August 19, 2013
In various ways, OBGYN is a boon for pregnancy care – as it brings together gynecology and obstetrics which are closely connected and support each other. But the downside of this is that it also leads to diverse complexities, high costs and billing challenges for OBGYN practices causing their bottom line to shrink gradually. There are several reasons for this - some of them are medical while some administrative and industry-driven issues. First, let us take a look at the medical issues that cause billing and coding challenges.
Few instances of medical issues leading to billing and coding problems-
There are many areas in the course of pregnancy where the requirements of gynecology and obstetrics overlap and it’s difficult to understand which one is what, leading to wrong assignment of codes
Also, during pregnancy surgeons perform multiple surgeries at the same time and each surgery needs to be billed separately
These issues if not handled properly can easily lead to rejected claims and affect revenues.
In addition to these, there are administrative or regulatory issues that equally contribute to the contracting financial bottom line-
One of them is broken global, which happens when a pregnant patient changes her insurer during pregnancy. Each insurer has their own policies and antepartum codes and while preparing claims a biller and coder has to be familiar with the policies and procedures of the previous insurer and also be able to separately code the medial services received by the patient while under the coverage of the previous and current provider following the policies and procedures of the applicable provider.
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What further adds to these challenges is that, because OBGYN providers generally cater to a wide range of demographic variety, each case/patient is different from another in terms of medical, demographic as well as insurance specifics (thanks to the varied types coverage available) and therefore each one requires close attention when details are handled and used to meet requirements like filling out forms, assigning codes, etc. While preparing claims for OBGYN requires several forms, and one needs to be extra careful, as inaccurate forms can easily lead to denials. A lot of this can be handled through proper documentation to capture the patient’s medical and other details which can be used later for effective reference.
In addition to these, there are multiple generic and industry related billing and coding needs that a care provider has to meet, like HIPPA, bundled payments, pay for performance and so on.
MBC’s Revenue Management Consulting services can help you by strengthening your revenue management cycle to effectively handle all these billing challenges. MBC will assess your revenue management cycle and make sure that there is sound coordination between various components of healthcare facilitating smooth flow of medical data so that you can develop proper records and documents and use them while preparing your claims. MBC can also train your staff to handle antepartum codes, billing for overlapping procedures and multiple surgeries along with challenges like broken global, denial management, billing enquiry, etc.
Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has also been helping several hospitals, in big and small cities of the US, with its Outsourcing services handling the entire range of OBGYN billing and coding activities, like charge posting, review of medical details, denial management and revenue follow-up. MBC’s considerable experience helps it to handle the various challenges and also ensure accurate documentation by talking to your staff and so on. If you don’t think you need our entire suite of services, however, you can also pick and choose such parts of our services as exactly fit your OBGYN billing and coding needs and save costs.
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