OBGYN Billing Services: How to Avoid Costly Broken Global Errors

Are you aware that a single mid-pregnancy insurance switch can disrupt your entire billing process and might require you to hire expert OBGYN billing services? Yes, you heard it right, and this happens due to the broken global rule.  Essentially, OB/GYN billing deals with the revenue cycle management of diverse obstetric and gynecologic services. The core of this kind of billing is the “Global Maternity Care Package”. It is a bundled billing procedure whereby prenatal visits, delivery (vaginal or C-section), and routine postpartum care are billed as a single claim after delivery. However, if a patient takes a transfer, changes insurance, or even delivers earlier than typical cases, the package must be broken. Dealing with such complex billing nuances requires expert help, and thus hiring professional OBGYN Billing Services is necessary. 

Understanding the Broken Global scenario in obstetrics and gynecology billing  

A broken global scenario happens when there is a disruption in the typical global maternity case and can be caused by several reasons. Essentially any scenario whereby the prenatal visits, delivery, and postpartum billing are not bundled to make one single claim, is known as a broken global scenario. Some of the common scenarios include: 

• When a patient changes their medical providers or insurance payer during mid-pregnancy, the global code which is 59400 or 59510 must be broken. In such cases, billers are required to report antepartum care (59425 for 4 to 6 visits, 59426 for 7 or more visits) to one payer and the delivery and postpartum care to the new payer accordingly. 

• Typically, prenatal care includes 10-15 visits. However, any high-risk conditions, for example, preeclampsia, necessitate additional visits. In such cases, billers are required to bill these extra visits separately. However, billers must be able to present proper documentation explicitly to show why a visit was not routine.  

• Lastly, while global codes include postpartum care, patients must actually visit for billers to bill the services. If a patient does not return, that portion of the global fee should not be charged, or a reduced fee should be applied. 

Challenges of broken global billing 

The challenges of such broken billing are insurmountable. Firstly, this kind of billing requires multi payer coordination, which can be quite challenging. For example, if the patient takes a transfer to a competitor of the primary insurance company, then building an effective communication pathway can be tough. Additionally, during such broken billings, coders will also have to deal with trimester specific coding adjustments to ensure proper itemized billing. For example, the ICD-10 code O25.11 is used to denote malnutrition in pregnancy during the first trimester. However, in the second trimester for similar conditions the code O25.12 will have to be used. Navigating such complex nuances can be tough. Lastly, it is noteworthy to mention here that unbundling the global maternity care package also requires precision and expert knowledge. For example, detailed documentation needs to be maintained by registering specific transfer dates and causes. This is why hiring a specialized billing team is necessary. 

How specialized OBGYN billing services solve this 

Professional obstetrics and gynecology billing solutions providers have the updated knowledge and expertise to tackle such complexities effectively. To begin with, these billers have the expertise to calculate the number of antepartum visits and thus bill for the same accordingly. Additionally, they can apply the correct modifiers indicating the full global package was not offered by the provider to ensure accurate billing. For example, modifier 54 is used when the practitioner only performs surgical care. Furthermore, they are updated on coding requirements and to do so they refer to insurance portals and regulatory websites regularly. This allows them to properly identify and assign the trimester-based codes. This ensures a smooth transition to itemized billing. Similarly, they ensure that the exact date and cause of the break is properly documented. Lastly, they are also motivated to establish communication with competitor payers; and to do so ensure constant follow-ups. This again ensures effectiveness of the billing procedure. All these lead to effective claim submission, ensuring effective revenue cycle management for practitioners. 

Why is outsourcing better than having an internal billing team? 

Outsourcing such billing solutions is much more lucrative than having an internal billing team. One of the main reasons for this could be their cost-effectiveness. For example, RCM solution companies like SunKnowledge charge as low as $7/hour and even offer free account managers. This helps practitioners reduce operational costs by eliminating the need for internal staff management and training. Furthermore, these companies claim to ensure up to 99% coding accuracy and 97% first pass claim collection rate. This is indicative of their coding expertise which is necessary to ensure proper obstetrics and gynecology reimbursement through proper claim submission. 

Optimize obstetrics and gynecology revenue cycle management with the right partner 

Broken global billing for obstetrics and gynecology services can be quite complex. It requires billers to manage complex nuances like trimester-based coding, meeting documentation needs, and communicating with different payers, among others. Navigating all these administrative work can be overwhelming for practitioners and hinder patient care. This is why hiring expert help, specifically outsourcing to an expert OBGYN billing company, is advised. 

Are you also struggling with navigating broken global billing rules in your OBGYN practice? Then outsourcing a team of expert billing services can be beneficial.