Obstetrics & Gynecology billing and accounts receivable

OB/GYN runs two revenue cycles at once. Maternity is a global package: months of antepartum visits, the delivery and postpartum care bundled into one claim filed after the birth. The gynecology side bills procedure by procedure — colposcopy, LEEP, ablation, hysteroscopy, laparoscopic hysterectomy. A mistake at the first prenatal visit surfaces only when the delivery claim goes out months later.

Where the money leaks in obstetrics & gynecology

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Global maternity package billed in full after the patient transferred care mid-pregnancy, when only the antepartum visits actually rendered here should have been itemised.
• A well-woman preventive exam and a problem visit on the same day, with the problem work never documented separately, so the problem visit denies as part of the preventive.
• The IUD or contraceptive implant insertion pays, but the device supply is left off the claim or denies because the invoice the payer asked for was never sent.
• A follow-up obstetric ultrasound written up as routine, with no indication in the note, denied as not medically necessary and never appealed with the findings that prompted it.
• Coverage checked once at the first prenatal visit and never rechecked, so the delivery claim months later goes to a plan the patient has already left.
• Prior authorization obtained for an open hysterectomy when the case was completed laparoscopically, and nobody reconciled the operative report against the approved request.

What a seat does about it

One trained person works your queue from the difficult end, from our office in Rawalpindi, Pakistan, logged into your own system on your hours. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing. Some payer contracts and some state Medicaid programs restrict or require disclosure of offshore access — check yours before placing a restricted queue on this seat (more on /security/).

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and medical coding at $2,500, on request.

The codes those turn into

Each of these is a denial code you are likely to meet working obstetrics & gynecology, matched to the problem above it in your own words. The route back to payment differs by code, so a queue sorted by recovery route clears faster than one sorted by date.

• CO-226 — Requested information not supplied
  The payer asked you for something, and either nothing arrived or what arrived did not answer the question.
  Recovered by being answered with the document the payer names. Matched from: “The IUD or contraceptive implant insertion pays, but the device supply is left off the claim or denies because the invoice the payer asked for was never sent.”
• CO-50 — Not deemed medically necessary
  The payer does not accept that the documentation supports the service. This is a clinical argument, not a clerical one.
  Recovered by being appealed with clinical documentation. Matched from: “A follow-up obstetric ultrasound written up as routine, with no indication in the note, denied as not medically necessary and never appealed with the findings that prompted it.”
• CO-27 — Coverage had already ended
  The patient was not covered on the date of service.
  Recovered by being fixed at coordination of benefits and rebilled. Matched from: “Coverage checked once at the first prenatal visit and never rechecked, so the delivery claim months later goes to a plan the patient has already left.”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and payers ultimately pay roughly 90% of claims even while using an initial denial to slow payment. Most of what sits in a obstetrics & gynecology AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

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