Avoiding Rejected Claims in Obstetrical Billing

Are rejected claims in obstetrical billing draining your practice’s revenue and efficiency? Changes in Current Procedural Terminology (CPT) codes and the implementation of ICD-10 have added layers of complexity, resulting in increased claims denials and slower revenue cycles.

Here are some effective strategies to help you avoid rejected claims in obstetrical billing and improve your practice’s revenue and efficiency.

Understanding Rejections vs. Denials

There’s a difference between claim rejections and denials. A rejection occurs before processing due to incorrect data, while a denial happens post-processing due to contract terms or processing issues. Managing these effectively is essential to maintain a successful obstetrical practice with a smooth revenue cycle.

Common Reasons for Rejected Claims in Obstetrical Billing:

  • Duplicate Claims: Always check the claim status before resubmitting.
  • Eligibility Issues: Ensure accurate patient information and obtain necessary authorizations.
  • Payer ID Errors: Use the correct payer ID and include secondary IDs if needed.
  • Missing/Invalid NPI: Ensure provider credentialing and correct tax ID usage.
  • Diagnosis Code Issues: Use the most up-to-date and specific codes.

Why Is Staying Updated on Coding Changes Essential?

Staying informed about coding updates is crucial for minimizing rejected claims in obstetrical billing and maximizing reimbursements. Over the past few years, several changes to CPT codes have been implemented. For instance, The American Medical Association (AMA) has announced updates to the Current Procedural Terminology (CPT) code set for 2024. These updates include the addition of 230 new codes, the deletion of 49 existing codes, and the revision of 70 codes, enhancing the accuracy and efficiency of billing for medical services and procedures.

Failure to keep up with these updates can cost your practice thousands of dollars. Hence, collaborating with billing and coding specialists who are up-to-date on these changes can prevent costly errors.

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Key Tips for ICD-10 in OB Billing

Transitioning to ICD-10 brought new challenges, but following these tips can help avoid rejected claims in obstetrical billing:

  • Document Specific Trimesters: For example, use ICD-10-CM code O09.01 for supervision of pregnancy with an infertility history in the first trimester.
  • Detail the Cause of Pelvic Pain: If known, always document the cause.
  • Account for Age Complications: For patients over 35, indicate if age may affect delivery.
  • Document Fetal Visibility Scans: Specify if the scan is routine or indicates potential issues.
  • Annual Gynecological Exams: Use code Z01.4 for routine GYN exams.

Proactive Claims Management can Avoid Rejected Claims in Obstetrical Billing

Effective denial management involves daily oversight of medical claims. The Medical Group Management Association (MGMA) states that 25% of unpaid claims are never followed up, leading to lost revenue. Implementing a systematic follow-up process can prevent this. Compile a list of top payers, tag claims with follow-up reasons, and work on them daily to avoid timely filing denials.

Role of a Clearinghouse

A clearinghouse can enhance denial management by securely transmitting electronic claims to insurance carriers, reducing administrative tasks and paperwork. This leads to cost savings, increased accuracy, and real-time claim delivery. Choosing a clearinghouse aligned with your needs can improve claim lifecycle management and financial health.

Common Clearinghouse Rejection Messages and How to Resolve Them:

  • “Entity/subscriber not found”: Verify the provider ID number and eligibility.
  • “Medicare member ID must be alpha/numeric”: Ensure the Medicare ID number format is correct.
  • “Payer claim control number is required”: Provide the original reference number for corrected claims.
  • “Diagnosis code must be valid”: Check the diagnosis code validity for the date of service.

Time to Outsource OB-Gyn Billing and Coding?

Even minor errors can lead to rejected claims in obstetrical billing. Given the high volume of claims in OB billing and coding, outsourcing may be beneficial. Finding in-house specialists with obstetrics expertise is challenging, making outsourcing a viable option. It enables your practice to concentrate on patient care while experts manage the complexities of billing.

How MBC Can Help

Medical Billers and Coders (MBC) specializes in OB billing and coding, helping practices navigate complex coding requirements.

Our Proud Achievements:


  • Revenue Growth: Assisting OB practitioners in achieving a 10-15% revenue increase.
  • Cost Savings: Delivering noticeable cost savings.
  • Revenue Leakage Solutions: Boosting profits by addressing billing claim issues.
  • Clean Claims: Increasing revenue by generating clean claims.

Take Action Now to Avoid Rejected Claims in Obstetrical Billing and Maximize Revenue!

Contact MBC today to see how we can help maximize your revenue and avoid common billing issues.


Q: What steps can I take to ensure my OB practice stays updated on CPT and ICD-10 coding changes?
A: To stay updated, subscribe to industry newsletters, attend coding webinars and workshops, and regularly review updates from the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS).

Q: How often should an OB practice update its coding knowledge?
A: It is essential to review coding updates at least quarterly. Keeping abreast of changes in CPT and ICD-10 codes can prevent denials and ensure accurate billing.

Q: How can outsourcing billing and coding improve OB practice’s efficiency?
A: Outsourcing billing and coding allows OB practices to focus on patient care while experts handle the administrative complexities, improving overall efficiency.