OB-GYN practices face unique financial and administrative challenges. Bundled maternity care and evolving payer rules are a few prime examples. Prior authorization requirements create yet another headache that can complicate gynecologist revenue cycle management.
Are you encountering some of these headaches? If so, gynecology revenue cycle management (RCM) can be invaluable. With the right tools in place, your practice can improve its workflows with automation and reduce denials.
Learning how to make each stage of the OB-GYN revenue cycle smoother and more efficient will result in a better billing system that also improves the patient care experience.
OB-GYN providers offer a wide range of services, including preventive care, surgical procedures, and maternity bundles. To make matters more complicated, obstetrics billing often spans several months or more. All services provided from the initial visit through postpartum care are typically grouped together for reimbursement.
Here are the most important stages of the revenue cycle management:
Consistency in documentation will help your team capture revenue at every phase of care. On the other hand, missed codes and incomplete records can easily lead to lost revenue. Effective RCM for gynecologists uses a mix of automation and analytics at each step to reduce these errors.
OB-GYN practices must contend with long billing cycles that span months of care. This increases the risk of missed or delayed charges. Without proper charge capture and follow-up, your practice may underbill or fail to claim additional services.
Many OB-GYN procedures require prior authorization. Some examples include ultrasounds and diagnostic tests.
When handled manually, the approval process can delay care and reimbursement. However, with an automated system, you can track and submit authorization requests before appointments, which creates a better experience for patients.
Another common headache is the crossover between in-network and out-of-network services. For example, about 10% of patients who are admitted in-network for maternity care incur some out-of-network charges.
Incomplete documentation or confusion about global periods often leads to denials or underpayments. Failure to track these trends across payers prevents practices from identifying recurring problems. Implementing denial analytics helps reveal payer-specific issues and reduce rework.
These factors make accurate and compliant OB-GYN revenue cycle management non-negotiable.
Creating a better RCM process for your OB-GYN practice requires a multifaceted approach that addresses each phase of the revenue cycle. You have to rethink how you capture patient data and introduce automation at every turn.
When you do, the result is a nimble workflow that helps you regain more revenue and protect the financial stability of your practice.
To win at revenue cycle management, OB-GYN practices need to take several actions.
Automation is a powerful way to minimize administrative delays and improve accuracy at the front end. Automated eligibility checks allow you to confirm that services are covered before a patient arrives for their appointment. That way, patients can access the benefits they pay for.
Automated authorization tools also streamline requests for ultrasounds, genetic testing, or procedures. With automated tracking and alerts, teams can stay ahead of payer deadlines and prevent claim rejections due to missing pre-approvals. Cutting down on manual inputs will also free up your team to focus on more dynamic work.
Every service must be documented and billed correctly. This includes:
A strong charge capture process ensures no encounters are missed within the global maternity package. Implementing integrated EHR workflows allows providers to record charges in real time and flag discrepancies automatically.
When you can catch issues before they are submitted, you’ll eliminate the need for frequent resubmissions. In turn, you can receive reimbursement sooner and with less legwork. This results in more stable cash flow and a better overall experience for all involved.
Conducting routine coding audits helps confirm compliance with payer and federal guidelines. You can also use audits to catch billing errors and unbilled add-ons. The goal is to identify trends in payer behavior so you can avoid recurring problems and create a smoother revenue cycle.
Data analytics turn revenue cycle data into actionable insights. When you track key metrics, you can identify inefficiencies and benchmark your progress against industry norms.
Analytics also help compare reimbursement rates across payers. Use this information to identify underpayment trends and level the playing field during negotiations.
No matter how much automation you add to your revenue cycle, your staff members will still have a huge impact on its efficiency. With that in mind, you need a well-trained team that is up-to-speed on the latest billing rules. Providing regular education and refresher courses will empower your team to work smarter and capture more revenue.
There are so many data points involved in the OB-GYN RCM workflow. Deciding which ones to pay attention to is a challenge in itself. If you aren’t sure where to start, focus on these performance indicators:
Tracking these metrics reveals performance trends and highlights where workflow improvements or staff training may be needed.
Are you looking for a way to modernize how you approach gynecologist revenue cycle management? Rivet Health’s Revenue Diagnostics solution empowers your practice to uncover inefficiencies and simplify claims management through automation.
With the right RCM tools in place, your practice can spend more time on patient care and less on chasing payments.
Schedule a demo with Rivet Health or download The Introduction to RCM e-book to learn more.
