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What You Need to Know About OBGYN Medical Billing 

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The billing process is never simple and has only gotten more complicated over time.  

Different codes, requirements, and regulations create a maze of potential hangups and slowdowns. Managing medical coding for every variation of every procedure is daunting, and mistakes can lead to long delays in receiving payments.  

This is certainly true for obstetrics and gynecology (OBGYN) specialists. OBGYN medicine can be sensitive to practice, and Current Procedural Terminology (CPT) codes can change, making it difficult to keep track of how to regularly get paid.  

Thankfully, there’s medical billing software for billing companies to keep codes up-to-date, ensure regulatory compliance, and make billing for OBGYN-related services easy and reliable.  

Workflow Steps for OBGYN Medical Billing Services 

When performing OBGYN medical billing services, it is vital to establish an efficient workflow. Your billing workflow should be a predictable, repeatable, step-by-step procedure. Knowing the correct order of operations and understanding the importance of every step will help billing professionals remember these workflows and avoid errors. 

Step 1: Pre-Authorization and insurance eligibility verification 

To begin the billing process, first determine if the patient has a valid insurance policy that will cover the required treatments. This is an important first step, since the majority of claim denials happen when someone fails to properly verify benefit information.  

OBGYN billing teams must complete the verification process before admitting patients to the hospital or providing them with medical services. Doing so without proper insurance can lead to future billing problems for patients and practitioners alike. 

Step 2: Rendering services and capturing charges 

Rendering patient services is up to the doctor and other medical professionals. Each service has its own claim code, and charge capture is the process of entering those codes into the appropriate system to begin the claims and billing process.  

The most important part of capturing charges is to input the correct code for each specific service rendered. Just like medical professionals have to get the treatments right, billing professionals must avoid mistakes such as undercoding (leaving out codes for procedures performed). 

Step 3: Submitting claims 

Claim submissions is more than just sending in an insurance claim. The billing professional must first calculate the net reimbursement the provider will receive once the insurer clears all the dues.  

OBGYN billing departments who spend minimal time having their reimbursement amounts confirmed by accounts receivable are said to submit “clean claims,” which results in faster payouts. A billing professional’s effectiveness is often evaluated by their percentage of clean claims, as faster payouts result in profitable revenue cycles.  

Step 4: Receiving payment 

When receiving payments, always ensure the amount received is correct — neither under or over the required amount. Insurers always collect overpayments.  

All payments should be accurately logged and track. Comprehensive medical billing software helps log and track payment data while avoiding data silos. 

Step 5: Reporting data 

After the payment itself, data is the most valuable byproduct of a billing process. Collecting data for analytics and business intelligence can lead to improvements in efficiency and productivity across an entire OBGYN practice.  

Manual data entry is time consuming and prone to error. A dedicated medical billing software is always best to handle billing, payment, and data collection.  

Challenges of OBGYN Medical Billing 

OBGYN medical billing requires precision and patience to submit clean claims and make sure payments come in quickly and the data accurately reflects performance. OBGYN revenues have dropped by roughly 10% annually for the past few years, and the obstacles listed below are just a few reasons why: 

  • Keeping up with Current Procedural Terminology (CPT) Codes: There are many codes and they are regularly updated. Entering the wrong code even once can result in long delays as payers receive and verify inaccurate information. 
     
  • Scarcity of OBGYN medical billing professionals: An aging workforce, burnout, and lack of teaching faculty have led to personnel shortages across the medical industry, from nurses to billing experts.  
     
    AAPC-certified billing staff with subspecialities in OBGYN practices and versed in ICD-10-CM codes were already uncommon, and this shortage only exacerbates the problem. 
     
  • Complex processes for appealing claims: Billing departments often have trouble finding a clear way to appeal when an insurer denies a claim, which can slow not only the claim in question but the overall billing process. 
     
  • Underpaying insurers are difficult to track down: Practices often have trouble dealing with obscure or smaller insurers when collecting on underpayments. 
     
  • Billing regulations get more complex for multiple procedures: Different OBGYN procedures require different codes and even different billing procedures, making it harder to submit clean claims. 

These issues, as well the ongoing pressure to keep up with new diagnoses and track pre-payments for large accounts means billing personnel have their work cut out for them.    

