OB/GYN Medical Billing Services

OB/GYN is the specialty where a single billing decision carries nine months of revenue. The global obstetric package bundles routine antepartum care, the delivery and postpartum care into one code, billed once, usually at delivery. Everything about OB denials comes back to whether that package was actually intact.

The global package only works when the patient was yours the whole time

The global obstetric codes assume one practice provided routine antepartum care, performed the delivery and provided postpartum care. Real pregnancies do not cooperate. A patient transfers in at 28 weeks. A patient moves away at 20 weeks. A physician covers a delivery for another group. In every one of those cases the global code is wrong, and billing it anyway produces either a denial or an overpayment that is recouped later with interest in staff time.

The correct answer is split billing. Antepartum care alone is reported with the four-to-six visit or seven-or-more visit codes depending on how many routine visits were actually provided, with one to three visits billed as office visits instead. Delivery is reported on its own, with or without postpartum care depending on who provided it. Postpartum care alone has its own code. We track visit counts per patient from the first prenatal visit so the right answer is known at delivery, not reconstructed afterward from a chart.

When insurance changes mid-pregnancy

This is the most common cause of a large OB denial and the least anticipated. A patient changes jobs in the second trimester. Medicaid eligibility shifts her to a different managed-care plan. Suddenly the pregnancy spans two payers, and neither will pay a global code covering care the other one covered.

Split billing is the fix here too, apportioned by which payer covered which dates. It requires knowing that the change happened, which is why we verify eligibility at every prenatal visit rather than once at the first. See insurance verification.

What the global package does not include

Practices lose real money by assuming the global code covers everything from the positive test to the six-week check. It does not. The initial visit that confirms the pregnancy is generally separately reportable. Ultrasounds are separate. Non-stress tests, biophysical profiles and amniocentesis are separate. Visits for problems unrelated to the pregnancy are separate. Visits addressing complications beyond routine care are frequently separate. Laboratory work is separate.

Routine blood pressure, weight, urinalysis and fetal heart tones at a prenatal visit are included, and billing those separately is what gets a practice audited. Knowing the line in both directions is the job. See coding and audits.

Ultrasound denials: necessity, frequency and components

Obstetric ultrasound is the most-denied service in most OB practices. Payers publish coverage policies specifying which diagnoses justify which study and how many are covered across a pregnancy, and they enforce the counts. A study ordered for a good clinical reason still denies if the diagnosis submitted is routine pregnancy rather than the indication that actually prompted it.

There is also a component question. A practice that owns its ultrasound equipment and employs the technologist bills globally. A physician interpreting a study performed elsewhere bills the professional component only. Getting that backwards denies as a duplicate in one direction and forfeits the technical revenue in the other.

Gynecology: preventive visits, contraception and global periods

The gynecologic side has its own patterns. A well-woman preventive visit and a problem-oriented visit on the same day are both billable with the right modifier and genuinely distinct documentation, and payers deny that pairing routinely. Long-acting contraceptive insertion and removal have separate procedure codes and the device is billed separately from the procedure, with supply codes and payer rules that differ meaningfully plan to plan. Preventive contraceptive services are frequently subject to no-cost-sharing requirements, so a denial or a patient cost share applied to one is often appealable rather than final.

Gynecologic surgery carries global periods. Visits inside that window for unrelated problems, staged procedures and returns to the operating room each need the correct modifier or they are denied as included in the surgery.

How we work an OB/GYN account

Claims go out within 24 hours of the charge. Denials are worked within 48 hours. Insurance aging is worked at 25 to 30 days, which matters more in OB than anywhere else because a global claim denied at 90 days represents nine months of care. Our clean-claim rate is 98%.

Insurance verification, coding, credentialing and monthly Practice Performance Reports are included at no extra charge. See revenue cycle management and aged A/R recovery if global claims have already been sitting.

Why practices choose Synergy for ob/gyn billing

A 98% clean-claim rate, claims submitted within 24 hours, denials worked within 48 hours, free provider credentialing, and transparent monthly reporting — with a 30-day free trial and a 90-day money-back guarantee.

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