6 Most Effective Tips for Streamlining Obstetrics Billing Services

Obstetrics is an essential process in the healthcare industry. It has three major parts, such as - antepartum care, childbirth, and postpartum care. Obstetricians face significant challenges during delivery, treating the newborn and the mother. Also, they offer routine gynecological exams, infertility services, and surgical procedures. On top of that obstetrics billing regulations add another layer of challenge for gynecology providers.  

Obstetrics or OB/GYN billing is an intricate process. Healthcare providers heavily depend on obstetrics billing services for seamless claim processing and revenue generation. Billers must follow the guidelines of HIPAA and other regulatory authorities to avoid billing errors. In this blog, we will share some effective tips to help providers streamline obstetrics billing. 

How to Streamline Obstetrics Billing? 

The most important feature of obstetrics billing is the application of correct codes. Coding errors lead to the maximum number of claim denials and providers face notable delays in their revenue collections. Also, we have observed that nominal errors like incorrect patient and payer details can lead to claim denials or delays. Hence, providers must walk the extra mile to eradicate billing errors and ensure timely reimbursements.  

1. Integrating Proper Codes: 

Billers must have a clear understanding of ICD-10, CPT, and other medical codes. The codes must perfectly align with the rendered services. Also, they must review the codes (if correct) before bill submission. After submitting the bill, they won’t get any chance to rectify coding errors, and the insurance payer will reject the claim. Again, they must review the bill and resubmit it for claim processing. It will take a significant time for the provider, and they will face delays in revenue collection.  

2. Verify Insurance Plans and Coverage: 

Providers must thoroughly check insurance plans when a pregnant woman first visits their facility for delivery. They must send the claim to the insurance company for prior authorization. Payers will smoothly cover a pre-authorized claim. Also, it will give a clear idea of the amount insurance will cover and the patient’s out-of-pocket expenses. So, gynecologists can swiftly render their medical services. 

3. Timely Claim Submission: 

Every insurance claim comes with a TFL (Timely Filing Limit). The TFL can be from 90 days to 1 year depending on the insurance companies. The TFL starts from the date when a patient first visits the obstetrics facility. Gynecology providers must submit the final claim within the time limit. In case of denied claims, providers must resubmit the claim within the appeal TFL (ATFL), which starts from the date of processing or denial.   

4. Integration of Digital Systems: 

Digital systems like EHR (Electronic Health Record), EMR (Electronic Medical Record), and EDI (Electronic Data Interchange) simplify the process of maintaining patient data. The traditional process of manual record-keeping is hectic and cumbersome. Electronic data will efficiently streamline the whole process. Also, it will empower gynecologists to access patient data from anywhere they like.  

5. Prompt Solution of Claim Denials: 

Claim denials are an intolerable headache for personnel associated with healthcare billing. The average rate of rejection is between 5% and 10% and the rate is increasing. Billers must thoroughly understand the reason for denials before they can rectify the errors and resubmit. The most common reasons behind most claim rejections are incorrect patient information, applying wrong codes, and not following the TFL.  

6. Outsourcing OB/GYN Billing: 

The best way to streamline obstetrics billing is by employing professional third-party obstetrics billing services. If the gynecology facility keeps an in-house team for billing, it will cost them 80% more than hiring an outsourced service provider. Third-party medical billers have extensive knowledge of billing and coding. So, they can avoid claim denials and ensure maximum coverage from insurance companies. Moreover, when an outsourced agency looks after the administrative process, gynecology providers can focus more on patient care.  

Streamlining obstetrics billing will make gynecologists more efficient in providing treatment. As mentioned, it is a pretty complex process and requires in-depth knowledge to eradicate common billing errors. Correct patient information and implementing correct codes are the basic requirements for seamless claim processing. These are the two sections where we observe the greatest number of mistakes, which lead to claim denials. So, the best way to eradicate such issues is to employ professional OB/GYN billing service providers. They have the expertise and will ensure accurate billing along with maximum claim disbursements.