Within changes in Current Procedural Terminology (CPT) codes and the implementation of ICD-10, many OB/GYN practices have faced medical billing and coding difficulties that have increased claims denials and slowed the practice revenue cycle. OB/GYN billing and coding comes with unique challenges because of the abundant claims filing that comes with a practice that covers Obstetrics, Anesthesia for the procedure, Gynecology, and Family Planning. If your practice is dealing with excessive claims denials that are hurting revenue, here’s a look at several strategies you can use to avoid claims denials and start improving revenue for your OB/GYN practice. ebix, Inc, is an expert in billing and coding for OB-GYN practices. Whether you’re starting a new medical practice or you want to increase revenue for an existing practice, contact us today to find out how we can help you avoid common industry pitfalls and help you maximize revenue.
Avoid the Most Common Causes of OB/GYN Denials
It helps to be aware of some of the most common causes of OB/GYN denials so you can avoid them. A Physician’s Practice report noted that in the past some of the unexpected top denials have included:
99214 – Outpatient doctor visit at a level 4
99000 – A specimen handling office-lab
81002 – Non-automated urinalysis without a scope
99213 – Outpatient doctor visit at a level 3
36415 – Routine blood capture
There are several different reasons that these denials occur.
In many cases, they get a code 18 denial for a duplicate claim or service. At the same time, the insurance claims denied was previously in another procedure or service. These claims refused because the procedure separately paid. The payor doesn’t cover the charge, or it could just be that the application has errors or lacks essential information required for reimbursement. Is it Time to Outsource OB/GYN Billing and Coding?
Even small errors can end up causing claims denials, and with all the abundant claims filing that comes with OB/GYN billing and coding, it could be a good option for your practice to outsource your billing and coding. Hiring billing and coding specialists experienced in obstetrics and gynecology can be difficult, which is why many OB/GYN practices choose to outsource. If your practice is continuously trying to balance efficient medical care with an uninterrupted flow of reimbursements, outsourcing can give your practice the ability to focus on patient care. At the same time, someone else takes care of the intricacies of billing and coding for you.
Experienced OB/GYN Billing Services gets you more
It is essential to realize that the key to successful Revenue Cycle Management is understanding all your practice’s revenue sources. Hence, our team will help improve profitability by monitoring, measuring, and managing all aspects of your revenue cycle.
Indeed, the ebix team has excellent tools and experience. Hence, our Revenue Cycle Management solutions are in place to capture revenue from claims remittances, patients, and evidence-based data. Collecting from all these sources will help secure your practice’s health care payments and enable it to become more profitable.
OB/GYN Billing Services for Your Practice
- Initial Credentialing is Free. Our expert staff reaches out to the carriers of your choice to obtain network status. Namely, free at a startup and a very reasonable fee per provider afterward.
- Fee Schedule Analysis. We will help research appropriate change levels. We enter the allowed amounts from the network contracts obtained to track and uncover any improper reimbursements.
- Workflow Consulting. Our management staff has over 100 years of combined experience. Therefore, we can advise you on the best practices to build a team and processes that ensure results.
- Carrier Contract Advice. Consequently, there are pitfalls to avoid in contracts and situations that may cause you to choose non-network status with challenging carriers. We have additional expert resources to bring help when necessary.
- Coding Expertise. The ebix team offers certified coding staff to “abstract” codes from provider documentation, or review what you’ve coded for accuracy and completeness. Additional revenue opportunities plus compliance and audit survival are the results of our efforts. We offer Chart auditing services and provider/staff education.
- Fees based on Results. We don’t get paid until we’ve obtained reimbursement for you.
- No Surprises. No additional charges for postage, claims, statements, or custom report/data analytics needs.
- Fast Claim Submission. Don’t suffer from delays or write-offs from inappropriate submissions. Your billing will be submitted promptly after receipt.
- Up to 10% Better Reimbursements.
Medical Coding Compliance
The ebix Chiropractic Billing Services team has a strong reputation as an expert in medical coding service. By and large, medical billing begins with accurate and complete documentation in the medical record. Hence, coding is the way your intellectual services and labor translate into a code used to bill insurance and document the value of your service.
Perhaps most noteworthy are the ICD-10 codes. The ICD-10 is currently the cornerstone of classifying diseases, injuries, health encounters, and inpatient procedures in morbidity settings. Because of this, the ebix, Inc. team has honed medical coding skills and business processes to meet the needs of independent physicians.
Therefore, the transforming of a provider’s narrative or description of the disease, injury, and procedures into universal medical code numbers for the insurance claim is the fundamental purpose of medical coding. For this reason, our team of professional certified medical coders ensures higher reimbursement by properly aligning services with a medical diagnosis. Consequently, this doesn’t just assure proper payment. It will also minimize denials resulting from the incorrect association of diagnosis and procedure codes.
Our financial reporting gives you the insight you need to address the root causes of charge issues, resolve process inefficiencies, improve coding compliance, and ensure the integrity of all claims. Office Managers and Administrators can quickly review performance and trends, drill down into the data to analyze root cause by reason, evaluate payer performance, and the financial impact of claim denials.
Examples of some of the financial reports we provide (above and beyond the regular month-end reporting that give details around charges, collections, and your AR) include:
- Charge & Revenue Analysis – evaluate financial ratios versus MGMA benchmarks
- Coding analysis – identify potential under, over and incorrect coding scenarios
- Procedure Analysis – analyze top CPT codes for cost-benefit analysis
- Payer Reimbursement Analysis – assess which payers consistently slow up payments through unnecessary denials and “lost” claims
- Provider & Staff Productivity Analysis – evaluate provider and staff productivity based on the specific place of service, revenue and RVU’s
- AR Aging Analysis – velocity of payments per payor and CPT respectively
Minimize Medical Claim Denials
Based on our experience working with physicians and healthcare organizations, we understand that the revenue cycle success starts at the patient registration and continues throughout the claims cycle. Accuracy of patient demographics and financial information upfront results in reduced denials, fewer rejected claims, and fewer returned statements. Claim cleanliness is the critical component that stops the denial from origination, and the following parameters impact it:
- Patient registration data quality
- Non-covered services and medical necessity management
- Eligibility and benefits coverage
- Clinical documentation quality
- Claim editing
- Payor rules & mandates