OB/GYN practices have medical billing challenges equivalent to those of practices many times larger, but without the administrative overhead to handle the mistakes that such challenges entail. Global maternity packages, billing for dual insurance, exceptions due to high-risk pregnancies, prior authorization for procedures that depend on payers... all handled by billing staff that are usually just one or two people.

The revenue that is lost through such issues does not make much noise. It simply adds up in hundreds of billing records until it is seen at the end of the year.

Why Billing Accuracy Matters for Small OB/GYN Practices

How Small Billing Mistakes Can Result in Big Financial Losses

Wrong payment of a global maternity fee, underpayment compared to the contract, unbilled denial left untouched because the appeal period ran out. On their own, they are insignificant losses, but on the scale of a whole year of obstetric billing, they become a revenue loss the practice will never be able to make up for.

The Consequences of Delayed or Denied Claims

When claims are delayed, this means much more than just the delayed cash flow for the practice. A small OB/GYN billing services for small practices firm will lose several months' worth of income due to denied appeals that have not been submitted in time.

Why Do OB/GYN Claims Require Special Knowledge?

Global obstetric packages, CPT code distinctions between planned and unplanned cesareans, coordination of benefits across dual insurance maternity claims; this isn't territory that general billing experience navigates reliably.

How Claim Denials Create Revenue Leakage in OB/GYN Practices:

Denials in OB/GYN practices can occur due to lack of prior authorization, wrong coding of episodes of care, incorrect documentation to justify the claim, and issues in coordination of benefit for dual insurance policies. The preventable denials of claims arising out of the mistakes in the front end of the revenue cycle process are the lost revenue that should have been recovered through improved processes.

How to Find Hidden Revenue Leaks in Your OB/GYN Billing Process

Check for revenue leakages related to charges that have been delivered but not billed. Check out the coding practice against the new OB-GYN CPT updates since there is an annual update to codes, and a practice that uses old code sets will make mistakes systematically. Identify denial trends by reason, code, and payer. Identify underpayments against your contractual terms. Check aging buckets in the AR ledger for claims about reaching timely filing periods.

Can Outsourcing OB/GYN Billing Reduce Revenue Loss?

In most cases, the utilization of outsourced billing services in Maryland and elsewhere with specialized OB/GYN billing partners will lead to better financial results compared to using an in-house billing staff who may have other duties to manage. There is a difference in competency, and there will be differences in income generated by proper and good billing.

In-House vs. Outsourced OB/GYN Billing: What’s Best for Your Business?

The foremost benefit of in-house billing is direct control; however, this method is based on fixed costs, lack of knowledge due to staff turnovers, and limitations to build up specialty expertise with respect to evolving payers’ criteria. On the other hand, outsourcing will help you transform your fixed cost into a performance-driven partner whose outcomes will determine how much money you are making. In small OB/GYN practices that lack a dedicated billing specialist, outsourcing is a natural choice.

How Eminence RCM Helps Small OB/GYN Practices Recover Lost Revenue:

Eminence RCM handles OB/GYN billing with the necessary specialization which small practices need but rarely can achieve; global obstetric billing accuracy, effective denial management, underpayment review, and real financial reports giving practice leaders a clear understanding of what happens with their revenues.  

Small OB/GYN practices working with Eminence RCM recover lost revenue which used to be left behind.

Contact today and find out what your practice is actually leaving on the table!

Frequently Asked Questions About OB/GYN Billing Errors

1) What are the most common OB/GYN billing errors?

The most common OB/GYN billing errors include global package unbundling, erroneous grouping of episodes of care, missing prior authorization, coordination of benefits mistakes in dual insurance claims, and using CPT codes which are outdated. They all result either in denials or underpayments which accumulate over billing volume until a pattern is finally noticed.

2) How do billing errors affect OB/GYN practice revenue?

Billing errors affect the revenue directly and quantitatively via denied claims that need fixing, underpayments processed without audit and late reimbursements which result in cash flow shortage not foreseen by the practice. It is particularly the case of small OB/GYN practices due to insufficient financial cushion.

3) How can a small OB/GYN practice reduce claim denials?

Reduction of claim denials starts with eligibility checks before every appointment, automatic claims scrubbing according to payer edits specific for the OB/GYN specialty, thorough pre-submission review of documentation and denial management workflow that puts emphasis on appeals in accordance with appeal deadline and not the submission date.

4) What is global obstetric billing?

Global obstetrics billing includes antenatal care, delivery, and post-delivery care in one reimbursement unit based on one billing code. The services that fall outside the scope of the global package, such as managing high-risk pregnancies, specific complications, etc., need to be coded individually as the necessity of these services must be separately proven.

5) How can I identify revenue leakage in my OB/GYN practice?

Look into the charge capture audit reports for unbilled charges. Conduct a study of the difference between the reimbursements and the contracted rates in order to detect under-reimbursements. Find out what kinds of trends there are within the denials according to the reason code and the payer. Compare the CPT codes being used.

6) Should a small OB/GYN practice outsource medical billing?

For the majority of OB/GYN clinics that do not have billing specialists for this particular type of specialization, the answer is yes. The experience needed to bill for the obstetric services properly; global package compliance, exception billing for high risk patients, dual insurances management; can take years to acquire on your own but will be instantly provided by external companies that specialize in such services.