obstetrical care

Obstetrical Care Medical Billing and Coding Guide for NY Practices

The billing of obstetrical care is under a radical transformation, introducing telehealth services and increasing patient engagement through apps and data portals. These services are new to the coding environment. Robust regulatory changes are also expected to improve coding accuracy. These are designed to provide a more seamless and efficient billing process, making it easier for ObGyn providers to focus on what truly matters: delivering high-quality care to patients.

Keeping up with an ever-changing environment can be costly, but providers have alternatives. By outsourcing daily billing, New York ObGyn practices can offload these labor-intensive tasks, enabling staff to focus on quality patient care.

Billing and Coding for Obstetrical Care

ObGyn providers know that the process of billing and coding for obstetrical care can be a labyrinthine journey through myriad codes and guidelines. Generally, obstetrical care involves every aspect of pregnancy, from regular check-ups to delivery preparation. Many obstetricians consult with a chosen hospital for delivery but reaffirm care through the post-natal phase.

Certain aspects of billing and coding are vital for accurate reimbursement and compliance. Proper coding of evaluation and management (E/M), knowing the intricacies of acute and preventative services, and delving into the comprehensive realm of maternity care are part of reliable reimbursement.

  • Evaluation and Management: Sound billing and coding protocols rely on coherent and comprehensive documentation. Documentation for evaluation and management services needs to show the medical necessity of each encounter, with supporting evidence that includes new and pervasive symptoms, the nature of the encounter, and relevant changes.
  • Acute or Emergency Care: Services unrelated to pregnancy but provided by an ObGyn are usually billed separately from global obstetric care. They can include E/M care like UTI or maternal asthma. It can also be directed at the health of the fetus, such as a fetal stress test or amniocentesis. These complicated billing situations require time and administrative expertise.
  • Maternity Care and Delivery: Many medical services are billed as bundles. Trends toward global billing of obstetrical services were originally intended to simplify the coding process. However, when more complex care is necessary, global or “bundled” billing and coding create a confusing environment. Insurance billing guidelines are vital for proper coding and reimbursement maximization for comprehensive maternity care. General obstetrical care includes regular check-ups, testing, ultrasounds, progression to term, and delivery.
  • Antepartum and Postpartum Care: Obstetric care also includes closely monitoring a new mother during antepartum and postpartum through consultation and evaluation. The majority of these services are included in the global billing packages. Most insurance providers have coding-specific requirements for pre- and post-delivery conditions.
  • Post-Natal Care: Depending on the scope of practice, many obstetric practices include post-natal care. This level of continuous care creates unique coding situations that require comprehensive and payor-specific knowledge.

Documentation Best Practices

Providers of obstetrical care in New York have the monumental task of documentation. Once used to chronicle treatment plans, patient files are now a historical and detailed accounting of every task, communication, and aspect of patient interaction.

  • Compliance with Local and National Regulations: In all aspects of medicine, insurance regulations are, at best, erratic. Practitioners can minimize claim delays or outright denials by staying current on federal billing and coding regulations. Depending on a practice’s scope, missing even a small change in state-specific requirements may adversely affect reimbursements.
  • Document Treatment Stages: Maintain comprehensive patient records for all obstetrical care encounters. Proper and sufficient documentation may seem like standard operations for obstetrical care. However, a growing number of insurance payors are denying claims for lack of detail at each stage, even when coded globally or comprehensively. These denials can be costly and time consuming to appeal. Many healthcare practices have discovered that engaging a billing and coding partner alleviates the negative impact of claim denials.
  • Proper Documentation of the Rationality of Care: The “why” in obstetrical care is just as important as the “what.” The continuum of care is part of the overall consideration. Be prepared to explain medical necessity decisions and rationale to ensure maximum reimbursement and avoid claims denials.
  • Appeal and Denial Management: Develop a detailed process for managing and appealing denied claims. Synchronize these protocols throughout the office and with any third-party billing services. A good approach is to be prepared to submit additional documentation to support claims from the beginning. This pre-claim investigation is often referred to as a pre-billing audit and is used to catch human errors and minimize claim denials. Another method is post-claim review. As regularly scheduled processes, daily or weekly inspections are conducted of rejected line items and reasoning.
  • Insurance Verification and Pre-authorization: Confirm patient insurance details and eligibility before providing services. The affirmation of coverage of specific codes or service ranges is also done at this time. A simple way to avoid unexpected denials is to ensure that the patient’s insurance covers the necessary care and the proposed obstetrical care over time.

Knowledge of the complex regulations and policies revolving around obstetrical care in New York is essential for a thriving medical office. From contraception to postpartum care, even minor billing errors or omissions can result in claim rejection, having a devastating effect on overall practice health and quality patient care. By outsourcing some or all of the billing process, ObGyn providers can focus on accurate documentation and maximizing reimbursement while minimizing errors and denials.

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.