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Understanding the Complexities of OBGYN Billing

September 17, 2013

It must not have come as a surprise to professional billers and coders that the complexities around OBGYN are beginning to take a toll on OBGYN care providers’ finances. Understanding the complexities of OBGYN, any expert will admit, is not easy as there are various rules as well as exceptions together with multiple codes for a range of medical billing services and phases involved in OBGYN.

When it comes to rules and regulations, coverage is a concern – because there are as many rules as there are exceptions or variations-  

  • Pregnancy coverage doesn’t form an independent insurance plan; it’s an additional coverage added to an existing plan, which involves an amendment to the existing insurance policy
  • Another thing that involves change in policy and procedures and codes is broken global, which happens when a pregnant patient changes her insurer in the course of pregnancy care
  • Moreover, coverage is not uniform across pregnancy care but is split into inpatient and outpatient services. Outpatient includes such parts of care as involve a visit or consulting (like prenatal and postnatal visits) whereas inpatient covers costs related to hospital stay and child delivery. And each one of these services has separate codes.
  • Additionally, there are complexities brought in by medical aspects of OBGYN. Gynecology involves multiple diagnostic tests and pregnancy is one of them, which requires the biller to be familiar with the tests performed for pregnancy so that they can separate them from the ones not for pregnancy.
  • Finally, all these policies, diagnoses and tests lead to amassing of data which requires effective documenting, so that they can be used as required for preparing claims accurately

These challenges have been found to undercut care providers’ finances by 7 to 10 percent, which, according to many, is a conservative estimate. MBC’s Revenue Management Consulting services can help you with this by assessing your in-house revenue management cycle and ensuring that there is sound coordination between various components of healthcare facilitating smooth flow of medical data. MBC also advises you on updating your staff to handle such OBGYN billing and coding challenges as antepartum codes, broken global, denial management, billing enquiry etc.

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has also been helping OBGYN care providers, 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 service modules are flexible and if you don’t think you need our entire suite of services, you can also pick and choose such parts of our services as exactly fit your OBGYN billing and coding needs and save costs.


Category : Best Billing and Coding Practices