When it comes to medical billing services, there’s no universal solution. This point is especially true with specialized services such as OBGYN practices. Having access to a team of highly-trained billing specialists can enhance your productivity. It also can help you stay within your budget. It’s vital to have a team that can help you with your reimbursements while preventing issues along the way.
Using OBGYN medical billing services has many benefits. A tailored billing service can help you stay on top of Medicare updates and public health plans. As well, it can make sure you stay compliant with current laws and regulations. You can reassign administrative duties to the company and focus on your patients. Best of all, you can get real results and increase your net collection rates and reimbursements. Here’s an overview of outsourcing OBGYN medical billing services and how they can benefit you.
What Is OBGYN Medical Billing?
Medical billing is a payment procurement system. First, a healthcare provider will need to submit the claim. Then, they will need to follow-up with health insurance companies to receive payment for services provided.
OBGYN medical billing is specific to this field. The process involves a two-pronged approach. The biller will need to file claims insurance companies for specific OBGYN practices and services. As well, they will need to collect payments from patients for services rendered. OBGYN medical billing specialists need expertise in the field to complete these processes correctly and quickly. You can do OBGYN medical billing yourself, but there are also outsourcing options available. Enlisting third-party services for medical billing outsourcing is a growing trend in the industry. Third-party companies can provide administrative medical billing practices for OBGYN practices.
Medical billing is complicated and requires deep expertise to do accurately and avoid claim denials. Few people go to school for this purpose. As such, the limited applicant pool makes it harder to hire specialists for your specific practice. The highly specialized knowledge required is why outsourcing a specialist in OBGYN medical billing is a sound idea.
How OBGYN Medical Billing Works
OBGYN medical billing is a multi-step process. After an obstetrician or gynecologist sees a patient, they assign a diagnosis and procedure code based on these services. These codes help the insurance company determine coverage based on various factors, such as medical necessity.
There are several codes that the medical service provider has to choose from, depending on the service provided. A few examples of these codes include:
- 59400 – Routine obstetric care, antepartum care, vaginal delivery, postpartum care
- 59425 – Antepartum care only, 4 to 6 visits
- 59426 – Antepartum care only, 7 or more visits
- 59514 – Cesarean delivery only
- 59515.- Cesarean delivery and postpartum care
These codes are but a few of the many different ones used by insurance companies to designate the services provided. Once they determine the correct code, the medical biller transmits the claim to an insurance company.
The insurance company processes the claims via medical claims examiners or adjusters. For the most expensive claims, the insurance company pays medical directors to review the services and determine their validity for payment. Approved claims get reimbursed for a specified percentage of the billed services. The insurance company negotiates this percentage with the healthcare provider. If the claim gets denied, the provider will reconcile the request with the original one, modify it, and resubmit. This process may require several repetitions until the practice receives the claim payout in full, or the provider accepts that the reimbursement will be incomplete. However, this is rare. Most claims get accepted, and only a small amount gets denied.
OBGYN Medical Billing Specialties
Most medical billing companies boast hundreds of specialties, ranging from surgery and anesthesia to radiology and medicine. Obstetrics and gynecology have their range of specific codes unique to the OBGYN field, such as:
- Maternal-fetal medicine
- Reproductive endocrinology
- Pelvic reconstructive surgery
- Laparoscopic procedures
- Family planning
- Pediatric, adolescent, menopausal, and geriatric gynecology
The most comprehensive services will cover everything, including:
- Patient enrollment and verification
- Scheduling and appointments
- Medical coding
- Reconciliation of accounts
- Insurance collection
The billing specialist will make sure to apply CPT, ICD-9-CM, ICD-10, and HCPCS Level II codes with suitable modifiers. These adjustments make sure that patients receive the most reimbursement possible with the lowest risk of claim rejection.
Benefits of Outsourcing OBGYN Medical Billing Services
As an OBGYN practice grows, they may develop the goal of reducing the amount of paperwork and administrative duties for their medical staff. Delegation can increase efficiency and allow the practice to grow. Companies can do this by outsourcing their medical billing services for various administrative tasks, including:
- Verification of insurance
- Reimbursement tracking
There are several benefits to outsourcing OBGYN medical billing services. For example, companies have seen a reduction in costs due to the reduced amount of time spent on administrative tasks. It also saves companies money by avoiding costs associated with purchasing and maintaining medical billing software and computer equipment. Medical billing is a slow process sometimes. Outsourcing allows businesses to keep their billing moving and increase cash flow. Also, hiring OBGYN medical billing professionals reduces the likelihood of errors in billing. Trained experts can ensure quick and thorough processing of claims and bills. Without the need to focus on billing, healthcare providers can focus on customer service and other areas of their jobs.
Frequently Asked Questions
Is it smart to outsource OBGYN medical billing to a company?
It’s not only smart, but it’s good business to outsource your medical billing and administrative tasks. Doing so allows you to concentrate on core competencies, such as providing quality medical care. It can increase your cash flow and help you save money in the long run.
How quick is the process for filing claims?
Most claims go to insurance companies within 24-48 hours of receipt. This period does not include weekends and holidays.
The small number of claims that take more than 48 hours is usually due to late submission or incomplete information.
Do billing service companies keep up with changing laws and regulations?
One of the most critical priorities of medical billing service companies is to stay up-to-date with changing laws. Doing so is the only way to prevent the denial of claims due to outdated paperwork.
Medical billing companies will often send out a newsletter on a weekly or monthly basis that highlights significant billing changes. They will also call, email, or fax if there are any time-sensitive issues.
What is the process for handling denied claims?
The OBGYN medical billing company will automatically review and resubmit appeals as needed. If the insurers request any additional documentation, the company will work with the medical service provider’s office to receive it.
Denied claims are rare. When they do occur, you can expect the agency to expedite the process so that the patient can receive their reimbursement sooner rather than later.
What’s the risk of outsourcing OBGYN medical billing?
There is minimal risk if you outsource your company’s OBGYN medical billing. On the other hand, there are a lot of risks if you don’t.
Medical providers can become buried in paperwork. The complexity of billing might require providers to shift their focus from their patients to their administrative duties, which can lose them money. Outsourcing can substantially lower the risk and increase revenue.
Outsourcing medical billing has been growing in popularity among healthcare providers for a good reason. It increases efficiency, reduces cost, and allows medical service providers to focus on their patients. The benefits of a patient-centered approach are especially vital for the very personal field of OBGYN.
Outsourcing your OBGYN medical billing is an excellent choice. To learn more about OBGYN medical billing, click here.