Dealing with ob gyn related payment delays

Dealing with Ob-Gyn related Payment Delays For obtaining accurate and timely reimbursements in Ob-Gyn, the billing and coding team has to be vigilant about all the coding facets of this practice. As per a historical data, around 90% of payment denials and delays can be prevented. Ob-Gyn coding is complicated and using the right code makes a considerable difference in reimbursements. The billing requirements need to be identified, CPT and Medicare's rules must be followed, PAP smear payments must be reported, along with the usage of apt modifiers, and following of compliances to stay profitable. After identifying specific risks related to payment denials in Ob-Gyn, is it essential to keep a track on trends which culminate to errors consequently removing them, and gain a foothold in a successful and complete Ob-Gyn revenue management. 1. Reduce AR: A good practice is to lower the accounts receivable as much possible; keeping it to less than 30 days. 2. Outsourcing: Investing in the expertise of obtaining reimbursements from insurance agencies to an outsourcing agency could prevent delays in payments. 3. Documentation: It is significant for the physician to document details correctly, so billers and coders can process claims faster with accuracy. Improving the clinical documentation will also aid in justifying the diagnosis if questions arise from insurance payers. 4. Clearinghouses: These catch problems related to claims early enough; and help in preventing problems which might have arisen in other practices. 5. Avoid abridged codes: A few categories of diagnosis require coding of up to seven characters/digits. Failure to mention the codes with utmost specificity can result in rejection of claims. For this, documentation must be precise and clear to be able to select and assign an appropriate code/modifier for reimbursements. 6. Missing services: The billers and coders must ensure that the note/documentation has been read and followed in its entirety. Reading only the headers will in all probability result in the selection of improper codes while also missing out on the services that might have been reported in detail. 7. Patients: It is important to distinguish between a new patient and an established patient. According to obgyn.net, "A patient is new if he has not received a face-to-face, professional service from the provider, or a provider of the same specialty/subspecialty in a group practice, within the previous 36 months. This is Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com

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commonly known as the 'three-year rule.'" The location is not the selection criteria for determining the new and old patient. Further, CPT'sÂŽ E&M Services Guidelines stress, "Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by a physician and reported by a specific CPTÂŽ code(s)." 8. Ob-Gyn CPT 2016 changes resulting in enhanced payments (as per supercoder.com): a) Ovarian Sclerotherapy: 49185 is the code to be used for Sclerotherapy of a fluid collection (eg, lymphocele, cyst, or seroma), percutaneous, including contrast injection(s), sclerosant injection(s), diagnostic study, imaging guidance (eg, ultrasound, fluoroscopy) and radiological supervision and interpretation when performed. Sclerotherapy is also an alternate treatment for endometriomas. b) MRI codes for foetal imaging: Code 74712, Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation; and code +74713, each additional gestation (List separately in addition to code for primary procedure) are to be used for foetal imaging. c) Mammography: Code 77057 is to be used for screening mammography, bilateral, determining a 2-view study of each breast. d) OB lab panel code for HIV testing: Code 80081 is to be used for the obstetric panel which includes HIV testing. e)New Genetic Market Test Code: 81432, Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic sequence analysis panel, must include sequencing of at least 14 genes, including ATM, BRCA1, BRCA2, BRIP1, CDH1, MLH1, MSH2, MSH6, NBN, PALB2, PTEN, RAD51C, STK11, and TP53. Ob-Gyn Medical billing companies possess well-trained and experienced personnel who understand the nuances of Ob-Gyn billing and coding as it encompasses obstetrics, gynecology and anesthesia. Their competency aids in reducing the pending claims cycle to 25 days from the practice's current one, and follow up on claims impending for more than 18 days. The spectrum of services includes Maternal-Fetal Medicine, Reproductive Endocrinology and Infertility, Gynecological Uro-gynecology and Pelvic Reconstructive Surgery, Advanced Laparoscopic Surgery, Family Planning, Pediatric and Adolescent Gynecology, Menopausal and Geriatric Gynecology. They also encompass processes such as charge capture, patient billing, procedure coding, electronic filing of claims, denial management, increasing collection rates and enhancing the options for research and development along with a large influx of patients.

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