February 15, 2016
Although Ob/Gyn or Obstetrics/Gynecology are different medical specialties, they refer to a solo surgical-medical specialty where the physician deals with the medical care of women with expertise in pregnancy, childbirth, postpartum and treatment of the female reproductive system ailments.
Due to the numerous facets of Ob/Gyn, the billing too requires a deep understanding of its processes which include coding, insurance and other healthcare practices. The medical biller must be well aware of the factors that are included in the Ob/Gyn package from the insurance provider and those that are not. This includes a deep knowledge of medications, inoculations and the devices used by an Obstetrician/Gynecologist.
Here are some tips for getting promptly paid for Ob/Gyn services without denials or rejections:
In 2014, the American Medical Association added around 335 codes in the CPT (Common Procedural Terminology) code set. This set came into effect from Jan 1, 2015. Along with the knowledge of these codes that eliminate unnecessary denials, the key descriptions must include the correct CPT codes, HCPCS -'what' and ICD-10 -'why,' and apt modifiers as per the diagnosis and procedures while submitting claims.
The Ob/Gyn medical biller must also be knowledgeable of the 'Well Woman Exam' coding along with an awareness of numerous diagnoses and their respective procedure codes. When certain codes such as G0101 (Cervical or Vaginal cancer screening), Q0091 (Screening papanicolaou smear), S0610 (New patient-annual gynecological exam), or S0612 (Established patient – annual gynecological exam) are documented and submitted, the biller must be well aware of the ones that shall/shall not be paid as some insurance providers pay for a single code while some combine them. Further, some payers only pay if Preventive Visit (9938*-9939*) codes are submitted or if they comprise an Office Visit (9920*-9921*) code.
Documenting correctly is the key to getting reimbursed with the new ICD-10 coding system. Coding must include specific trimesters (e.g. first trimester is ICD-10-CM code O09.01), routine examination (ICD-10-CM code Z01.4), and documentation of pelvic pain and migraine causes, fetal visibility scans details and complications in pregnancy, if any.
3. Billing concern:
An annoying issue in Ob Gyn billing process is 'Broken Global.' This occurs when a lady during her pregnancy changes her physician or the insurance provider. Since payers have their own policies for ante partum codes, single/multiple births etc. it is advisable to take apt measures of such procedures and codes while submitting claims for payments.
4. Practice Management Software (PMS):
Using a PMS becomes easier for billing in Ob/Gyn. As codes become outdated and some software are not able to connect the services against the codes, a highly effective PMS makes amendments when required and leaves no room for mistakes with its outstanding troubleshooting process. This software also administers the revenue cycle along with ongoing billing maintenance.
Incorrect coding and incomplete documentation leads to revenue loss and compliance concerns. Hence, this specialty requires the biller to be knowledgeable and educated in all its disciplines for claiming full reimbursements for services rendered to patients.
Revenue Cycle Management