Obstetric Billing has its own dialect. We are fluent!
Worldwide maternity packages, ultrasound bundling, split care modifiers, payer-specific prenatal rules- generalist billers guess, and you pay the prices. We have coded thousands of deliveries and understand exactly where OB/GYN claims go to die, and how to keep yours out of that pile.
59499 | Global OB care, antepartum, vaginal delivery, postpartum | Paid |
76895 | Ultrasound, pregnant uterus, ≥14 wks | Paid |
59519 | Global cesarean delivery package | In Review |
z34.99 | Supervision of normal pregnancy, unspecified trimester | Paid |
57452 | Colposcopy of the cervix | Paid |
OB/GYN sits at the intersection of surgical, preventive, and bundled maternity care, three billing rulebooks in one specialty. A biller who’s never worked a global deal will bill it wrong.
Antepartum visits are billed separately when they must roll into the global code or vice versa. It also triggers automatic denials from most major payers.
Patient transfers practices mid-pregnancy. Without correct modifier use (-52, -53) and visit counts, both practices risk getting shorted or denied outright.
Payers cap how many 76805/76816 units they will repay per pregnancy. Bill past the limit without documentation, and the claim bounces back.
An annual well-woman exam that turns into a problem visit requires the perfect E/M modifier, or the well-visit reimbursement disappears.
Hysteroscopies, LEEP procedures, and specific high-risk OB services require authorization before the appointment, not after the denial letter arrives.
Global OB claims can not go out until delivery. Practices that do not record this end up with a backlog of claims aging out past timely filing restrictions.
OB/GYN covers a huge range of practice types, and every one leans on a distinctive set of codes, payer policies, and documentation needs. We tailored our workflow to the specialty in front of us.
High-risk consults, serial ultrasounds, and non-stress tests carry their own frequency restrictions. It also has medical necessity documentation needs that are distinct from routine OB care.
Surgical staging, chemotherapy administration, and prior authorization for screening needs close coordination among coding and medical documentation to prevent underbilled claims.
IVF cycles, monitoring visits, and fertility medications are billed under fertility-specific policies that vary enormously by state mandate and individual payer.
Pelvic floor procedures and incontinence treatments often sit on the boundary between gynecologic and urologic coverage. This is exactly where claims get denied for jurisdiction.
The entire spectrum of routine prenatal care, well-woman visits, and deliveries. The volume-heavy core of most practices, and where clean, persistent billing practices matter most.
From the first prenatal visit to final patient statement, our team manages your complete OB/GYN billing process. We manage coding, claims, denials, insurance verification, patient billing, and reporting to support decreased errors and improve your practice’s revenue.
We manage accurate CPT and ICD-10-CM coding for obstetric and gynecologic services. Our team reviews charges, diagnoses, and modifiers to ensure claims are coded correctly and meet requirements. Our charge entry and coding process focuses on:
We handle billing for antepartum, delivery, and postpartum care. Our team also manages complex situations such as split care and transfer-of-care conditions to help ensure maternity services are billed correctly. We handle common situations such as:
Submitting a claim is only one part of the billing process. A claim that contains incorrect patient information, coding errors, missing information, or payer-specific issues might be rejected or denied. We review areas such as:
Denied Claims can quickly create a backlog of unpaid revenue. If denials are not reviewed and followed up promptly, they may become harder to recover or even reach filing deadlines. Our denial management team records denied and rejected claims and investigates why each problem occurred. We review issues such as:
Our expert team helps verify patient insurance coverage and identify authorization needs before scheduled services whenever possible. This is especially essential for medical, diagnostic services, screening, ultrasounds, and other services that may have specific payer needs. Our eligibility and authorization process can include:
Patient billing is an essential part of the revenue cycle, especially for OB/GYN practices where maternity care might include multiple visits and different billing arrangements. Confusing statements can lead to individual queries, delayed payments, and additional calls to your front desk. Our team helps make patient statements easier to understand by presenting charges, insurance payments, adjustments, and remaining balances clearly. Our patient billing support includes:
Adding a new OB/GYN provider or joining a new insurance network can involve a potential amount of paperwork. Delays in credentialing or enrollment can prevent providers from billing certain payers and might effect practices revenue. Our credentialing and enrollment services support handles this administrative process from beginning to end. We can assist with:
This is the piece of OB billing that trips up general medical billers most often. Here’s how a routine pregnancy is billed from the first visit to postpartum check – and where the rules can break.
