Florida OBGYN Medical Billing Services Case Study: $300,000 Recovered in 60 Days 

Prepared by BillingFreedom LLC

Published: August 2026  |  Last reviewed: August 7, 2026

BillingFreedom is a nationwide specialist in OB/GYN medical billing, coding, denial management, and revenue cycle optimization.

From Revenue Leakage to Revenue Recovery

BillingFreedom Turnaround Plan 

Significant Results 

• Significant Results
• Approximately $300,000 recovered within 60 days
• Denial recovery workflow was restructured  
• Ultrasound billing & documentation review was strengthened
• Eligibility verification was moved to a 48–72-hour pre-service workflow
• Billing support was provided for five OB/GYN physicians

Client Profile  

A high-volume, multi-location, Florida-based OB/GYN specialty group provided services to a diverse population of women's health patients across the communities. The practice offered obstetric and gynecologic care, including prevention, prenatal and maternity services, in-office procedures, surgery, and imaging services.

The organization's expanding patient population, multiple payer combinations, and escalating reimbursement demands created administrative strain and the need to maintain an effective, compliant revenue cycle to provide quality patient care and financial stability. Leadership knew that patient demand for care is consistent, but they realized they needed a specialized medical billing partner with proven experience in OB/GYN revenue cycle management.
 

The Challenge

The clinics served more than 22,000 patients each year, but collections were still delayed. Leadership did not have a clear view of what was driving denials, aging A/R, and payer-specific reimbursement barriers. Key risks involved OB and gynecology coding, ultrasound documentation, eligibility and authorization, coordination of benefits, & global-versus-non-global maternity billing.

Baseline Performance

*Measurement definitions & before/after methodology should be documented internally before publication.

What the Team Revealed Through Audit

BillingFreedom conducted a detailed review of the practice’s revenue cycle. The team evaluated everything from patient eligibility verification and coding accuracy to denial and ultrasound billing. It also reviewed timely filing, payer performance, coordination of benefits (COB), and A/R follow-up.

The audit showed many operational gaps.

1. Denied claims were not always worked within payer deadlines
   Causes: Rejected claims were not always corrected and resubmitted promptly, while adjudicated denials were not consistently routed for correction, reconsideration, or appeal within applicable payer deadlines. In certain cases, correction or appeal deadlines were approaching or had already passed.
   
   BillingFreedom created denial follow-up queues based on denial type and CPT code. Individual owners were assigned to follow up on the claim.  This helped ensure corrections, appeals, and resubmissions were completed before payer deadlines expired.
    
2. Some ultrasound claims did not align with the documented study type, trimester, or gestational age. 
   The claims also did not consistently reflect the number of fetuses, imaging route, study components, or applicable payer medical-necessity requirements. The audit identified instances in which billed ultrasound codes did not fully align with the patient’s gestational age or with supporting clinical documentation.
   
   BillingFreedom introduced a review process to confirm that ultrasound codes and documentation supported the services reported on each claim.
   
    
3. Patients’ eligibility verification didn’t include plan-specific benefits
   The clinics regularly verified active insurance coverage, but the review did not always include OB/GYN-specific benefits, prior authorization requirements, or visit limitations.
   
   BillingFreedom reverified eligibility and plan-specific benefits 48–72 hours before the scheduled service. Prior authorization requests were initiated according to each payer’s required lead time. The process included benefit coverage, authorization requirements, service limitations, and payer-specific requirements before the patient’s appointment.
    
4. Coordination of benefits required additional review.
   Some patients had both commercial insurance and Medicaid coverage. In these cases, payer sequencing and secondary coverage were not always confirmed before claims were submitted.
   
   Before releasing claims, BillingFreedom checked payer sequencing, current eligibility, and applicable coordination-of-benefits requirements. This was especially important for patients with commercial primary coverage and Medicaid secondary coverage.
    
5. Additional-fetus services were not always identified.
   Multiple-fetus encounters were not consistently reviewed for separately reportable additional-fetus services when supported by the documentation and applicable payer policy.
   
   The revised workflow added a focused review of multiple-gestation pregnancies to identify appropriate separately billable services.
    
