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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.

Medical Billing for Your OB/GYN Practice

4 Feb 2019

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.

Medical practices that are connected with hospitals and hospital networks have the benefit of billing departments and coding professionals right there within the network, which means that OB/GYN providers in hospital networks have less to worry about. Unfortunately, private practice providers end up spending a lot more of their time worrying about medical billing issues, because they don’t have that support.

Essentially, all OB/GYNs are affected by the complexities of medical billing, but independent clinics, private practitioners, and small clinics that lack the support of a large hospital network are set up to have a harder time adjusting to changes in medical billing standards, laws, and software.

Many small OB/GYN practices choose to outsource their medical billing. It alleviates the pressure that comes with performing medical billing tasks independently and it creates an important safety net. Choosing the right medical billing company to take care of your practice’s unique billing needs is an important decision that, when made with care, can eliminate stress and increase the overall profitability of your practice.


Choosing the right medical billing company ... can eliminate stress and increase the overall profitability of your practice.


Before we talk about the many ways a medical billing service like Heartland Medical can support your OB/GYN office with their expertise, let’s take a look at the unique challenges of medical billing as they relate to obstetric and gynecological care.

Changes in Healthcare Laws

America’s healthcare system is in flux. Although the Patient Protection and Affordable Care Act (ACA) was signed into law in 2010, many aspects of the law were not implemented immediately. Many of the requirements of the ACA were not designed to go into effect until 2014, whereas other parts were to be implemented by 2020, causing some confusion. Because of significant hostility to the law, there have been some aspects of it that were stalled or have since been replaced by other policies, and the current administration has directed also some changes via executive order. Among medical billing professionals, there are some policies that are expected to continue indefinitely no matter the political climate, whereas other aspects of the task are essentially up in the air.

Advocates of various healthcare strategies are active at the state and federal level, which means that medical billing professionals must be constantly updating their knowledge of what is required, what is prohibited, and what is in compliance with the latest local, state, and federal laws.

Here are just a few of the ways that the ACA has impacted medical billing:

  • There has been an increase in the number of people carrying insurance, which means an increase in claims and visits to medical providers.

  • Many OB/GYN visits are now covered as preventative medicine and are provided copay-free to insured individuals. This includes annual exams, preconception care, family planning counseling, HIV screenings, screening for intimate partner violence, and various disease screenings, such as HPV and cervical cancer.

  • The ICD-10 has been implemented and is now required for all medical coding, including OB/GYN codes.

Significant Knowledge of Medicare, Medicaid, Public Insurance Plans, and Private Insurance Plans

Medical billers need to be experts in the intricacies of numerous health insurance companies and plan types. Consider these issues and topics that medical billing specialists should be proficient at integrating into the practice:

  • Patients whose provider is in their network

  • Patients whose provider is out of their network

  • Global billing vs technical billing (which is especially important for OB/GYN providers)

  • Avoiding duplicate claims or procedures that are covered by an already existing code

  • All available public and private healthcare plans that patients may be using to cover costs

  • Discount policy for cash payments

  • Payment plan options

One important service OB/GYN offices should provide is having someone available who can explain (in easily understandable terms) the way that billing will work for pregnancy, taking into consideration factors like whether or not prenatal care and delivery will take place during the same calendar year or not.

Helping patients understand their insurance plan often falls to the office staff, especially for OB/GYN offices where patients want to anticipate the costs of prenatal care, labor and delivery, postnatal care, covered and non-covered scans and tests, and emergency treatment such as a c-section.

The Importance of Preventing Improper Coding/Coding Errors

Since the implementation of ICD-10 coding, one of the biggest reasons for insurers to refuse to issue payment is improper coding. This is also something that many patients are familiar with, with some patients even asking for coding information during their visit. ICD-10 is paired with the Current Procedural Terminology (CPT) code. ICD-10 covers the diagnosis, whereas CPT covers services rendered.


Avoiding coding errors is one of the most important jobs of a medical billing professional.


Avoiding coding errors is one of the most important jobs of a medical billing professional. Understanding the differences between codes.According to CPT statistics, the most common coding errors for OB/GYN offices include:

  • 36415: Routine blood capture

  • 81002: Urinalysis non-automated without scope

  • 99000: Specimen handling office-lab

  • 99213: Outpatient doctor visit, level 3

  • 99214: Outpatient doctor visit, level 4

And the frequent explanations for these denials are:

  • 16: Claim lacks information or has errors

  • 18: Duplicate claim/service

  • 96: Non-covered charge(s)

  • 97: Benefit for service was included already in the payment for another procedure

  • 234: Procedure is not paid separately

Avoiding these mistakes requires intense attention to detail, but also specialized training for the person or people who are responsible for completing all of the CPT and ICD-10 codes for the practice. Inaccurate coding, insufficient coding, or a lack of detailed information in the coding process can lead to insurers denying payment and patients being unable to pay.

