How to improve your OBGYN Practice’s Revenue by 60% in 3 months

 Erika Regulsky Tags: , , , , Practice Management, RCM

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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.

  1. Inconsistent revenue audits
  2. Coding issues that go unnoticed
  3. Inadequate knowledge of timely filing limits
  4. Improper billing for antepartum care and NST services
  5. Patient billing mistakes
  6. Small things matter
Not finding time to read this blog? Not to worry. Download this case study in a PDF format. Download this OB/GYN Practice’s RCM Case study (60% Revenue increase in 3 months) here

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

Auditing allows an organization to make sure they’re properly paid for the services they provide. So there’s a compliance risk or [the auditor’s] validation that you’re billing correctly.” – Karen Bowden, Executive vice president of revenue integrity, Craneware

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.

Inconsistent-revenue-audits

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.

Coding-issues-that-go-unnoticed

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

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.

Inadequate-knowledge-of-timely-filing-limits

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.

Billing-for-Antepartum-and-NST-services

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-mistakes

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.

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.

small-things-matter-for-obgyn

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.

 Appointment Scheduling using Robotic Process Automation

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.


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