6. Antepartum-only services were not consistently identified.
   Some antepartum services may be separately reportable when the circumstances of care, documentation, and applicable payer requirements support reporting outside a global maternity package. Partial maternity care, transfers of care, changes in payer coverage, and other non-global obstetric circumstances were not consistently identified and billed according to the applicable payer’s policy.
   
   BillingFreedom added a review for partial-care and non-global obstetric situations to help ensure that separately billable services were captured appropriately.
    
7. NCCI edits were not consistently reviewed before submission.
   The practice’s billing team did not always review claims for applicable CMS NCCI procedure-to-procedure edits. The billing team did not consistently review applicable CMS NCCI procedure-to-procedure edits, medically unlikely edits, global-package requirements, and payer-specific bundling rules before submission. This increased the risk of coding conflicts and avoidable denials.
   BillingFreedom added pre-submission NCCI and bundling reviews to identify and correct potential issues before claims were sent to payers.
8. Modifier documentation was not always clear.
   Documentation did not always clearly support the use of modifiers for distinct or separately identifiable services.
   Modifier application was tied more closely to the clinical documentation and applicable payer requirements to support appropriate reporting before claim submission. 

Root Causes and Strategic Response

1 — Unresolved A/R from Denial Follow-Up Gaps: Denial claims were not promptly corrected, appealed, or resubmitted before the payers' deadlines.

Strategic Response: Denial-specific work queues and claim ownership were set up by BillingFreedom. BillingFreedom’s coding team monitored corrections, appeals, resubmissions, and payer deadlines.

2 — Inconsistent Pre-Bill Coding Controls: The practice did not consistently validate coding, ultrasound documentation, modifiers, NCCI edits, and OB billing requirements before claim submission. 

BillingFreedom introduced a pre-bill coding review to ensure accurate coding, documentation, modifier use, NCCI edits, gestational age, and global versus non-global obstetric service status.

3 — Incomplete Benefits Verification: Eligibility checks were made, but were not always performed to determine the coverage or need for authorization of specific OB/GYN services.

Strategic Response: BillingFreedom enhanced pre-service verification by reviewing benefits, coverage requirements, authorizations, and visit limits before appointments.

4 — Coordination-of-Benefits Gaps: Coordination of benefits was incorrectly handled for some patients with commercial primary insurance and Medicaid secondary coverage.

Strategic Response: BillingFreedom's experts verified payer sequencing and secondary coverage. This was done before the claims were released.

5 — Missed Revenue Capture: Additional gestation and antepartum-only services were not always identified for separate billing when supported by documentation.

Strategic Response: BillingFreedom added a focused review of multiple-gestation & partial-care encounters to identify services that could be separately reported when supported by documentation & payer requirements.

6 — Limited Revenue Cycle Visibility: The practice staff didn’t have visibility into denial causes and aging A/R. They had difficulty checking payer-specific reimbursement barriers.

Strategic Response: BillingFreedom conducted a revenue cycle diagnostic and established performance-monitoring and escalation controls to prioritize recovery opportunities and resolve unresolved claims.

BillingFreedom’s Approach

Revenue cycle assessment and recovery planning

BillingFreedom began with a comprehensive assessment of the revenue cycle. We paid attention to everything. The review covered:

• Charge capture accuracy
• CPT®, ICD-10-CM, and documentation-supported modifier assignment.

Our coders assigned modifiers  only when the clinical record and applicable payer policy supported separate reporting. Modifiers were not used solely to bypass a claim edit.

The review also covered ICD-10-CM diagnosis selection, sequencing, trimester, and fetus identification. It also audited episodes of care and documentation supporting medical necessity.

• Denial trends were reviewed by payer & reason
• A/R aging was reviewed to identify outstanding balances
• Timely filing compliance was checked
• Coordination of benefits workflows were reviewed
• Payer reimbursement patterns were evaluated

The review identified additional recovery opportunities for the clinics.

Denial management and appeals

Denied claims were categorized by root cause, including eligibility, authorization, coding, modifier, timely filing, COB, duplicate claim, and payment variance issues.

Depending on the denial, BillingFreedom corrected and resubmitted claims, prepared appeals, provided additional documentation, resolved insurance information issues, and followed up with payer representatives.

Payer-specific appeal workflows were also established to account for differences in documentation requirements, filing deadlines, and reimbursement policies.

