With so many complexes and complicated medical billing and coding, practice along with OB/GYN practices have always been navigating through guidelines and requirements of general 2010 OB/GYNS. According to a survey, OB/GYNS make up 5% of the total number of physicians in the United States. In the same year, there were 3000 OB/GYNS serving around the country. Obgyn medical billing for practices can be time-consuming, especially for practices dealing privately and individual physicians with separate clinics.
On the other hand, when medical practices and physicians are connected with the hospitals and medical organizations, they have departmental benefits of filing claims through claim filing departments. In addition, they don’t have to deal with the coding and claiming funnels as the professionals are assigned with these specific tasks which automate the process quickly and easily.
This is the big reason why OB/GYNS practitioners have the least stress when they are connected with a hospital. And unfortunately, private practices lack this support and therefore, spend a lot of time dealing with the complex process of Obgyn medical billing issues.
Precisely, it would be so straight to mention that private clinics and practitioners stay behind when it comes to keeping themselves informed regarding changes in standard guidelines and coding, laws, and the use of impeccable software. This is the main reason why many private practitioners and small clinics tend to outsource their medical billing services. This in turn alleviates the stress of independently managing the billing tasks before the deadline approaches, using the right codes, attaining all the required targets, and filing all the claims by submitting the right forms.
Besides, opting for the right medical billing company for outsourcing Obgyn medical billing services would be the first and most important decision to profoundly enhance the profitability of your individual practice.
Before we explore some ways where a medical billing service company like Sybrid MD can help you deal with unique Obgyn medical billing needs, we first hover over some challenges that individual OB/GYNS practitioners have to face on the road to successfully running a practice.
Continuous changes in Obgyn medical billing laws
The Healthcare system in the United States has always been facing fluxes in the past decades. However, ACA – Affordable Care Act and Patient Protection Act were legislated in 2010, but many aspects of the laws have never been implemented to date. Since the laws were signed, many clauses from the Acts should have been implemented by 2014, and many others were supposed to be executed by 2020 which was confused due to the pandemic.
In addition, there have been many other aspects that changed by every new administration since 2010 and replaced by policy changes through executive orders. Although, among medical billing professionals, some policies are there which haven’t been affected by the political climate. For these reasons, advocates of the medical healthcare industry remain informed about the state and federal changes in the healthcare system.
This translates the importance of constantly updating knowledge of medical bills and claim filing, the required documents and the proper use of codes, compliance with the essential federal, state, or local laws, and most of all knowing what should be avoided which leads to claim denials.
Here are a few explanations of how ACA implementations have affected medical billing;
- An increase in the number of acquiring healthcare insurance has been seen. This means that the visits to providers and increases in claims have increased significantly.
- Insured individual visits to OB/GYNS practices are covered in preventive medicine and are considered copay-free visits. This includes family planning counseling, preconception care, annual health examinations, HIV screening, screening for cervical cancer and HPV diseases, and screening for violence from an intimate partner.
- The new ICD-10 codes are now introduced and every practice including OB/GYNS private or small has to comply with the specific relevant codes.
What you need to know from Medicare, Medicaid, Private & Public Insurance plans
No matter if medical billers are from an outsource medical billing company or if he is hired by a medical organization, they have to be experts in handling complex billing issues, dealing with intricate insurance companies’ requirements, and having knowledge of coverage and plans. Contemplate that your medical billing provider must be proficient in executing these issues;
- Know how to bill patients whose provider is billed in the network
- Know how to bill patients whose provider is out of network
- The difference between technical billing and Global Billing certainly is important for OB/GYNS providers
- Avoid claims from duplicate coding and mentioning procedures through codes that are covered in already used codes
- Knowledge of private and public healthcare plans used to cover costs for the required treatment
- Payment options and mediums
- Discount options and policies for cash and credit payments.
One important thing that OB/GYNS providers should consider is providing support in comprehending the billing for pregnancy in understandable easy terms. This will help patients identify if delivery and parenting will be executed during the same calendar year or not.
OB/GYNS practice office staff is often obligated to help in understanding patients about their insurance plans. So that patients can anticipate the costs of labor, delivery, parental care, postnatal care, covered and non-covered tests and scans, and any emergency treatments and procedures like C-sections.
Why it is important to avoid coding errors
The obligation of implementing ICD-10 coding in medical billing and claims have made claim filing more challenging than ever. And errors in the implementation of coding have become the main reason behind claim refusals. Many patients with private insurance know about ICD-10 and they ask about certain codes when they visit. ICD-10 is associated with the CPT codes, which are used to cover services acquired by the patients. On the other hand, ICD codes are used only for diagnosis.
This is why avoiding errors in coding must be the first important thing in medical billing. Plus, understanding the complexities of the codes and the difference between relevant codes should be the priority of an experienced professional. CPT statistics show that the errors in OB/GYNS billings commonly include;
- 81002: Urinalysis non-automated without scope
- 36415: Routine blood capture
- 99000: Specimen handling office-lab
- 99214: Outpatient doctor visit, level 4
- 99213: Outpatient doctor visit, level 3
And these errors are refused with the explanations;
- 18: Duplicate claim/service
- 16: Claim lacks information or has errors
- 234: Procedure is not paid separately
- 97: Benefit for service was included already in the payment for another procedure
To avoid these coding errors, the OB/GYNS medical billing professional must be trained and specialized in coding and are well informed in when to use ICD-10 and CPT codes for OB/GYNS practice. Incomplete and insufficient coding, lack of coding information, and inaccurate billing will eventually lead to claim denials and delays in the RCM process.
Importance of accuracy for the CMS billings
Many times, when OB/GYNS providers offer services to patients insured by Medicare or Medicaid fall under the CMS – Centers of Medicare and Medicaid services guidance. Besides, even if a lot of patients at an OB/GYNS clinic carry public insurance plans, they need to adhere to the CMS guidelines when it comes to accuracy in coding and medical billing. This is because it is CMS that is responsible to create baselines for each and every treatment and medical procedure and their costs.
And then again, inaccurate and insufficient coding and billing to CMS lead to delays in claim processing and claim denials. Basics of clinical measures that CMS considers while billing while evaluating claims include;
- Patient safety
- Engagement of patient and family
- Public/Population Health
- Care Coordination
- Effectiveness of the Clinical process
- Efficiency in utilizing healthcare resources
Often these components are directly associated with the billing procedure. CMS especially counts efficiency in utilizing healthcare resources and effectiveness of the Clinical process.
Correction and Prevention of the data entry errors
As said, professionals need to be extra vigilant while compiling the medical billing for insurance providers. Even small medical billing errors can create a huge problem for your practice.
Creating a duplicate bill, misspelling in a patient’s credentials, mismatched information for diagnosis and treatment, incorrect dates of services offered, and inaccurate information either about the patient or codes are just a few common examples of errors in the medical billing process. And no matter what, they create a long list of troubles and delays down the line.
This is why attention to detail in every aspect is vital while billing and coding. A small error can significantly affect your revenue in the long run.
Why should you outsource medical billing services?
Independent and experienced professionals that are experts in coding and billing for individual OB/GYN providers can help you speed up the process. Outsourcing medical billing companies like Sybrid MD has proved and has been one of the profound companies that helped clients minimize their existing errors and improve their billing needs through standard coding experience and software. We provide credentialing services, transparent billing, and an audit of your billing mistakes. Therefore, finding your solutions is easier than ever before. Contact today for more analysis and evaluation.