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How Downward Trends Are Affecting The OB-GYN Billing?

August 10, 2017



How Downward Trends Are Affecting The OB-GYN Billing?

Today more and more Ob-Gyn practices are finding themselves in a crisis situation. The number of surgeries performed by these independent Ob-Gyn practices has seen a rapid downfall over the past decade. According to researches carried out by Agency for Healthcare Research and Quality, certain types of surgeries—including gastrectomy and knee arthroplasty—have increased in hospitals across the nation while, some OB/GYN surgeries are on the decline. While the survey studied the number of various surgeries women undergo, it became clear that of the surgical procedures on the upsurge none were Ob-Gyn procedures however, of the 10 procedures that are witnessing a significant decline at least 4 are Ob-Gyn related. Oophorectomy (unilateral and bilateral) saw a 54% decline between 2003 and 2012. Hysterectomy, which included procedures done through open surgery and those done vaginally, decreased by 51% during the same time of evaluation. Genitourinary Incontinence procedures fell at 62.5% and vaginal obliteration by 59% shows research.

Work with figures also brought forth a revelation that has to DO with age in Ob-Gyn surgeries. Incontinence procedures decreased in the groups aged 18 to 44 years, 45 to 64 years, and 65 to 84 years. Vaginal obliteration surgery also decreased in the same age groups. However, in the 85 years and older group, lumpectomy and mastectomy were the OB/GYN procedures that showed the largest decrease. There were no OB/GYN surgeries that increased in any age group.

Additionally, as higher numbers of insurers shift to narrow insurance provider networks hoping to keep the premiums down, hospitals find themselves caught in the middle of the patients, insurers and physicians' fight. This duel is often over who should pick up bills for services those patients unknowingly received from out-of-network doctors. Often times a pediatrician is called after a birthing surgery, the charges of which are not covered by insurance. In these cases there is a lot of confusion about the payment of the doctor from outside. Many hospitals have started using physician outsourcing firms for anesthesiologists, emergency physicians, hospitalists, pathologists and radiologists. In many instances, these doctors don't participate in all the same plan networks as the hospital does. Physician groups typically refuse to accept insurers' unreasonably low rates, while insurers argue the medical groups are demanding excessive prices. Surprise out-of-network bills—which don't count toward the Affordable Care Act's annual limit on individuals' and families' out-of-pocket costs—typically arise in two scenarios. The first is when patients go to the emergency department at an in-network hospital. While the ACA requires health plans to pay out-of-network emergency providers at network rates, patients in many states still are exposed to balance billing. The disputes boil down to who will be financially responsible for out-of-network charges. Will the patient's health plan cover all provider charges, or will physicians or other providers accept the plan's in-network rates? Or will the patient get stuck with the bill? Insurers and hospitals are handling the issue in several ways, and some are moving to hold patients harmless.

It is need of the time that health plans tell consumers whether the doctor they are about to see is in network and about the consequences of using an out-of-network provider. We also need to prohibit providers from billing patients for more than the copay or deductible. We require insurance companies to shelter plan members from balance bills in situations. There are two ways to resolve this. Either we set the amount the insurance company must pay the provider or make available a dispute- resolution process to settle on a fair amount. However, hospitals could require physicians, as a condition of practicing at their facilities, to join the same health plan networks in which they participate.

 

Category : Best Billing and Coding Practices