By Larry Carr
Dec 08, 2022
OB/GYN practice is one that treats and performs a wide range of conditions and procedures. And all of this means copious claims filing to get timely payments. No wonder, OB/GYN medical billing is complex and takes away time and focus from patient care. With numerous codes, constant changes to billing policies and guidelines and different rules for each payer, OB/GYN’s struggle to navigate the complexities of medical billing. Coding deliveries incorrectly, failing to submit claims for “problem visits” during pregnancy, omitting or wrong usage of modifiers, and filing claims with inadequate documentation to support payments are a commonplace occurrence. Let us in this blog discuss what makes OB/GYN billing complicated and the best practices to be followed to handle the complexities.
What makes OB/GYN billing quite complicated?
Global billing
This is one of the biggest challenges faced by OB/GYN billers. All the important aspects of pregnancy right from confirming pregnancy through post-partum is billed under a single claim. And as each is for a large sum, it is important to ensure clean submission to avoid rejections and denials. Moreover, reworking claims denials related to global billing would entail going through months of notes, diagnoses and codes to catch the errors and resubmit the claims.
Varying coverage needs
Obstetrics and Gynecology are the two areas of medicine where insurance companies are most likely to limit or not provide coverage at all. Their guidelines are usually complicated and typically provide coverage only for some services or procedures and may deny coverage for a few others. This should be clearly communicated to the patient at the time of visit in order to avoid getting hit by pricey, unexpected medical bills or confusions later on
Multiple tests/procedures performed at multiple facilities
The OB/GYN practice may perform various tests and procedures for the same patient at multiple facilities, each of which needs careful consideration while assigning codes. The medical biller should be knowledgeable enough to identify which tests/procedures/services are billable under each circumstance and make sure everything is perfectly documented.
Best practices to handle the complexities in OB/GYN billing
Stay up-to-date on coding updates
Keeping up with the latest coding requirements helps the OB/GYN practice to handle the medical billing with ease and ensure that claims aren’t denied. In the last few years the AMA has not disappointed OB/GYN specialty with the number of changes or the significance of the changes, making it essential to stay informed and updated. Failing to stay up-to-date on current coding rules and practices will lead to denials and lost revenue.
Stay clear of common triggers for coding errors
When it comes to OB/GYN medical billing it is best to know the common factors that trigger denials so that you can stay clear of it. It is also important to be aware of state-specific OB/GYN regulations and billing requirements. The following are some of the top reasons for denials.
36415 – Routine blood sample collection
Though this may seem like a common procedure of inserting a needle into the patient’s vein and collecting blood samples, it is the third highest denied code.
81002 – Non-automated urinalysis test
This is the simplest dip stick test to check for ketones, bilirubin or glucose in urine. Whatever the test might be for, adding a modifier helps to avoid denial code CO 16.
99000- Handling and/or transportation of specimen
This code is used to refer the expenses incurred in sending a specimen from the OB/GYN practice to a lab. This is little code with a big issue because if it doesn’t involve significant costs it will result in a denial code CO 97. This is because the payment is adjusted as this procedure/service is not paid separately.
99213 and 99214 – Outdoor patient visit level 3 and 4 respectively
If a routine office visit is billed using code 99213 as most practitioners do as a one-size-fits all generic code it can be denied with the reason code CO 18 on the grounds it’s a duplicate claim. Typically, a level 3 visit implies that it involves medical decision making of a low complexity issue.
99214 requires a medical decision making that is moderately complex in nature and involves the ordering of medications, tests, or procedures for treating the patient. Generally, a level 3 visit would be required if the OB/GYN spends a considerable amount of time with the patient explaining the new drug prescribed. It is level 4 if the OB/GYN recommends a new drug based after an in-depth analysis, extensive testing and solid research. This is why, reason code CO 96 as excluded from coverage is often the most common denial reason.
Stay informed of ICD-10 requirements
The following are some of the things to be borne in mind to keep denials at bay
Outsource your OB/GYN billing needs
Even if all the pieces are right denials do occur and cause a major impact on the practice’s bottom line. Hence, outsourcing your OB/GYN billing is the best bet. You gain access to certified professionals who make sure there are no errors in the coding and billing process to reduce the chances of denials. Outsourced professionals ensure that their team is up-to-date with the latest HCPCS, ICD, and CPT coding conventions. Most importantly, you can avail the latest tools, technology and procedures for handling OB/GYN coding and billing tasks for your practice.
Are you an OB/GYN struggling to handle the complexities of OB/GYN billing? Are you experiencing a lot of denials and underpayments? Is ensuring on-time collections and staying compliant with current laws and regulations challenging? If yes, Scribe4Me is for you. Our team of specialists help you stay on top of Medicare updates and public health plans, all while improving efficiency and revenue for your practice. If you want to know more about how Scribe4Me can help you improve your bottom line, reduce denials and improve your OB/GYN practice’s efficiency give us a call at (908)736-4180.
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