Effective OBGYN Billing – The Key Revenue Cycle Factors
By: Gilbert Johnston
For OBGYN’s, the medical billing process has never been simple. A uniquely consistent and lengthy treatment cycle has led to a billing system where numerous patient visits are interlinked and treated like a single insurance claim. Recent changes to American Healthcare have only further complicated matters, as patients now cover a greater percentage of costs.
Numerous factors make OBGYN medical billing unique and more difficult than billing for other specialties. Today we’re going to discuss two of the largest, most impactful elements:
- Global to the Delivery
- Patient Payment Reliance
Global to the Delivery
What is it?
“Global”, as it’s often called, is essentially the grouping of an entire pregnancy into a single insurance claim. It begins after the confirmation of pregnagncy and ends with postpartum care.
Explanation:
Medical insurance claims are analyzed by diagnoses and treatment codes. And most treatments are rather short, with single visits making up the majority of claims. Even when claims are for longer treatment periods, it’s rare for so many patient visits and procedures to be grouped together in a consistent manner, like Global is. It makes sense though, that childbirth would be treated specially, as it is a very unique life event.
For ‘Global to the Delivery’, Obstetricians don’t file individual claims for each patient visit. They wait until the pregnancy is complete and file all visits and treatments together.
This type of billing process already requires greater organization and expertise on behalf of the biller. However, what makes the OBGYN revenue cycle truly troublesome is this: The specific patient encounters included in ‘Global to the Delivery’ vary greatly, depending on the insurance payer.
Without an expert biller, OBGYN practices can really end up in a tough position. A denied Global claim is a denial for months of work. Moreover, if OBGYNs don’t know their insurers’ rules well, they can make a mistake that leaves patients with a larger bill than expected. This can hurt a physician’s reputation. More than ever, OBGYN providers and practices need a truly efficient and knowledgeable medical billing team to protect their financial interests. The days of turning the work over to practice staff are disappearing.
Patient Payment Reliance
What’s the issue?
Patient bills now make up a larger chunk of total healthcare costs, as some of the financial burden has shifted from insurers to patients.
Explanation:
Since the rollout of the Affordable Care Act, OBGYN providers and their patients have seen some major changes. While more patients are now insured, many have seen significant increases in premiums and deductibles. In other words, more costs are being pushed onto patients from insurance payers.
A few years ago, many physicians, from a wide variety of specialties, would spend very little time trying to collect payments from patients with outstanding balances. Doctors would cut their losses at a certain point because insurance payments made up so much of their revenue. Nowadays, patient bills are much more important to physicians’ finances. In fact, timely patient collections have become essential to a stable physician revenue stream.
However, following up with patients can be both unpleasant and time-consuming. Plus, when the follow-up comes directly from the OBGYN’s staff, it can be bad for business. Obstetricians and Gynecologists can really benefit from having a third party biller handle patient payments and collections. It can result in higher collection rates, better PR, and more time for staff to focus on patient care.
A careful approach with these two issues is critical to successful OBGYN billing. At The Valletta Group, we have years of experience providing robust OBGYN billing services to physicians across the country. We know the ins-and-out of the Global system and the overall OBGYN revenue cycle. Plus, we’ve worked with clinicians in various sub-specialties of Obstetrics and Gynecology.
At Valletta, we also handle all patient bills. We send out statements, accept payments, and periodically remind overdue patients to pay. We also instruct patients to call us with any billing inquiries. We even offer online payment solutions with the option of automatically recurring installments, which have proven effective at increasing the percentage of timely patient payments.