Ensuring Accuracy for The Centers for Medicare and Medicaid Services (CMS)

Most OB/GYNs provide services to patients who use Medicare or Medicaid, which of course falls under the guidance of the Centers for Medicare and Medicaid Services (CMS). However, even clinics that don’t have a lot of patients on public plans still need to be compliant with all CMS policies, as it is CMS that creates the baseline cost of each medical procedure and treatment available. Inaccurate coding and reporting to the CMS can lead to claim denials and delays. Clinical Qualities Measures Basics, which is overseen by CMS, takes the following into consideration for evaluating providers:

  • Patient and Family Engagement

  • Patient Safety

  • Care Coordination

  • Population/Public Health

  • Efficient Use of Healthcare Resources

  • Clinical Process/Effectiveness

Several of those components have medical billing connections, especially efficient use of healthcare resources and clinical process/effectiveness.

Avoiding and Correcting Data Entry Errors

Small medical billing errors can lead to big medical billing problems.

Misspelling a patient’s name, creating a duplicate bill, mismatched diagnosis and treatment information, inaccurate patient information, and incorrectly entering dates of service are just some of the errors that a medical biller can make during the medical billing process, and each one can create headaches down the line.

Attention to detail is vitally important. Even a seemingly insignificant error can result in your practice getting seriously underpaid for the services you’ve rendered.

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When do you bring in the professionals?

Knowing when to outsource your medical billing work doesn’t have to be hard. The decision of outsourcing comes easily to many providers once they realize how much time and effort they are putting into billing, while still encountering a high number of errors, insurance claim denials, and poor payment percentages from patients.

At Heartland Medical Billing, we don’t just view outsourcing as a great idea because it’s the business we’re in. We also understand that it is good for providers and clinics because outsourcing billing gives you your time back and usually increases revenue.

Your desire to provide outstanding patient care should not be infringed on by the logistics of medical billing. Small clinics and private practices simply don’t have the support that large hospitals and networks have. We know how hard private practices work to provide exceptional care to their patients, and we know how difficult it can be to get that done when you are overburdened with medical billing complications and headaches.


Free up your time and talk to us about how we can help.


Why should you choose Heartland Medical Billing?

We have the experience and expertise that comes from working with independent OB/GYN medical providers and private practices for nearly twenty years. Over the past two decades, we have earned the trust and respect of our clients because the work we do is excellent, detail-attentive, and cost-effective.

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Here are some of the things we can do for your OB/GYN office:

  1. We find existing mistakes and fix them! One of the first things we do for all of our clients is complete a full audit of their existing billing system. As we go, we catch errors and mistakes and fix them, always informing you of what problems we see and why they are happening. During this process, we rebill every single bill that is still outstanding and open. Any SuperBills or ChargeSheets that are used by the provider, we update as we go along.

  2. We set you up with the best medical coding and billing software--which you keep even if we part ways! When we set up the software needs for a provider, we do so with what we call “radical transparency.” You will be able to see everything we’re doing for you! And yes, if our client relationship ends, the client still gets to keep the software and all of the data.

  3. We keep you in the loop. We want you to be informed. When we make changes, we tell you. When we catch errors, we tell you. When we come up with a strategy to implement that will increase your billing returns and fix issues, we make sure you understand it. We also want to talk to you! That’s why, when you call us, you get to talk to us--not just a machine or an automated system.

  4. We can manage all of your credentialing. Medical provider credentialing can be a huge job, especially if you have several providers working in one place. Most hospitals have dedicated medical staffing professionals who do the time-consuming work of credentialing. If you are interested in working with us as credentialers, we are happy to do that job for you.

  5. We provide transparent billing that is predictable and easy to understand.Instead of charging you a flat monthly rate plus fees for everything else imaginable (postage, statements, credentialing and re-credentialing, hourly rates, etc), we bundle everything into one easy to understand and predictable fee. We can talk about how this will work and what will be included when we learn more about your practice and what your needs are.

At Heartland Medical Billing, we believe in producing great results for our clients. We understand the importance of maintaining a meticulous approach to medical billing and coding, especially for obstetric and gynecological billing. Without that attention to detail, you end up being underpaid for medical services that you provide.

If you are interested in learning more, we would love to talk! We can help you identify the gaps in your current medical billing processes, look for ways to streamline your work, discuss the ways that we can increase the return you get on the bills you send out, and figure out why you might not be getting the results you want from your current medical billing system. Outsourcing your medical billing for OB/GYN is a great idea, but only if you choose the right company. Choose a company that cares about its clients and prioritizes excellence, transparency, and great client care. Choose Heartland Medical Billing for your outsourced billing needs.

Contact us today.



About the Author

Stacey Dill

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