Avoiding Claims Denials for OB/GYN

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Avoiding Claims Denials for OB/GYN

• Claims Denials for OB/GYN are a thorn in the
  flesh for most medical practices. However, some
  specialties have an exceptionally high denial
  rate. Unfortunately, OB/GYN is one of them.
  Denial rates in this specialty are the highest,
  at 22.42. Denials are an everyday occurrence for
  most OB/GYN centers.
• OB/GYN billing and coding present unique
  challenges because of the voluminous claims
  filing required for a practice that covers
  Obstetrics, Anesthesia for procedures,
  Gynecology, and Family Planning. If your practice
  is experiencing excessive claims denials hurting
  revenue, here are several strategies to avoid
  claims denials in OB/GYN and improve revenue.
• Common OB/GYN Procedures and Their CPT Codes
• Hysterectomy
• Abdominal hysterectomy CPT 58150
• Vaginal hysterectomy CPT 58260
• Laparoscopic hysterectomy CPT 58570

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Avoiding Claims Denials for OB/GYN

• Myomectomy
• Abdominal myomectomy CPT 58140
• Laparoscopic myomectomy CPT 58545
• C-section (Cesarean section)
• CPT 59510
• Ovarian Cystectomy
• Laparoscopic ovarian cystectomy CPT 58662
• Open ovarian cystectomy CPT 58925
• Endometrial Ablation
• CPT 58353
• Most Common Causes for Claims Denials for OB/GYN
• There are so many facets to appealing a denied
  claim. While each denial may seem the same, each
  one is unique. The first thing one should do when
  a claim is rejected is to review the EOB and
  determine why it was denied. It helps to be aware
  of some of the most common causes of OB/GYN
  denials to avoid them.

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Avoiding Claims Denials for OB/GYN
You usually get a code 18 denial for a duplicate
claim or service. At the same time, its often
expected that the claims are denied because the
benefit for service was already included in the
payment of another procedure or service. These
claims may be denied because the procedure isnt
paid for separately, the payer doesnt cover the
charge, or it could just be that the claim has
errors or lacks essential information required
for reimbursement. Keep a Close Eye on Coding
Updates One of the best ways to ensure claims
arent unnecessarily denied so you can maximize
reimbursements is to stay well-informed on coding
updates affecting OB/GYN practices. Several
changes in CPT codes have been made within the
past few years, so its essential to stay
up-to-date. Failing to be updated on current
coding updates can cost your practice thousands
of dollars, which is why its so important to
work with billing and coding specialists who are
current in their knowledge. With the new 2019
ICD-10-CM code set, more than 30 changes apply to
OB/GYN. These changes include updating coding
multiple gestation pregnancies to coding for
obstetric surgical wound infections.
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Avoiding Claims Denials for OB/GYN
Outsource to avoid Claims Denials for
OB-GYN Even minor errors can cause Claims
Denials for OB/GYN, and with all the voluminous
claims filing that comes with OB/GYN billing and
Coding, it could be a good option for your
practice to outsource your billing and coding.
OBGYN coding is already tricky, and these new
changes to the ICD-10 codes for 2019 only add to
coding difficulties for your practice. Simply
forgetting to add additional characters to codes
that specify a type of surgical wound is enough
to get your claim denied, and denials can cost
your practice big time. Through outsourcing, many
OBGYN practices can improve billing and coding
efficiency and focus more on offering quality
patient care to patients. Medical Billers and
Coders is a reputable medical billing and coding
company that offers the highest quality service
for clients nationwide. Contact us today to learn
more about how we can end your OB/GYN billing and
coding difficulties. It is critical to follow
the appeals process laid out by the payor. Never
assume payor appeals processes are identical.
Mark the dates for deadlines and plan on sending
appeals 4 -5 days before a deadline.
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Avoiding Claims Denials for OB/GYN

• Repeat this for each level of appeal. A winning
  appeal always involves solid payor policy
  research, supplying complete medical records
  (with Orders, Lab Results, X-ray Reports, and the
  works to ensure medical necessity), and crafting
  a well-written appeal letter addressing the
  denial reasons while providing vital details of
  support from the documentation.
• FAQs
• Why do OB/GYN practices have high denial rates?
• OB/GYN practices face high denial rates due to
  the complexity of claims involving services such
  as Obstetrics, Anesthesia, Gynecology, and Family
  Planning. The intricacies of coding and the
  volume of claims filed contribute to the high
  rate of denials, which can significantly impact
  revenue.
• 2. What are some common causes of claims denials
  in OB/GYN?
• Common causes of claims denials in OB/GYN include
  duplicate claims, lack of essential information,
  procedures not covered by the payer, and failure
  to follow updated coding guidelines. These issues
  can result in claims being denied because they
  were already included in the payment of another
  procedure or service.

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Avoiding Claims Denials for OB/GYN
3. How can OB/GYN practices avoid claims
denials? To avoid claims denials, OB/GYN
practices should stay informed about coding
updates, such as changes to CPT and ICD-10 codes.
Accurate documentation of specific details, like
trimesters and reasons for procedures, is
crucial. Outsourcing billing and coding to
specialists can also help minimize errors and
improve reimbursement rates. 4. What are some
best practices for OB/GYN coding? Best OB/GYN
coding practices include documenting specific
trimesters, causes of pelvic pain, patient age
complications, and reasons for fetus visibility
scans. Accurate documentation, such as using the
correct ICD-10-CM codes for routine gynecological
exams and surgical procedures, is essential. 5.
Why should OB/GYN practices consider outsourcing
their billing and coding? Outsourcing billing
and coding can help OB/GYN practices reduce claim
denials by ensuring accuracy and staying updated
with coding changes. This allows practices to
focus on providing quality patient care while
improving billing efficiency and reducing
administrative burdens. Medical Billers and
Coders is one company that offers reliable
outsourcing services for OB/GYN practices.