rcm solutions OB/GYN facilities

Medical Billing And Revenue Cycle Management Solutions For OB/GYN Facilities

OB/GYNs help in the diagnosis and treatment of a wide range of health conditions in patients and provide assistance to pregnant patients with their pregnancy and childbirth, including the general sexual and reproductive health of teens and women. Given the complex condition of obstetric and gynecological services, it becomes very crucial for practices to understand the importance of accurate coding, timely submissions, and insurance follow-ups are critical to maintaining a healthy revenue cycle. StafGo Health provides personalized billing solutions to meet your requirements with the help of comprehensive expertise with nuanced technology to enhance coding accuracy and minimize denials.

Optimizing OB/GYN Billing With Specialized RCM And Accurate CPT Coding

StafGo Health has a team of certified coders who are well-versed with the application of common OB/GYN codes like 99213–99215 for office visits, 59400 for routine obstetric care (including antepartum care, delivery, and postpartum care), 59510 for cesarean delivery and related care, 58300 for intrauterine device (IUD) insertion, 58150 for total abdominal hysterectomy, and 57500 for cervical biopsy. In addition, procedures such as colposcopy (57452) and pelvic ultrasounds (76856) are frequently billed. Our team also ensures accurate use of modifiers (such as -22, -59, and 25) and understanding of global obstetrical billing in avoiding denials.

Why Outsource Medical Billing And RCM To Stafgo Health For Your OB/GYN Practice?

At StafGo Health, we specialize in revenue cycle management for women’s health, offering in-depth expertise in OB/GYN-specific CPT coding, global obstetrical billing, and payer guidelines. Our certified billing professionals ensure accurate documentation, timely claim submission, and effective denial resolution—maximizing reimbursements and minimizing revenue leakage. Your practice gets benefits from streamlined operations, reduced burden, and more time to focus on delivering exceptional patient care by outsourcing your RCM services to StafGo Health.

Common RCM Challenges Faced by OB/GYN Practices

Due to the technical nature of OB/GYN procedures, changing insurance regulations, and a demanding clinical setting, RCM is challenging for these practices. The common challenges involve

Complex Coding for Obstetric Services - OB/GYN practices provide various services like prenatal visits, delivery, and postpartum care and adhere to global obstetric billing. Misunderstanding global package guidelines or inaccurate use of CPT codes can cause claim denials or underpayments.
High Volume of Prior Authorizations - Many procedures in OB/GYN practices require prior authorization, such as ultrasounds, hysteroscopies, and surgeries. A delay in getting pre-auth can lead to delayed patient care and denied care.
Insurance Eligibility Issues - If a patient changes the insurance plan during their pregnancy, it leads to confusion and complications in coverage verification. Insufficient verification and eligibility checks generally result in claim rejections or delays in payment.
Denied Claims and Incomplete Documentation - Incomplete supporting documentation and incorrect coding for procedures are some of the prevalent reasons for claim denials. It occurs most of the time when handling both preventive and problem visits in a single encounter.
Managing Global Billing Periods - Tracking and maintaining records of services that fall inside and outside the global billing period can be time-consuming and difficult without a proper system. Errors in this step can result in duplicate billing or missed charges.
Balancing Preventive and Diagnostic Services - If a patient avails both preventive (e.g., annual well-woman exam) and diagnostic (e.g., treatment for abnormal bleeding) services in one visit, the use of proper modifiers plays a crucial role, and failing to distinguish them correctly often results in claim bundling or denials.
Frequent Insurance Policy Changes - Medicaid, Medicare, and multiple private payers frequently change their policies, and OB/GYN practices often deal with these payers. Keeping up with policy updates is time-consuming and error-prone.

Solving Your OB/GYN Practice’s Challenges with StafGo Health

Expert Global Billing Support - At StafGo Health, our team specializes in understanding the complexities of global obstetric packages and provides you the tailored solutions by ensuring accurate CPT coding application for prenatal, delivery, and postpartum services to avoid revenue loss.

Efficient Prior Authorization Management - Our team handles prior authorizations smoothly by ensuring that all the essential documents are gathered and engaging payers directly to speed up approvals for ultrasounds, surgical procedures, and other OB/GYN services.
Real-Time Insurance Eligibility Checks - Our team verifies all the patient insurance and plans in real time, even for Medicaid and exchange plans, which reduces the chances of rejections due to coverage problems and improves claim acceptance rates.
Denial Prevention and Documentation Accuracy - Our team works on finding out the root cause of denials, and coders and billing experts work with your staff to ensure clinical documentation supports all services billed, minimizing claim denials and improving compliance.
Global Period Tracking and Charge Capture - Our team tracks and maintains data of global billing periods to make sure that all services rendered by doctors outside the global package are properly billed and reimbursed.
Proper Modifier Usage and Billing Compliance - Our coders make sure that when preventive and diagnostic services are rendered during the same visit, they apply accurate modifiers and codes to get complete reimbursement.
Stay Updated with Payer Rules - Our team of experts stays updated with changing insurance policies and payer-specific rules to ensure clean and error-free claim submission.