No wonder that Gynecology billing and coding require a commodious claim filing system! It involves services for family planning, obstetrics, gynecology, and anesthesia procedures. Yet this specialty confronts maximum challenges when it comes to revenue reimbursements. Under-coding, omitting modifiers, and submitting claims without accurate documentation are frequent obstacles faced by gynecology professionals. The lost revenue is definitely no small change.
Outsourcing gynecology billing and coding can really aid in understanding the particulars that go into the process for OB-GYN billing services. Most of the gynecology practices have seen problems with the current CPT code updates. The difficulties had slowed down the revenue cycle management process due to an increase in claim denials.
This article explains the ways to make gynecology billing and coding better to experience seamless revenue flow.
To improve Gynecology Billing and Coding Services:
- Understand and be well informed on coding updates
- Avoid the common causes for denials
- Keep an eye on ICD-10
- Billing guidelines for gynecology billing and coding
- Hire efficient billers
Understand and be well informed on coding updates:
- One of the better ways to understand and ensure that the claims aren’t purposely denied is to stay well informed on coding updates that affect gynecology practices.
- In the last decade, there were several changes in the CPT codes and it’s essential to stay informed and updated.
- For instance, in 2017 there was the deletion of the bull’s eye symbol, which indicated moderate sedation that was used for gynecology procedures. The symbol was deleted for several CPT codes, including 10030 (fluid collection drainage by catheter, image-guided), 49407 (retroperitoneal or peritoneal, trans-rectal or trans-vaginal), 57155 (insertion of vaginal ovoids and/or uterine tandem for clinical brachytherapy).
- When the practice fails to stay up-to-date on CPT coding, it’s prone to lose thousands of dollars. It’s important to work with billing and coding specialists that are current in their knowledge.
Avoid the common causes for denials:
- Avoiding the common causes for denials includes ways to be aware of them. A healthcare professional’s report in the past included some of the top unexpected denials. They are:
- 99214– Outpatient doctor visit at a level 4
- 99000– A specimen handling office-lab
- 81002– Non-automated urinalysis without a scope
- 99213– Outpatient doctor visit at a level 3
- 36415– Routine blood capture
- These denials occur due to several reasons. In various cases, they get a code 18 denial for a duplicate claim or service. It’s often common that the claims are denied because the benefit for service was already included in the payment of another procedure or service.
- These claims are denied because the procedure isn’t paid for separately, or the charge isn’t covered by the insurance company. Or it could just be that the claim has errors or lacks in essential information required for reimbursement.
Keep an eye on ICD-10:
- Many practices now follow ICD-10 coding. But there are few tips to remember in order to reduce claim denials for gynecology billing and coding.
- It’s necessary to document specific trimesters. For example, by using the new ICD-10-CM code which is for the supervision of a pregnancy with an infertility history within the first trimester, it can ensure accurate coding and make way for lesser denials. Also, be aware of codes that may vary depending on the specific trimesters.
- The cause of pelvic pain requires to be documented soon after it has been known.
- If a patient’s age is complicating pregnancy or if she’s over 35 years old, indicate and inform whether their age may affect their delivery.
- If the fetus visibility scans are performed, document the accurate reason. Specify whether it’s simply a routine screening or there have been signs that would indicate a potential miscarriage.
- Be precise while documenting the annual gynecological exams, the annual GYN exam code is in ICD-10-CM chapter 21 instead of in chapter 15 where you may expect it. The code for a routine GYN exam was Z01.4.
Billing guidelines for gynecology billing and coding:
Outsourcing is a wise decision:
Outsourcing gynecology billing and coding services are considered straightforward procedures. The bills are scanned electronically and sent to the medical billing service team to have a thorough check on the claims. They check if they have missed anything or will have to add anything necessary. The industry average pay is around 7% charge for processing claims. In addition, the medical billing service follows up on rejected claims, handles delinquent accounts, and sends invoices directly to the patients.
Billing Guidelines help with right coding:
Gynecology professionals are well-versed with the effects of incomplete, wrong or delayed clinical documentation that affects the bottom line of revenue payments. Accurate documentation is the fundamental process and stands as the base for all medical coding, billing, and claims submission and follow-ups. With the accurate gynecology billing and coding services, it’s very easy and hassle-free to receive accurate and timely revenue payments which in turn, hinges around quality, precise, and thorough clinical documentation. It would initiate a follow up on patient claims pending for more than 18 days and optimize healthcare professional’s current cycle to 21 to 25 days depending on the kind of insurance accepted by your clinics, with their accumulated knowledge of:
- Accurate Coding On ICD-10 And CPT Platforms
- Raising Paper And Electronic Bills
- Following Up With Pending And Under-Paid Claims
- Working On Pre-Authorization For Approaching Procedures
Hire efficient billers:
- The gynecology billing and coding team must understand fee schedules, commercial payer regulations, and Medicare or Medicaid guidelines.
- The team should be experts in answering patient queries regarding billing.
- The billing team should be compliant with all HIPAA regulations and rules to assure accurate and complete billing.
- Data and charge entry must be absolute.
- Management of accounts receivable actually strives in reducing denials.
- Physician credentialing for hospitals is necessary.
- They should have good knowledge of HCPCS, ICD-10, and CPT Coding.
- They should be experts in payment posting.
- They should have Electronic Data Interface.
- They must be experts in handling denials through dedicated revenue management.
Complexities in OB/GYN Billing:
- Gynecology billing can be more challenging to most providers and medical billers. It could be because of the global claims, widely varying coverage terms, and multiple tests performed at numerous facilities.
- Most of the practitioners lack billing support provided to large hospitals and organizations.
- Let’s see few standard errors that occur in OB/GYN billing & coding:
- Overlooking the separately billable services that have been proceeded during the global period.
- There is a lack of understanding where that pregnancy coverage is an amendment to an existing insurance plan.
- Pregnancy coverage includes inpatient & outpatient services and sometimes is split between them.
- Inaccurate and Improper documentation of the policies & services provided.
- It also requires proper understanding, which determines the “medical necessity” to code various levels of ground and air ambulance services used.
- Therefore, it’s also important to understand that all laparoscopic OB/GYN surgical procedures involve diagnostic laparoscopy
Hope you got enough information on gynecology billing and coding. For more queries and updates on healthcare, please subscribe to our blog. Follow us on Facebook, LinkedIn, Twitter, and Instagram.
