Obstetrics & Gynecology Practices
Efficient Billing for OB/GYN: Your Practice, Our Priority.
Obstetrics & Gynecology Practice Billing
Obstetrics and Gynecology is a specialized field of medicine that focuses on women’s health, covering pregnancy, childbirth, and disorders of the female reproductive system. While OB/GYN practices provide essential medical care, they also face unique challenges in medical billing and insurance claims. The complexity of billing for OB/GYN services stems from multiple factors, including global maternity care packages, varying CPT codes, frequent imaging tests, and the need to comply with constantly evolving payer policies.
Given the complexity of OB/GYN billing, an in-house team may struggle to manage claim submissions, insurance denials, and compliance updates. Partnering with a specialized medical billing company like us ensures accurate coding, faster reimbursements, and a higher clean-claim rate. By outsourcing billing to us, your OB/GYN practice can focus more on patient care, reduce administrative burdens, and increase revenue without worrying about insurance claim headaches.
Unbeatable Service, Quality & Price
ACCURACY
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%
TURNAROUND TIME
<
0
Hours
COLLECTION
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%
PRICE
Starting from $
1100
/Month
CHALLENGES
Challenges in Obstetrics & Gynecology Practice Billing
Global Maternity Billing vs. Split Billing: Global maternity care billing covers prenatal, delivery, and postpartum care under a single claim. However, split billing occurs when a patient changes insurance plans or providers during pregnancy, requiring complex coding adjustments. Inexperienced billers often struggle to determine when to use global codes vs. individual service codes.
Insurance Pre-Authorization Issues: Many OB/GYN services, such as hysterectomies and infertility treatments, require prior authorization. Failure to obtain pre-approvals can result in claim denials or delays in patient treatment.
Frequent Use of Imaging and Diagnostic Tests: OB/GYN involves high volumes of imaging services, including ultrasounds, mammograms, and hysterosalpingograms. Each imaging test has specific guidelines for medical necessity and insurers may deny claims if documentation is inadequate.
OUR PROCESS
Our Obstetrics & Gynecology Practices Billing Process Workflow
At RCM Workshop, the billing process workflow for an obstetrics and gynecology practice involves several key steps to ensure accurate and timely reimbursement. It begins with pre-authorization and insurance verification to confirm the patient’s coverage and benefits, preventing claim denials due to coverage issues. After providing medical services, we document the charges and code them using appropriate CPT and ICD codes. Then we prepare the claims and submit them to the insurance company, ensuring they are error-free to expedite processing. Once payments are received, we post them in the billing system and reconcile any discrepancies.
Denial management is a crucial part of the workflow, where we review and correct the rejected claims and resubmit them. Then during patient billing, we generate statements for any remaining balances after insurance payments and follow up on unpaid balances. Through regular reporting and analysis, we monitor financial performance and identify areas for improvement, allowing the practice to optimize processes and reduce errors. This comprehensive workflow ensures that OB/GYN practices manage their revenue cycles effectively, securing timely and accurate payments for their services.
Scheduling & Registration
Carry out well-coordinated appointment scheduling, update insurance details, and handle inbound and outbound calls from/to patients.
Eligibility & Benefits Verification
Confirm primary and secondary insurance and benefits coverage of patients and verify their coverage, co-pays, co-insurance, and deductibles.
Prior Authorization
Initiate request for prior authorization with the payer, follow up to check its status till closure and finally update the system with Auth approval reference number.
Medical Coding
Check the accuracy of codes and modifiers according to specialty and assign corresponding and appropriate charges to the codes.
Charge Posting
Enter the charges for the services provided into the billing system including the cost of the medication and the administration fee.
Claims Edits & Submission
Audit the claims thoroughly to check for accuracy and edit if necessary and submit claims – both EDI and paper format.
Payment Posting
Carry out both auto as well as manual posting for payments received and conduct reconciliation against claims.
Denial Management
Analyze and categorize denial claim according to denial codes, $ amount and payers, and resubmit claims after correction.
AR Management
Follow-up with payers to gather status for unpaid claims, and their resolution.
Patient Collection
Sending patient statements and follow-up with patients for final and outstanding payment.
You can confidently rely on us to manage your entire billing process, or you have the flexibility to select specific DME billing services that suit your needs, ensuring a seamless operation without any interruptions.
BENEFITS
Outcomes Guaranteed
Our structured method for handling obstetrics and gynecology practice billing provides actionable insights to boost your ROI. We ensure adherence to the latest regulations and standards, keeping your center audit-ready and safeguarded from legal issues. Our team maintains the highest quality standards, ensuring significantly enhanced financial results.
WHY US?
Why partner with us
Partnering with us can significantly benefit your OB/GYN practice by enhancing revenue cycle management, improving billing accuracy, and reducing administrative costs and time. This can allow your practice to focus more on patient care, reduce claim denials, and ensure compliance with the latest regulations, ultimately leading to better patient satisfaction and streamlined operations.