Pre-bill coding review

BillingFreedom introduced a pre-bill coding review to identify problems before submission. The review included:

• Diagnosis-to-procedure alignment was reviewed
• Modifier documentation & reporting support were checked
• Applicable NCCI edits & payer-specific bundling rules were reviewed before claim submission
• Ultrasound documentation was reviewed
• Gestational age was verified
• Global and non-global OB services
• Multiple-gestation reporting

The review was designed to improve claim accuracy and reduce coding-related errors and denials. 

A/R recovery prioritization

Instead of working A/R strictly in chronological order, accounts were placed into recovery tiers based on:

• Outstanding balance
• The date by which the case must be filed or appealed.
• Payer volume
• Recoverability
• Patient insurance status
• Age of the account

High-dollar balances, claims nearing deadlines, commercial payer accounts, recoverable Medicare and Medicaid claims, and patient accounts requiring updated insurance information received priority attention.

RCM Performance monitoring and escalation

BillingFreedom created an escalation process for unresolved claims. Accounts were escalated based on aging, claim value, appeal status, payer response delays, medical necessity concerns, and contract or payment variances.

Key performance indicators were monitored throughout the engagement to support timely intervention and maintain improvements.

BillingFreedom’s workflows are designed to support accurate, documentation-backed claims, internal monitoring, corrective action, and applicable federal, state, and payer requirements.

Results

Within 60 days, BillingFreedom’s team recovered approximately $300,000 in payments from aged A/R & previously denied claims. After the revised workflows were implemented, the practice saw monthly collections increase by approximately $40,000–$50,000. Focused patient-balance follow-up accounted for approximately $10,000–$15,000 of that increase.

These results should be read together with the methodology below so that the recovery figure and monthly collection increase are not interpreted as separate additive amounts unless the underlying reporting confirms that they are distinct.

The engagement also improved First-pass claim acceptance rate, denial rates, and days in A/R.

The engagement also improved  the timeliness of filing, ultrasound collections, and claim-status visibility.

These results are based on the experience of one client & are not typical or guaranteed. Results can vary depending on payer mix, claim volume, starting performance, and documentation quality. Further coding complexity, reimbursement policies, and the specific recovery opportunities within each practice can also affect the result.

Operational Improvements

Results Methodology

Before publication, BillingFreedom should document the measurement period, numerator, denominator, data source, and calculation method for each KPI.

For the initial claim denial rate, use a consistent claim-level methodology before & after implementation. The percentage should represent submitted claims that received a denial status during the defined measurement period.

For the ultrasound collection rate, clearly explain whether the metric is calculated as payments collected divided by the applicable contractual allowed amount. Also specify the payer population & measurement period used for the calculation.

For timely filing compliance and claim-status documentation, define the account population, measurement period, and criteria used to determine compliance or accuracy.

Most importantly, the approximately $300,000 recovery figure should identify whether it represents actual payments received, cash collected attributable to recovered A/R, or another defined financial measure.

What “Recovered Revenue” Means

[Insert BillingFreedom-approved definition after internal financial validation. Do not publish the placeholder until the financial methodology is confirmed.]

Want to see where your OB/GYN practice may be losing revenue?

Schedule a complimentary revenue cycle assessment 

Is Revenue Leakage Affecting Your Practice?

Your practice may not need more patient volume. It may need cleaner billing execution and stronger revenue capture.

Revenue cycle gaps may be affecting your bottom line if your practice is experiencing:

• Rising or unresolved accounts receivable.
• Denial rates above target.
• Delayed payer follow-up.
• Uncertainty around global and non-global OB billing.
• Ultrasound or obstetric services that may not be consistently captured or billed according to documentation and payer requirements. 
• Modifier, NCCI, or coordination-of-benefits issues.
• A billing team stretched by payer-specific OB/GYN requirements.

BillingFreedom LLC helps OB/GYN practices improve charge capture, correct coding errors, recover lost revenue, reduce denials, strengthen A/R performance, and build a scalable revenue 

cycle operation without adding to clinical workload.

Client Feedback

“Within 60 days, we recovered more revenue than we initially expected. More importantly, we had a much clearer view of where claims, denials, & outstanding balances were breaking down. BillingFreedom helped us put processes in place that continue to support stronger financial performance.”

— Practice Administrator, Multi-Location OB/GYN Group

Testimonial published with client permission. Practice identity withheld for confidentiality.

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