difficult process. Billing professionals cannot find a clear way to appeal. It happens whenever an insurer denies a claim. These issues slow down the reimbursement claim. They also affect the billing process.

    4. Underpayments

Many insurers underpay hospitals for their OB/GYN services. Such insurers are difficult to track down. You may not be able to deal with them properly. It is important for you whenever you collect underpayments.

    5. Complex Regulations

Billing regulations can get difficult especially for OB/GYN services. Different procedures need different codes. They also have different billing procedures. As a result, submitting clean claims becomes difficult.

The Benefits Of Outsourcing OB/GYN Billing Services

OB/GYN Billing Services

    1. Cost Reduction

Outsourcing OB/GYN billing reduces costs in a variety of ways. It firstly decreases the cost of wages by hiring workers from developing countries.

Second, they have less overhead because they don’t have to maintain as many offices or employees. Also, outsourcing allows you to focus on your patients. while an expert handles the billing details for you.

    2. Accuracy

Accuracy is also important for OB GYN medical billing. You should ensure that your data is correct and accurate. After that, you can send it off to insurers.

There can be mistakes or discrepancies in your claims as well. They can cause reimbursement problems for your practice. As a result, you can even lose revenue and face legal trouble.

You can outsource your OB GYN billing services to avoid these problems. You do not have to do everything yourself.

    3. Better Patient Care

Outsourcing OB/GYN billing allows you to focus on patient care. You can also pay attention towards growing your practice. You can have more time for your patients.

This way, they can feel comfortable in your hospital. OB/GYN doctors also do not have to worry about billing issues or claim denials.

Outsourcing companies handle all the processes like these. They ensure OB/GYN billing runs smoothly. As a result, you can ensure quality care at affordable rates.

    4. Detailed Reporting

Outsourcing companies also provide detailed reports. These reports can inform you how they are handling your OB/GYN billing.

You can use these reports to set baselines for future comparison. You can also identify patterns and trends to improve patient care.

Types of OB/GYN CPT Codes

OB/GYN Billing Services

    1. Evaluation and Management

These codes document and report OB/GYN services. You can assign them for evaluating and managing the reproductive health of women.

The 99202-99215 codes are for billing office visits. These visits can be brief as well as comprehensive.

The 99384-99387 codes are for preventive evaluation and management. You can assign them for age and gender-appropriate history. Other services include examination and counseling.

    2. Surgery

You can assign surgery codes to surgical procedures in OB/GYN billing services. They include hysterectomies and laparoscopies among other procedures.

 Hysterectomy uses the CPT code 58150. This code covers total abdominal hysterectomy. It includes the removal of the cervix and uterus.

You can assign the CPT code 58956 to Oophorectomy. It is a standard code for a unilateral (one side) oophorectomy. This procedure involves the surgical removal of an ovary.

    3. Radiology

Radiology codes are related to imaging studies like ultrasounds and mammograms. Transvaginal ultrasound is a common procedure with the code 76830.

It describes an ultrasound exam of the pelvis. It also includes the uterus, cervix, and ovaries. Hysterosalpingography is another procedure with the code 74740. It is an X-ray procedure for the uterus and fallopian tubes.

    4. Pathology

You can assign pathology codes to laboratory tests and pathology studies. Common tests include pap smears and biopsies.

Pap smear has the codes 88141, 88142, and 88143. These codes report the collection and interpretation of cervical or vaginal smears. These smears detect abnormal cells.

HPV testing has the codes 87624 and 87625. These codes report the testing for papillomavirus in women.

    5. Medicine

There are specific medical procedures related to gynecology and obstetrics. They include diagnostic tests and surgeries. The code 57420 is for the colposcopy of the cervix. You can also assign it to the biopsy of the endocervical curettage.

The code 58300 is assigned to the insertion of an intrauterine device. Whereas, the code 58301 is used to remove that device.
OB/GYN Billing Services

The Bottom Line

This blog covered OB/GYN billing services in detail. We learned how they can benefit hospitals. We also looked at the workflow and challenges of OB/GYN billing. The blog discussed the benefits of outsourcing its services. It finally discussed different types of CPT codes as well.

CloudRCM Solutions has a professional team that manages revenue cycles. Contact us today to learn more about increasing revenue through OB/GYN billing.

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