Avoiding Claims Denials for OB/GYN

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Avoiding Claims Denials for OB/GYN
Denials are a thorn in the flesh for most medical
practices. But there are some specialties that
have an exceptionally high denial rate. OB/GYN
is, unfortunately, one of them. Denial rates in
this specialty are the highest at a whopping
22.42. Denials are an everyday occurrence for
most OB/GYN centers. OB/GYN billing and coding
comes with unique challenges because of the
voluminous claims filing that comes with a
practice that covers Obstetrics, Anesthesia for
the procedure, Gynecology, and Family Planning.
If your practice is dealing with excessive claims
denials that are hurting revenue, heres a look
at several strategies you can use to avoid claims
denials OB/GYN and start improving revenue for
your practice. 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 definitely unique. The
first thing one should do when a claim is denied
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 so you can avoid
them.  In most cases, you will get a code 18
denial for a duplicate claim or service, while
its often common 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 charge
isnt covered by the payer, or it could just be
that the claim has errors or lacks essential
information required for reimbursement.
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Avoiding Claims Denials for OB/GYN

• Keep a Close Eye on Coding Updates
• One of the best ways to make sure claims arent
  unnecessarily denied so you can maximize
  reimbursements is to stay well informed on coding
  updates that affect OB/GYN practices. Within the
  past few years, several changes in CPT codes have
  been made, so its important to stay up-to-date.
  Failing to be updated on current coding updates
  has the ability to cost your practice thousands
  of dollars, which is why its so important to
  work with billing and coding specialists that are
  current in their knowledge. With the new 2019
  ICD-10-CM code set now available, more than 30 of
  the changes apply to OB/GYN. These changes
  include updating coding multiple gestation
  pregnancies to coding for obstetric surgical
  wound infections.
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• Follow Best Practices for OB/GYN Coding
• Specific trimesters need to be documented. For
  example, using the new ICD-10-CM code O09.01 is
  for the supervision of a pregnancy with an
  infertility history within the first trimester.
  Be aware that codes may vary depending on the
  specific trimester.
• The cause of pelvic pain needs to be documented
  if it is known.
• If a patients age is complicating a pregnancy.
  For example, patients over 35 years old, indicate
  whether their age may affect their delivery.

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Avoiding Claims Denials for OB/GYN

• If fetus visibility scans are done, document the
  reason. Specify whether its simply a routine
  screening or there have been signs that may
  indicate a potential miscarriage.
• Be careful when documenting annual gynecological
  exams, since the annual GYN exam code is in
  ICD-10-CM chapter 21 instead of in chapter 15
  where you may expect it. The code for a routine
  GYN exam is Z01.4.
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• Outsource to avoid Claims Denials for OB/GYN
• Even small errors can end up causing 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 difficult, and these new
  changes to the ICD-10 codes for 2019 only add to
  coding difficulties for your practice.
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• 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 are able to improve billing
  and coding efficiency so theyre able to spend
  more time focusing on offering patients quality
  patient care.

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Avoiding Claims Denials for OB/GYN
Medical Billers and Coders is a reputable medical
billing and coding company that offers the
highest quality service for clients across the
country. To learn more about how we can end your
OB/GYN billing and coding difficulties, contact
us today.   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. 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, the works, to ensure medical necessity),
and crafting a well-written appeal letter
addressing the denial reasons while providing
strong details of support from the
documentation.