It’s nothing new that gynecology billing services require a commodious claim filing system.
There is also the trepidation of billing and coding errors along with revenue loss. With the changing coding regulations and billing guidelines it is often difficult for gynecologists to sustain the practice’s performance in the long run.
Under coding, omitting modifiers, and inaccurate documentation all are signs of poor gynecology billing services and can cripple your practice’s functionality.
To Improve Your Gynecology Billing Services
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Stay informed about the coding updates and understand the coding procedures
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Avoid inaccurate documentation and missing information
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Keep an eye on the payors’ claim submission guidelines
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Hire efficient billers
One of the better ways to avoid denials is to understand the claim submission requirements of various payors. Furthermore, you must understand the coding updates and changes within the CPT codes to implement the same as per the services rendered.
For instance, there are several changes in CPT codes. In 2017, there was a deletion in the bull’s eye symbol, which indicates moderate sedation that is used in gynecology procedures.
On the other hand, this year's changes to the CPT codes set include 230 additions, 49 deletions, and 7 revisions.
While providing accurate and quality care to your patients, staying updated about these codes is difficult and there are higher chances of mistakes and claim denials.
Avoid Common Causes of Denials
Claim denials in gynecology occur due to various reasons. For instance, a duplicate claim or services can lead you to the denial code 18.
Also, if the services are not covered by the insurance company or procedures are not charged separately, you will face claim denials.
How to avoid this?
Well, you need to collect accurate information about your patient and manage the data accordingly.
Always review the information about the patient and verify the patient’s insurance eligibility, whether it’s a regular visit or a new patient.
Obtain prior authorization for the required services and make sure, if there is an authorization denial, you have a defined system to resolve the same.
Workflow in Gynecology Billing Services
While performing OBGYN billing and coding services, it is essential to maintain a defined workflow to sustain your practice’s revenue. Make sure your billing workflow is predictable, understandable, and transparent.
Eligibility verification and prior authorization:
After patient registration and documentation, you need to verify your patient’s coverage benefits every time whether it is a new patient or a regular one. This is a crucial step as most claim denials happen due to a lack of eligibility verifications and patient benefit information.
To make your OBGYN billing services more efficient you must obtain the prior authorizations. If you deliver the services without preauthorization, then your claims will be denied.
Medical coding and Capturing Charges:
Implement accurate codes and modifiers for the services you rendered. Your codes must be up to date with the current guidelines to ensure a clean claim submission.
Just keep in mind that every service has its claim code. Entering the accurate services in the invoice along with accurate charges is essential to obtain accurate reimbursements.
Make sure your clean claim rates are higher than 95%. In fact, a clean claim rate of less than 60% is a warning sign for your practice.
Claim submission:
This step is just more than sending claims to the insurance company. You must calculate the net reimbursements you will receive once the payor clears all the due bills.
Gynecology billing departments are reported to file "clean claims," which leads to quicker payouts if they spend as little time as possible getting accounts receivable to validate their reimbursement levels.
The percentage of clean claims submitted by a billing expert is frequently used to gauge their efficacy because quicker payouts translate into more lucrative revenue cycles.
Claim Adjudication:
The payor verifies the claim in this stage to understand whether it is valid and compliant. And if all the necessary requirements are fulfilled how much to reimburse to the provider.
Receiving and posting payments:
When receiving payments, make sure all the amounts received are correct- neither under nor over the required amount. Insurers always collect the overpayments.
You must accurately log and track the payments. Comprehensive medical billing software systems help in proactively logging and tracking reimbursements.
Denial management:
If a claim is denied or rejected, you need to identify the reason and resubmit corrected claim within revised timeline.
Follow-up and collections:
Conduct regular follow-up on unpaid claims, patient balances and other accounts receivable to ensure timely and accurate reimbursements.
Reporting data:
After the payment is received, the data is the most valuable product of a billing process. Collecting data for billing analytics and monitoring the practice’s financial performance is essential.
Through regular internal audits and consistent monitoring of the data, you can identify the loopholes within your gynecology billing procedures.
However, with increasing patient volume and frequent changes in the administrative nuances, it is difficult to implement these strategies within your practice.
You are already occupied with your clinical responsibilities, and managing the business side of the practice is an added headache.
Then how to eliminate OBGYN billing and coding challenges?