Billed separately from the global package as a standard office visit, before antepartum care officially begins. This visit ensures the pregnancy and permits the providers to establish the individual’s maternity care plan. Accurate documentation helps ensure the visit is billed correctly and not incorrectly included in the global package.
Roughly 13 routine prenatal visits, bundled into the global fee, not billed line by line. It generally includes daily pregnancy checkups and daily administration throughout the pregnancy. Our teams make sure these are properly recorded as part of the global maternity package.
Vaginal or cesarean delivery closes out the global package. The claim can’t be filed until this date is confirmed. The delivery date and type of delivery should be documented correctly before the final claim is submitted. This helps avoid delays, incorrect billing, and issues with payer processing.
The final piece of the bundle. Missing this, and the whole claim sits unbilled past its filing deadline. We record postpartum care to support confirming the global maternity claim can be completed on time. Proper follow-up helps prevent missed billing opportunities and unnecessary delays in payment.
Step | What We Do | What It Means for Your Practice |
01 | Practice Assessment | We review your current A/R, denial history, and payer mix to identify where revenue is being delayed or lost. |
02 | Onboarding & System Setup | We connect with your existing EHR or practice management system, so you can continue using the software your team already knows. |
03 | Go-Live | Charge entry and claims submission typically begin within two weeks of signing, helping your billing process move forward quickly. |
04 | Ongoing Optimization | We review monthly reports and adjust workflows based on denial trends, payer changes, and your practice’s billing performance. |
Patient information, especially maternity and reproductive health records, requires careful handling and strong security. Our billing processes are designed with privacy, security, and compliance in mind at every stage of the revenue cycle.
We use secure processes for handling protected health information (PHI) throughout the billing cycle. Access and data handling are managed with privacy and security in mind.
Our medical coders have specialized experience with OB/GYN billing and coding. They understand the specific coding requirements involved in obstetric and gynecologic care.
Access is limited based on each team member's role and responsibilities. This helps prevent unauthorized access to sensitive maternity and reproductive health information.
Billing activity and claim changes are tracked to provide a clear record of what was changed and when. This supports accountability and easier review when needed.
Here are the details of KPIs or Performance Metrics:
KPI | Description |
Clean Claim Rate | Measures the claim submitted without any mistakes that might be the reason for rejection or delay. |
First Pass Claim Acceptance | Indicates how successfully claims are accepted without any additional work. |
Days in A/R | Records the average time outstanding payments stay in accounts receivable. |
Denial Rate | Shows how often claims are denied, and supports identifying recurring problems. |
Collection Rate | Measures how effectively the practice collects payments for facilities delivered. |
A/R Aging | Shows older unpaid claims and accounts that require follow-ups. |
Handling OC.GYN billing can be time-consuming and complicated. Our experienced team understands global maternity billing, coding, claims, denials, insurance verification, prior authorizations, patient billing, and other specialty-specific needs. We work closely with your practice to maintain accurate claims, follow up on unpaid accounts, decrease billing issues, and support a smoother revenue cycle. Book DocVaz Medical Billing today and provide your practice with reliable OB/GYN Medical Billing support you can count on.
This may be based on the circumstances, services provided, coding rules, and payer needs. Our team reviews every situation to ensure the services are billed correctly.
Yes, we review the care provided by every provider, applicable modifiers, documentation, and payer needs to support controlled split-care billing precisely.
Our expert team can work with your existing EHR or practice management system when supported, providing sustain a smooth billing workflow.
We help with provider and payer enrollment, credentialing applications, recredentialing, documentation, application recording, and payer follow-up.
We understand coding, patient details, modifiers, insurance details, authorizations, and payer requirements before claims are submitted.
