Why do OB/Gyn Practice organizations, time and again, experience denial/ reduction of claims ?
Why this nightmarish incomplete/inaccurate OB/Gyn documentation hiccups in Ob/Gyn practices?
In the real world OB/Gyn practice scenario, one has to often perform coding operations for diagnosis and treatment procedures using incomplete documentation to process their insurance claims reimbursement speedily. At this juncture, discharge summaries (DS) and other important information are often not yet available at the time of coding. Such missing information can result in inaccurate/incomplete/missed-out coding that, in turn, can cause loss of revenue and profitability, besides creating compliance issues. According to federal and state regulations, patients histories and diagnostic and treatment documentation have to be completed within 24 hours, while overall record has to be completed within 30 days, and often DS fall within this time period.
Coding from incomplete and inaccurate records will not result in 100% coding accuracy. It is imperative that OB/Gyn professionals are aware of the effects of incomplete, delayed or inaccurate clinical documentation and its effect on the financial bottom line, performance-improvement activities (such as review of serious cases), and compliance with federal and state governing laws. Thorough and precise documentation is the basis of all coding, billing, and claims submission and follow-up. Correct Coding of OB/Gyn care services is crucial for receiving accurate payment for those services, which in turn, hinges around quality, precise, and thorough clinical documentation.
The clinical documentation should be complete and legible.
What do Correct “Coding OB/Gyn” services imply?
Some of nuances/intricacies of Correct-Coding for these services include :
• Selection of the right diagnostic, treatment, and re-habitation codes-that describe more accurately “what” and “why” “who” and “where” of the OB/Gyn process work-flow
• Supported by clinical documentation
• Consistent with coding guidelines
• Coding to the highest degree of specificity
• Linking the ICD-9/10 to the correct CPT-4 on the claim form
• Linkage and Medical Necessity: ICD-9/ICD-10 codes “justify” the services provided
• Failure to appropriately link leads to denials and delays of reimbursement claims
• Coding to the highest degree of certainty
• Avoiding bundled codes
• Coding only relevant OB/Gyn diagnoses
• Sequencing the OB/Gyn diagnoses
• Correctly understanding the billing requirements of each insurance agency, which varies from agency to agency, as well as with federal and state-specific regulations.
The Need of the Hour :
• Be in sync with the latest emerging documentation trends, guidelines, and formalities related to OB/Gyn business practices-this in turn. This will boost your coding accuracy, decrease insurance reimbursement claims denials, and safeguard your payments.
• Be conversant with ICD-10 related Ob-Gyn documentation that is needed as diagnosis system changes. Stay up to date on the most timely, relevant, and accurate ob-gyn coding guidance straight.
• Find your way out of coding tight spots thanks to precise and thorough supporting documentation.
• Implement the latest coding, compliance, legal and regulatory updates.
• Documentation and coding principles are intimately linked and affect patient care, reimbursement, and compliance. An understanding of the principles is required for the successful practice of modern-day OB/Gyn practice.
• The documentation of each patient encounter should include :
1. Reason for the encounter and relevant history, physical examination findings and prior diagnostic test findings, as well as the patient’s progress, response to and changes in treatment, and revision of diagnosis according to the level of service provided.
2. Assessment, clinical impressions or diagnosis, and identification of risk factors.
3. Plan for care and the actual time spent plus date and identity of the clinician.
4. The CPT and ICD9/10-CM codes reported on the health insurance claim form or billing statement should be supported by the documentation in the medical record.
How to boost-up revenue and profitability of OB/Gyn business venture ?
It would be a wise and judicious decision for OB/Gyn care providers to outsource their documentation and coding worries to BillingParadise. BillingParadise is an established, experienced, knowledgeable and leading one-stop outsourcing provider of documentation, billing and coding, and revenue cycle management (RCM) operations. BillingParadise specializes in OB/Gyn documentation, coding, and billing and is familiar with the procedures, treatment and terminologies concerned in OB/Gyn services in the US.
• You don’t have time to wade and sort through the never-ending onslaught of information about OB-Gyn documentation, coding and coverage. We at BillingParadise are here to do it for you efficiently, as well as effectively as we are diligently seeking to serve your Ob/Gyn RCM needs.
