How to Drive Ob/Gyn Billing with Best Practices

April 17, 2017

How to Drive Ob/Gyn Billing with Best Practices

Obstetrics and Gynecology billing and coding practices can be complex. Technically, the OB/GYN specialties are two separate medical specialties performing multiple complex procedures, surgeries and treatments which can generate an abundance of claims and involve multiple payers.

For example, in case of delivering twins, with the first baby being a normal/vaginal delivery but the second being cesarean. Even though the OB/GYN performed the vaginal delivery first, that does not mean you should report this code first. You should report 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care) for the second baby and 59409-51 for the first. Why? You should bill the cesarean first because 59510 have higher RVUs (relative value units) than 59409. Most carriers typically consider the primary procedure to be the one with the higher RVU.

These complex scenarios may result in a myriad of claim issues. Plus with 24/7 OB/Gyn call schedules, there is little time for practitioners to focus on collections. So it's very important for the practice's financial health to have an excellent and experienced billing and coding team.

Some of the complications affecting OB/GYN revenue collection procedure:

  • Pregnancy coverage
  • Lack of uniformity across pregnancy care
  • Patient collection process
  • Complexities of multiple diagnostic tests
  • Rules around multiple procedures

Following are simple yet important points that may enhance the success of any OB/GYN practice:

  1. Develop a Strategic Plan:
    Every practice needs a strategic plan because if you do not know where you are going, how will you get there? Make a strategic plan that provides the destination and direction of the practice to everyone. It can be a one-year or a five-year plan. Most of the times, your goals include purchasing new equipment or opening a second location or bringing on an additional provider. To meet your practice goals, it's important to set some billing specific goals since all your goals will be directly or indirectly related to your increase in cash revenue. But regardless if your goals are clinic specific or billing specific, it's important to put it on a paper, communicate the same to your team and break it into manageable steps.
  2. Contract and Coding:
    All billing starts with a contract. The practice administrator/medical director should decide what they want in/out of a contract. Strategically, it's important to re-contract every year to optimize your returns and to get an increase in your fees. Multi-year contracts are good if they automatically increase the annual rates for the life of the contract. Apart from the contract, coding is a crucial part of any medical practice. Physicians should optimize their coding practices and should know that they are ultimately responsible for any coding inadequacies. For any Ob/Gyn practitioner, it is important to take a coding course by either the American College of Obstetricians and Gynecologists for general Ob/Gyn or The Society for Maternal-Fetal Medicine for maternal-fetal medicine specialists to improve collections through better documentation and appropriate coding. There are practices which have invested in a professional coder to help them code efficiently but the coder needs to stay updated with the rapidly changing rules and should be able to provide continuous education related to coding issues to the physician and his/her staff. The coder can perform audits to improve compliance and put in place appropriate processes for better, safer coding.
  3. Be efficient with Claims:
    It's important to be efficient with your claim collecting process so that you can hire and keep good staff and purchase appropriate equipment for your practice. Either buy a great electronic patient accounting system or outsource your billing to a service with expertise in ob/gyn accounts. It is important for any practice to collect all copays, coinsurances and deductibles at the time of the patient visit.
    Billing at a later time and trying to recoup these copays is usually costly and wastes time.
  4. Analyze Measure and Report:
    Anything that is not measured, never improves. Built an effective suite of indicators for your practice. Monitor your performance through:
    • Patient satisfaction surveys
    • Individual follow-up when complaints are raised
    • Time taken for a patient to get in for an appointment
    • Patient waiting times
    • A/R
    • Provider and facility volume
    • Charges/Payments/Adjustments
    Once you have the reports, compare them on monthly, yearly basis to gain more insights.

To become a successful medical practice, it's important to work hard and stay on top of the latest medical technology to take care of your patients in the best possible way. A similar approach must be followed in terms of effectively following best billing practices. Some practices do employ the expertise of a professional medical billing outsourcing service provider. This can help in reducing the operational costs, accelerate the pace of revenue generation and above all increase the efficiency delivered by the practice.


Category : Outsource Medical Billing