Is Texas Medicaid Managed Care Underpaying Your OBGYN Deliveries?

Yes—Texas Medicaid Managed Care is underpaying OBGYN deliveries by $1,200–$2,800 per case when managed care organizations (MCOs) apply incorrect global package rates, deny separately billable high-risk services claiming they’re “included in maternity,” and bundle diagnostic ultrasounds that contract language allows separately, destroying 18–32% of potential revenue on complicated pregnancies where additional services beyond routine care […]

Are Global Period Gaps Costing Your OB-GYN Practice?

Yes—global period gaps are costing your OB-GYN practice $830,880 per 12 months when global maternity packages bundle services that should bill separately, post-global encounters get written off incorrectly, and diagnostic ultrasounds go unbilled despite payer contracts allowing separate payment. Your practice loses $1,680 per high-risk pregnancy, $420 per post-global visit, and $1,840 per complication requiring […]

Are Global Bundle Write-Offs Higher Than Your Vendor Reports?

Yes—global bundle write-offs are 3–5× higher than vendor reports show because billing companies track only documented adjustments (services denied as bundled) while hiding the larger revenue loss from services you performed but never billed (knowing payers would bundle them). Practices collecting $1M–$5M+ monthly lose $1.2M–$3.8M annually when vendors write off global maternity services “at submission” […]

What Is Causing Revenue Leakage in OBGYN Billing — and How Do You Stop It?

Revenue leakage in OBGYN billing is the leading cause of suppressed Financial Performance in practices collecting $1M to $5M or more per month — driven not by fraud, but by global period miscoding, missed complication billing, and split-care modifier errors that compound silently across every billing cycle. What Is Revenue Leakage in OBGYN Billing? Revenue […]

Are Payer Policies Complicating Gynecology Procedure Billing?

Yes, payer policies are complicating gynecology procedure billing—with OBGYN practices collecting $1M–$5M+ monthly experiencing 42–58% denial rates when variable payer policies create systematic confusion over global maternity package requirements, IUD insertion coverage, and Medicaid sterilization consent timing rules, costing $1.2M–$3.8M annually when practices apply single standardized workflows across all payers instead of payer-specific protocols, directly […]

Are Maternity Claims Increasing Payer Audit Exposure?

Yes, maternity claims are increasing payer audit exposure—with OBGYN practices collecting $1M–$5M+ monthly experiencing 42–58% audit rates on global obstetric billing when commercial payers scrutinize CPT 59400 claims for unbundling violations, delivery complications underdocumented creating medical necessity denials, and VBAC coding errors triggering systematic recoupment demands of $1.2M–$3.8M annually, directly suppressing EBITDA and net realized […]

How Global Maternity Bundle Exceptions Are Costing OBGYN Practices $1.2M-$3.6M

Global Maternity Bundle Exceptions Costing OBGYN $1.2M–$3.6M

Global maternity bundle exceptions cost OBGYN practices collecting $1M-$5M per month between $100,000 and $300,000 in monthly revenue totaling $1.2M-$3.6M over 12 months because the four categories of services that fall outside the global obstetric package high-risk pregnancy complications, transfer-of-care scenarios, separately billable diagnostic procedures, and ancillary services excluded by payer-specific contract terms are systematically […]

Are Preventive GYN Exams Facing High Rejection Rates From Payers?

Yes, preventive GYN exams are facing high rejection rates from payers—with OBGYN practices collecting $1M–$5M+ monthly experiencing 32–48% denial rates on routine pelvic examinations and annual Pap tests because recent USPSTF guidelines classify screening pelvic exams in asymptomatic women as having insufficient evidence for benefit, prompting commercial insurers to deny claims as “not medically necessary” […]

How Staffing Shortages Are Impacting OB Coding Accuracy

Staffing shortages are impacting OB coding accuracy by creating $1.2M–$3.8M annual revenue leakage for OBGYN practices collecting $1M–$5M+ monthly—because the 30% certified medical coder shortage combined with 31% of healthcare staff considering leaving forces existing coders to process 40–60% higher claim volumes under burnout conditions, resulting in systematic undercoding errors ($1,582 per provider weekly in […]

Why 2026 Is a Turning Point for Women’s Health Reimbursement

2026 is a turning point for women’s health reimbursement because three simultaneous policy shifts—the 2026 Medicare Physician Fee Schedule Efficiency Adjustment, HRSA’s expanded preventive care mandates, and 46-state permanent Medicaid postpartum extensions—are restructuring financial performance metrics for OB-GYN and women’s health practices, creating both significant revenue risk and recoverable opportunity for practices collecting $1M to […]

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