Effective medical billing practices play a pivotal role at the heart of every obstetrician-gynecologist (OB/GYN) practice. For your practice to thrive financially and stay compliant, you must continuously streamline your billing processes and tackle any challenges head-on. A financially healthy practice that can scale and best serve its patients relies on dependable cash flow and robust revenue from efficient medical billing. Common errors in OB/GYN billing, however, can disrupt your operations and limit your profits. .
The Unique Aspects of OB/GYN Billing
OB/GYN billing encompasses various services, from prenatal care and deliveries to postnatal care, hormonal treatments, and routine exams. This diverse service range makes OB/GYN billing notably complex, especially with the intricacies of coding each type of care.
Global fees, which bundle services like prenatal visits, delivery, and postpartum care into one comprehensive charge, aim to simplify this complexity and are unique to this speciality. For instance, CPT code 59400 covers the full spectrum of maternity care, which helps streamline billing processes and manage patient and insurance expectations.
Despite these measures, OB/GYN practices still face high denial rates, with research showing that as many as 20% of claims can be denied. These denials are often due to common billing errors, but understanding and navigating the specifics of global billing can significantly mitigate these issues and improve the rate of successful reimbursements. By staying updated with changes in billing regulations and maintaining meticulous documentation, OB/GYN practices can enhance their billing efficiency and ensure they are properly compensated for the essential services they provide.
Top Five Billing Mistakes and Solutions for OB/GYN Billing
- Inaccurate or Non-Specific Coding
Inaccurate coding can lead to claim denials, underpayments, and the risk of audits. Staying on top of coding changes and using the most specific codes and modifiers possible is not just a regulatory requirement; it’s a significant revenue maximizer.
Solution: Employ specialized OB/GYN billing services that are up-to-date with the latest coding standards and changes. To maintain accuracy, your billing staff must be regularly trained.
With CPT® 2025 now in effect, there are several changes to note, including modifications to some E/M code descriptions. These changes encompass the addition of observation services, adjustments in the decision-making levels, and specifications on the required time for OB/GYN services if billing is based on time. Refer to the detailed chart below to see some of the most-used updates highlighted in the descriptions of the CPT® 2025 codes.
New Code Description Old Code Description
| 99222, Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | Initial hospital inpatient or observation care with moderate level of medical decision making. If using time, 55 minutes or more |
| 99223, Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | Initial hospital inpatient or observation care with high level of medical decision making, if using time, 75 minutes or more |
| 99232, Subsequent hospital care with moderate level of medical decision making, if using time, at least 35 minutes | Subsequent hospital inpatient or observation care with moderate level of medical decision making, if using time, 35 minutes or more |
| 99233, Subsequent hospital care with moderate level of medical decision making, if using time, at least 50 minutes | Subsequent hospital inpatient or observation care with high level of medical decision making, if using time, 50 minutes or more |
| 99234, Initial hospital care with same-day admission and discharge with straightforward or low level of medical decision making, per day, if using time, at least 45 minutes | Hospital inpatient or observation care with admission and discharge on the same date with straightforward or low level of medical decision making, if using time, 45 minutes or more |
| 99235, Initial hospital care with same-day admission and discharge with moderate level of medical decision making, per day, if using time, at least 70 minutes | Hospital inpatient or observation care with admission and discharge on the same date with moderate level of medical decision making, if using time, 70 minutes or more |
| 99236, Initial hospital care with same-day admission and discharge with high level of medical decision making, per day, if using time, at least 85 minutes | Hospital inpatient or observation care with admission and discharge on the same date with high level of medical decision making, if using time, 85 minutes or more |
| 99238, Hospital discharge day management, 30 minutes or less | Hospital inpatient or observation discharge day management, 30 minutes or less |
| 99239, Hospital discharge day management, more than 30 minutes | Hospital inpatient or observation discharge day management, more than 30 minutes |
| 99242, Outpatient consultation with straightforward medical decision making, if using time, at least 20 minutes | Office or other outpatient consultation with straightforward medical decision making, if using total time, 20 minutes or more |
| 99243, Outpatient consultation with low level of medical decision making, if using time, at least 30 minutes | Office or other outpatient consultation with low level of medical decision making, if using time, 30 minutes or more |
| 99244, Outpatient consultation with moderate level of medical decision making, if using time, at least 40 minutes | Office or other outpatient consultation with moderate level of medical decision making, if using time, 40 minutes or more |
| 99245, Outpatient consultation with high level of medical decision making, if using time, at least 55 minutes | Office or other outpatient consultation with high level of medical decision making, if using time, 55 minutes or more |
| 99252, Hospital consultation with straightforward medical decision making, if using time, at least 35 minutes | Inpatient or observation consultation with straightforward medical decision making, if using time, 35 minutes or more |
| 99253, Hospital consultation with low level of medical decision making, if using time, at least 45 minutes | Inpatient or observation consultation with low level of medical decision making, if using total time, 45 minutes or more |
| 99254, Hospital consultation with moderate level of medical decision making, if using time, at least 45 minutes | Inpatient or observation consultation with moderate level of medical decision making, if using time, 60 minutes or more |
| 99255, Hospital consultation with high level of medical decision making, if using time, at least 80 minutes | Inpatient or observation consultation with high level of medical decision making, if using time, 80 minutes or more |
- Failure to Verify Insurance Coverage Regularly
Insurance coverage can change frequently, impacting claim submissions and reimbursements. Just because you see a patient regularly during prenatal care, office staff should not assume their coverage is the same as it was at their last visit. This presumption is a costly yet common mistake. Insurance status can change due to several factors, including:
- Experiencing a job loss.
- Transitioning to a new employer.
- Receiving new insurance plans from an employer.
- Aging out of a parent’s insurance plan.
Solution: Implement a policy to verify insurance at every visit before any services are rendered. This step helps avoid unnecessary claim rejections or delays due to insurance issues.
- Claim Submissions Delays
Timely filing of claims is crucial, and when your practice provides care under several insurance companies, it’s also imperative to know each company’s submission guidelines. Claim submission delays can lead to late payments and negatively impact your cash flow.
Solution: Streamline your claims process to ensure timely and regular submissions. Consider automated systems that alert your team to upcoming deadlines and track claim status.
- Underbilling Due to Coding Errors
OB/GYN appointments often involve multiple procedures, so failing to code one or more procedures can significantly impact the reimbursement received.
Solution: Detailed reviews of claims before submission can prevent underbilling. Using advanced billing software can automate checks for such errors. Regular staff training is also essential to avoid underbilling errors.
- Poor Patient Financial Communications
Clear communication regarding financial responsibilities can prevent surprises and improve the likelihood of receiving payments on time. When patients understand their payment responsibilities upfront, it increases their confidence in seeking necessary care and prevents the stress of unexpected medical bills.
Solution: Provide patients with clear, understandable financial policies and potential costs before their appointments. Offering various payment options also facilitates easier transactions for patients. Open discussions about financial expectations can foster a positive client relationship and ensure a smoother experience for everyone involved.
Partner with 4D Global and Boost Your OB/GYN Practice’s Revenue
If you are a growing OB/GYN practice, streamlining your billing process by partnering with our 4D Global team can increase your efficiency and profitability. Our dedicated team understands the specific needs of OB/GYN billing and brings expertise that can significantly enhance your practice’s revenue cycle management.
Are you ready to optimize your OB/GYN practice’s billing operations? Contact 4D Global today to learn how our expertise can help you reduce billing headaches and maximize your revenue.