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With ever changing landscape of payment regulations, obstetrics and Gynecology specialty is also not an exception. Obstetrics and Gynecology is a specialty which encompasses focus on pregnancy and non pregnancy conditions. Surgical interventions are also quite common in Obstetrics and Gynecology.
Billing for Obstetrics and Gynecology is complex and is very specific when it comes to diagnosis coding. Keeping abreast of the coding updates ensures prompt reimbursement and avoids pitfalls in the overall revenue. The most common services performed in the Obstetrics and Gynecology specialty include evaluation and management services, specimen handling, urinalysis, routine venipunctures etc.
illing and coding operations are similar to other specialties but there are a few areas that a coder/biller would have to stay up to date. Understanding the trimester information and coding for the correct ICD 10 CM codes are a major challenge for many practices. Billers must know the procedures which are bundled as a package and which can be billed during the post operative period.
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10 Day and 90 Day Global codes: Medicare implemented mandatory postoperative visit reporting requirements for services provided to patients with traditional Medicare policies. This reporting affects the Obstetrics and Gynecology practices that practice in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island. This reporting of the postoperative code CPT®99024 is for the MACRA which allows CMS to gather data for 2019. The valuation of global surgical packages may be adjusted if CMS determines that the number of actual post op visits differ from what has been valued in the global package.
Billing for Pessary : A Pessary is a device used to correct pelvic floor weakness which may result in uterine prolapses and urinary incontinence. This device is a non surgical method to treat uterus prolapse. Not only it is cheaper for insurance carriers, but it is also better for the patient and physician. The cost of performing the procedure is less and so the reimbursement for the pessary will also be less. Coding for the correct diagnosis codes is the key for payment of pessary devices. Another key element is that if you are coding for an evaluation and management code with the pessary insertion, you must have other data to substantiate the evaluation and management service.
Well Woman Visit: Coding and billing for well woman visits is one of the easiest of all when you know the right codes for the right program. Coders must be aware of the correct set of codes to be used based on the payers. Some of the payers like Aetna, Cigna and UHC use HCPCS codes for well woman visit that was originally applicable only for BCBS. Now many local BCBS are reverting back to reporting the CPT preventive medicine code sets for well woman visits.
Appeals: When it comes to procedures performed in obstetrics and gynaecology, insurances may deny one or more services performed as per the coverage policy determinations. The practices would have to refer to the individual payer rules for appealing process. Use of correct forms and ensuring which information to be included to support the payment of the claim is very important. Medicare and other third party payers have well defined process and forms for appeal. Billing organizations would have to understand the correct payer requirements for a successful appealing process.
Prior Authorizations: Obtaining prior authorizations are also very essential for procedures performed in obstetrics and Gynecology. Practices must have processes and checks in place for obtaining prior authorizations. Strict policy guidelines apply with regards to the frequency of the services that can be utilized and billed. Failing to comply with the guidelines will leave the provider to lose money on the table.
HHaving worked with multiple EHR platforms and understanding your EHR and the practice
management system is never a concern with us. Our experts and customized solutions can help
practices to find a better platform if required.
We are very particular in defining the processes and operations from the transition phase to the
implementation and assign dedicated workforce who are adept in pioneering and streamlining the
We proactively analyze the denials and take necessary measures to ensure that the denial rate is
constantly reducing and thereby maximizing the revenue flow for a practice. Our proven analytics
fetches information on data patterns and improvement strategies for a practice.
Communication and transparency from the start of the project is our strength which makes us
Stand alone from our peers.