Obgyn Billing procedures
Obgyn Billing procedures are about detail in three main common areas if the details are missed an OBGYN practice can be shut down in months if not weeks as the staff requirements are tremendous and overhead is outrageous.
OBGYN Billing is by most rights a specialty and Infallibill has to date become one of the leading companies in new hires in and around OBGYN Medical coding and billing bringing on 25% more staff in 2017 around the demand for this specialty alone. Our staff must pay close attention to detail and they know one error is this field could cost our clients dearly. They train rigorously to know that when billing for a global obstetrical package from the first prenatal visit, through delivery, until the postpartum visit if no complications exist that is all billed under the package and for any complications those need to be billed separately and each insurance carrier has different modalities. The billing companies typically have a review, edit, apply logic to their methodologies, however with OBGYN this can not and will not work out properly to acquire full reimbursement for all medications, injectables, and devices the billing company must “KNOW” the process intimately or else you will hear statements like well your clinician notes are horrible or the facility is lacking documentation etc etc etc.
Ask your Biller or Billing company of their input on the Well Woman Exam Codes and or which insurance plans will pay when S0612 is submitted as this is textbook 101. The real strategist IE: Infallibill biller Knows coding updates. By november of last year over 512 new code changes were released for the then current procedural code sets. Category III code sets are common place now and typically set with a letter at the end of primary codes like 99213-t etc etc
Keeping ahead of coding updates ensures that claims do not just get first round denials.
Avoid common causes of denials
Below is a list of “alarming” code sets top list for denials
- • 99000: Specimen handling office-lab
- • 99213: Outpatient doctor visit, level 3
- • 81002: Urinalysis non-automated without scope
- • 36415: Routine blood capture
- • 99214: Outpatient doctor visit, level 4
The top five reason codes for these denials are as follows:
- • 97: procedure already adjudicated
- • 18: Duplicate service
- • 16: Errors
- • 234: Procedure not paid separately.
- • 96: Non-covered charge(s)