Medical claim denials in obstetrics and gynecology (ObGyn) can be a significant challenge for healthcare providers and patients alike. Understanding and tracking the common reasons for insurance rejections and implementing simple policies can help ObGyn practices in New York successfully avoid medical claim denials while focusing on patient care.

Record Keeping That Minimizes New York ObGyn Medical Claim Denials

Claim rejections are the bane of any medical office. However, attentive staff can reduce the likelihood of a claim denial through accurate, complete, and consistent record-keeping.

• Complete and Accurate Records: ObGyn offices are busy places. To ensure proper reimbursement, you’ll need to accurately and legibly document relevant clinical findings, diagnostic tests, and treatment plans for every encounter.
• Proper ICD-10 and Modifier Coding: Regularly train administrative staff to review and update your coding practices to comply with evolving guidelines. Since they’re constantly changing, procedures should always be coded to the highest level of specificity. Proper coding also includes ensuring that all the appropriate codes for a visit or procedure are listed.
• CPT Coding: Understanding the nuances of coding takes time and training. An ObGyn office that is current with appropriate CPT codes is less likely to receive medical claim denials. However, time is a luxury. Outsourcing to a qualified third-party billing service that understands New York ObGyn reimbursement complexities may be a viable solution.
• Prior Authorization: A common practice in medical billing is pre-certification. Seeking prior approval enables payment for a specific procedure to be confirmed prior to treatment. However, each insurance plan has different requirements for pre-approval. To avoid medical claim denials, ObGyn staff should make prior authorization a priority. This small step ensures a smooth process and demonstrates to patients that their needs are prioritized.
• Ongoing Audit Process: ObGyn practices are more likely to avoid future medical claims denials if they develop a policy of auditing records. Auditing and comprehensive reporting are vital, providing a snapshot of the health and viability of a practice. In addition to simple billing and coding validation, third-party billing services offer various reporting options that give practice administrators a granular overview of an ObGyn practice.

Patient Involvement That Reduces Claim Denials

A growing number of insurance plans require patients to take financial responsibility for their healthcare. New York ObGyn practices often develop a partnership with their patients, which helps avoid claim denials. In fact, establishing open provider-patient communication pathways, either in-office or through third-party service providers, reduces error-based claim denials and minimizes non-payment of services.

• Informed Consent: Informed consent is an ethical and legal requirement when treating patients. It must always be obtained before treatment and is vital to ongoing patient education and positive outcomes. Failure to obtain proper consent can lead to claim denials or payment recoupment during patient-specific or comprehensive audits. To ensure complete records, as with medical encounters, documenting the education and consent process is essential.
• Verification of Insurance Coverage: Insurance plans are in continuous flux. While rare, medical treatment is sometimes denied because of insufficient or lack of coverage. A simple verification of insurance coverage and filing requirements reduces claim denials. Patients can also assist ObGyn staff by keeping their information current.
• Clear Billing and Financial Discussions: One way to minimize claim denials is to explain the billing process and patient responsibilities clearly. Even a slight misunderstanding can lead to financial frustration for all parties. An office that engages its patients in economic discussions is more likely to have their advocacy when a claim denial occurs.
• Follow-Up and Education on Claims: Don’t wait until an outstanding balance affects patient care. Emphasize the importance of providing and maintaining accurate personal information. Also, keep patients informed about claims status, including any potential issues that may arise. Billing and claims follow-up are two areas where outsourcing can be beneficial to an ObGyn practice. Third-party billing companies often provide a degree of separation between the patient and the provider, allowing the latter to focus on quality patient care.
• Complaint Resolution: Create a well-defined process for handling patient complaints and concerns related to claims, billing, or payment issues. Communicate in a timely manner. Additional information or a surprise invoice months after an appointment can create a difficult environment and jeopardize future care. Also, all interactions with patients regarding claims or billing should be documented. Similar to appointments and treatments, documenting financial encounters ensures transparency, a crucial factor during audits.

All New York ObGyn practices that want to avoid medical claim denials must have a multifaceted approach that entails thorough documentation, a clear understanding of billing and coding policies, and open communication with patients. An effectively trained staff or reliable third-party billing service like StarkBilling that adheres to practice policies can significantly reduce the likelihood of claim denials and ensure the financial stability of the practice. Having a straightforward billing, coding, and claims process enables ObGyn offices to concentrate on improved patient satisfaction and healthcare outcomes.

Take your ObGyn practice and financial health to new heights with the help of a New York specialized medical billing partner who delivers reliable, responsive, and timely quality work. Contact StarkBilling today.