Here are top 6 money drainers that stop ob-gyn practices from realizing their full revenue potential.
We’ve been for more than a decade in the medical billing industry. On paper, we know all that it takes to improve the revenue of healthcare organizations. But in reality, every day throws a whole new set of problems and possibilities. Working with ob-gyn centers for several years we’ve learned that the performance challenges vary and usually it is not just poor collections. There are a lot of fault lines that can lead to operational and financial bumps. But no matter the size, location or patient population of the ob-gyn practice, a few reasons for revenue leakage and operational inefficiency remain surprisingly constant.
Note: These are not 6 points hastily pilfered from the net but are based on our experience of working closely with ob gyn practices over the years.
- Inconsistent revenue audits
- Coding issues that go unnoticed
- Inadequate knowledge of timely filing limits
- Improper billing for antepartum care and NST services
- Patient billing mistakes
- Small things matter
Okay, we can hear you saying “we know this”. But there is something you don’t know. It is that through simple steps and consistent efforts you can make course corrections. No need for expensive software upgrades, hiring an army of billing experts or major workflow changes. We recently helped an ob-gyn center based in New Jersey increase revenue by 60%. This blog is not a brag story of that. This blog is about how through small changes your ob gyn practice too can improve revenue and modernize processes.
If you are a major health system with best in class technology and expertise to keep your revenue cycle engine chugging at top speed, you may not find this information to be engrossing. But if you belong to the huge number of ob gyn centers who are struggling, this information can make a difference to your bottom-line.
1. Inconsistent revenue audits
Most ob gyn practices overlook a crucial aspect of running a financially successful institution – regular revenue audits. Sometimes the cause for revenue leakage can be as simple as poor data collection efforts. A revenue audit can surface troubling trends and risk areas. Recently while reviewing the frequency of provider services of an ob gyn practice we noticed that the ob gyn practice was seeing lesser number of patients than other practices with a similar organizational makeup.
The ob gyn practice was encouraged to use a productivity tracking tool to improve financial and operational outcomes. Nine out of ten times an audit reveals several areas for incremental revenue opportunities. Organizations that do not analyze their service and payer mix miss out on, maximizing revenue and keeping up with market demands.
2. Coding issues that go unnoticed
Coding for bundled claims is an art in itself. Let’s see what the decision makers say.
You don’t want government agencies to spot coding deficiencies and challenge your claims. But that’s what happens when your coding process is not audited regularly. Analyzing CPT code usage by provider and billing staff can help you make course corrections befores it’s too late. A coding audit of an ob gyn practice in Florida brought to the surface that a high number of claims were rejected by insurers because the medical coding team failed to add modifier QW for screening services.
Another audit revealed that codes assigned by registered nurses (RN) of a ob gyn facility were inconsistent and not in compliance with NCCI guidelines. And not very surprisingly bundling/unbundling claims is also an error prone zone. Frequent coding audits increase the precision and speed of your coding process tenfold.
3. Inadequate knowledge of timely filing limits
Expert speak: “One challenge to recovery of AR is that while many accounts which are uncollected may be older than the contractual timely filing and appeals limits, they may still be recoverable. Diligent analysis of these low balance claims will divide those accounts into two buckets: uncollectible, or “deadwood,” and collectable opportunities.” -Jeff Means, a principal at Colburn Hill Group
A lot many ob gyn specialists are blissfully unaware of timely filing limits. But an average provider works with 20-40 insurers. So it is only natural confusion over TFLs arise as each insurer marches to a different beat. Agreed. It is the medical billers job. But to ensure SLAs are adhered to and that claims don’t slip through the cracks for minor oversights it is essential that ob gyn practices stay abreast of TFLs and ensure their billers stick to the deadlines given.
4. Billing for Antepartum and NST services
Do you know that not understanding global billing packages can lead to revenue loss? Yes. An ob gyn group failed to send out patient statements to patients who’d moved to other states and providers. And their billing company wrote off payments. The high number of adjustments caught the eye of our analysis team.
Turns out that the billing company took the easy way out and numerous claims for antepartum and NST services were unbilled. An e-statement pathway was created. And guess what? 97% of the patients paid. Most practices do not bill with the number of visits while billing for prenatal visits. Errors while billing for prenatal visits is another revenue drainer.
5. Patient billing mistakes
In a consumer focused environment patient population management has taken on a sense of urgency. Here is the insight of an expert.
The key to reducing unnecessary medical costs and adverse outcomes lies in understanding how to best manage your patient population” – Bruce Carver, associate vice president of payer services at MedeAnalytics
Patient payment responsibilities are on the rise. Old news. Ob gyn practices still leave patient collections on the table. Old news again. Despite the meteoric increase in patient payment responsibilities it still remains an overlooked aspect of the billing cycle.
Patient billing errors result not only in a loss of revenue but patients as well. An ob gyn practice found this the hard way when nearly 20% of their patients left due to conflicting and opaque patient statements. The practice had to fire their billing office and look for an alternative. Major damage control had to be done before the practice could increase its patient flow.
Know the biggest mistakes your OBGYN billers make Click Here
6. Small things matter
Investing in technology is essential to survive in the healthcare field. Here is what a practice administrator reveals.
We’ve seen tremendous cost and time savings from our investment in technology. We feel it’s important to do everything we can to deliver care as efficiently as possible for our patients, and automation of our administrative transactions is one way that we deliver on that goal.” – Jody Meza, Practice Administrator, Alpine Medical Group, LLC.
Do you know that automating just one minuscule part of your billing cycle can grow revenue? That’s true. By enrolling an ob gyn group for ERAs they saw a drastic decrease in cycle times and operational costs. Another ob gyn centre increased its first pass claim acceptance rate by 67% by investing in a simple claim scrubbing solution that costed them less than $200 a month.
Conclusion
It doesn’t require an entire overhaul of your operations to see a difference in revenue. Strategies that are well planned and executed, offer the key to financial stability and success. Automating processes, conducting revenue audits, improving coding accuracy and focusing on patient billing, save your ob-gyn practice from financial fluctuations and inefficiency.
Frequently Asked Questions
Revenue audits help identify areas of revenue leakage, compliance issues, and inefficiencies in billing and operations. Regular audits ensure that practices are properly reimbursed for services rendered and can surface trends that indicate opportunities for revenue improvement.
Incorrect or inconsistent coding can lead to claim denials, delays, or reduced reimbursements. Regular coding audits ensure compliance with guidelines, such as NCCI, and help prevent errors like missing modifiers for bundled services.
Timely filing limits are deadlines set by insurers for submitting claims. Missing these deadlines can result in denied claims and lost revenue. Staying updated on TFLs and ensuring billers adhere to deadlines can significantly reduce revenue loss.
Understanding global billing packages and ensuring accurate billing for the number of prenatal visits can prevent revenue loss. Implementing e-statement pathways and using technology to track billing for these services can also improve collections.