Tips for Streamlining OBGYN Medical Billing 

Understand the coding system 

OBGYN medical billing requires a strong understanding of the coding system, including the CPT Codes and International Classification of Diseases (ICD) codes. Medical coders should confirm they are using the correct numbers for the services provided to ensure the fastest maximum reimbursement.  

Double-checking every code entered is always a good idea, as is choosing a robust medical billing software platform to keep codes up-to-date automatically. To help billing teams with this vital process, here is an OBGYN coding cheat sheet with a few must-have CPT codes: 

Diagnostic OBGYN 70000 – 76499 

Diagnostic Ultrasound 76500 – 76999 

Radiologic Guidance 77001 – 77032 

Breast, Mammography 77051 – 77059 

Bone/Joint Studies 77071 – 77084 

Radiation Oncology 77261 – 77999 

Nuclear Medicine 78000 – 79999 

Interventional radiologists signify the procedures they perform with surgical codes. Some major surgical codes include the following: 

Mechanical Thrombectomy 34201, 34421, 34490 

Biliary Drainage 47510, 47511, 47530 

Cholecystostomy Tube Placement 47490 

IVC Filter Placment 37620 

Biliary Stone Removal 47630 

Verify insurance coverage 

Before providing any services, it’s necessary to verify every patient’s insurance coverage and benefits. This will help determine what the patient owes separate from their insurance. Insurers are quick to refuse payments they’re not actually required to make, so it is vital to make the patient aware of their responsibility for out-of-pocket expenses.  

Mistakenly billing insurance companies for fees their customers owe will result in delayed payments for the practice. It will aslo cause sudden unwanted stress for the patient, who may be tempted to find doctors who don’t cause them such headaches.  

Accurate documentation 

Billing departments should ensure all documentation related to the patient’s medical history, examination, and treatment is accurate, complete, and up-to-date. This includes keeping track of all diagnosis codes, CPT codes, and modifiers.  

Correct documentation will ensure clean claims and result in faster and more accurate payouts. The best billing departments distinguish themselves by their accuracy and precision, without which speed is impossible.  

Timely submission 

When working with insurance companies, it’s important to be aware of their payment policies. One thing to keep in mind is that they may have the right to refuse payment entirely if you submit invoices after a certain timeframe from when the procedure was performed.  

Medical billers who stay on top of deadlines and ensure all claims are submitted within the required time frame will minimize chances of unpaid claims.  

Stay up-to-date with regulations 

The medical billing landscape is constantly changing, with new regulations and policies being introduced regularly. Staying up-to-date with these changes is critical to makig sure all billing practices are compliant.  

But as with CPT codes, these changes can be difficult to stay on top of. And failing to adhere to all OBGYN billing guidelines could cause delays in payments. Neglecting to include accurate documentation when it’s required can result in insurers sending bills back unpaid.  

Hire a professional medical billing company 

Practices that find it difficult to manage OBGYN billing services in-house might consider hiring a professional end-to-end medical billing company. The right professional service can save time and resources, while ensuring all billing is accurate and compliant with regulations.  

Use technology 

There are many technical solutions available to help streamline the medical billing process, from electronic health record (EHR) systems to medical billing software. These tools can help automate most billing-related tasks, reduce errors, and save time and money.  

As technial innovation continues, these tools become more robust and automated, which can make the billing process essentially foolproof by preventing errors, outdated codes, or regulatory violations.  

OBGYN Billing Software 

Ultimately, a modern billing software solution will minimize errors and produce timely and correct payments. Look for a software that comes with at least the following features: 
 

  • Automated bill preparation for any procedure 
     
  • Self-updating databases of all codes and regulations 
     
  • Tools for collecting and formatting all data for business intelligence 
     
  • Protections against missed deadlines such as warnings and timed submissions 
     
  • Integration with other software such as scheduling, diagnostic, and insurance databases 

HMS USA is dedicated to making sure medical claims are paid quickly. A cloud-based medical billing software, HMS USA will simplify all billing processes, streamline workflows, and provide OBGYN practices the business intelligence and reporting tools to improve billing and thrive along with their patients. 

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