OB/GYN medical billing is complex. Every year, tens of thousands of OB/GYNs operating in the United States must navigate the complexities of medical billing. In 2010, general OB/GYNs made up 5% of the total physicians in America. There were more than 30,000 of them working around the country, predominantly in metropolitan areas. OB/GYN billing can be challenging, especially to private practice physicians and independent providers and clinics.
Unlike for physicians whose practices are connected with big hospitals and their networks, growing and running a successful private practice means you’re responsible for setting up an effective internal billing infrastructure, which means putting into place procedures and practices to ensure you’re billing the maximum amount for your OB/GYN services.
The Devil Is In The (Coding) Details
The receivables function for a private OB/GYN practice requires so much more than submitting weekly billings. Your systems and processes have to be conducive to recouping the maximum amount for services rendered so your practice remains healthy and so your business remains sustainable.
And believe it or not, implementing better coding controls and procedures with an emphasis on accuracy is one of the biggest keys to running a profitable OB/GYN practice. Far too many offices leave money on the table when they fail to recognize this one, basic fact.
Let’s take a look at some of the more common reasons private OB/GYN practices aren’t recouping maximum payments.
As with all other businesses, communication is key to running an efficient private practice. Too often, even a minor miscommunication between a coder and the provider--- especially if the coder is inexperienced --- can result in undercoding. Instead of inputting the appropriate code to accurately reflect a more complex and so more expensive procedure, the coder erroneously omits or exchanges the code for a less expensive item.
Enough of these undercoding events can add up to huge losses.
Although counterintuitive on its face, the act of upcoding can actually have a negative financial impact on the practice. Often as the result of a miscommunication, a coder may add or exchange a code for an expensive procedure, which should have been assigned a code corresponding to a simpler, less expensive procedure.
Not only does this make for administrative headaches (and higher admin costs), it can even leave the practice exposed from a legal standpoint.
In either scenario, a practice must absorb the consequences which can put a damper on productivity and threaten the financial health of the practice.
So it’s paramount that any OB/GYN private practice medical billing department be highly communicative, experienced and dedicated to meticulousness. Anything less, and it’s almost guaranteed you’re not billing for the full value of services delivered.
Improper Coding and Compliance Issues
One of the primary reasons so many practices struggle to bill for maximum amounts each year is because of improper coding. It’s no secret, insurance companies have rigorous coding standards, so any errors or omissions in a claim mean they can and probably will refuse payment.
Professional coding specialists spend years training to become experts in ICD-10 and Current Procedural Terminology coding guidelines. It takes experience and a heavy knowledge base to master the inherent complexities, and yet many private OB/GYN practices make the mistake of thinking they’ll save money by having an untrained office staff member do this work.
ICD-10 coding requirements for things like non-specific diagnosis codes or incorrect modifiers are so exacting and so stringent that many practices without a highly skilled internal billing department lose hundreds of thousands of dollars in reimbursements as the result of improper coding each year.
The Centers for Medicare and Medicaid Services (CMS) have strict guidelines for how claims are assessed using Clinical Qualities Measures Basics criteria like Efficient Use of Healthcare Resources and Clinical Process/Effectiveness. And these all have a significant impact on when and how your billing department can and should bill for medical services under these programs. If your billing systems aren’t compliant with these requirements, it’s unlikely you’re recouping maximum amounts.
By some estimates, as much as 80% of all medical bills contain errors. Even the simplest of errors like misspellings, duplicate billing or mismatched diagnosis and treatment information can cause an insurance company to refuse payment, which obviously has a huge negative impact on a practice’s bottom line.
Perhaps less obviously, these small errors can elongate the billing cycle as invoices are submitted, rejected, edited and then re-submitted. This can mean weeks or even months before a provider sees payment for his or her services. It’s a huge problem. And that’s not even taking into consideration the hidden costs associated with this type of inefficiency and duplication of effort.
A Maximum Solution
Even the most entrepreneurial of physicians may find themselves struggling to keep up if they don’t have adequate resources dedicated to the medical billing function. As the billing cycle lengthens, they may find themselves struggling repeatedly to maintain positive cash flow, and as claims are edited and resubmitted, already overburdened medical office staff must fight just to keep on top of their most critical tasks.
Heartland Medical Billing has the experience, training, and expertise to provide a comprehensive solution to your practice’s medical billing challenges. We’ve recouped more than $30 million from insurance companies for our clients, and we consistently help them get the maximum amount allowable for claims. We’ll perform a full audit of your existing billing systems, correct any errors and promptly handle denied or rejected claims.
We invite you to call us today to discuss how we can help your practice become more profitable today.