Case Study: How We Changed a Nevada Bases OBGYN Practice from Loss to Profit
Discover how BillingFreedom transformed a struggling Nevada-based OB/GYN practice from financial losses to profitability.
Medical Billing Case Study
| Practice | OB/GYN Specialty Office |
|---|---|
| Client | Nevada-based OB/GYN specialty office |
| Client’s History | Experienced ongoing financial losses despite increasing patient volume |
| Key Challenges |
|
| Impact on Practice | Significant financial instability and a threatened future for the practice |
The Challenge
A Nevada-based OB/GYN specialty office faced several significant challenges in its billing process, leading to revenue loss and inefficiencies.
One of the primary issues was navigating the complex coding requirements for medical billing procedures like prenatal care, deliveries, and surgeries. Incorrect or incomplete coding led to frequent claim denials and underpayments, significantly impacting their financial performance.
Additionally, managing global period billing posed another challenge. Services provided outside the global period, primarily related to surgeries and deliveries, were often improperly tracked and billed, resulting in missed reimbursements.
The office also encountered issues with correct modifiers, such as 22 (increased procedural services) and 52 (reduced services), which are crucial for reflecting procedural variations. Improper or inconsistent application of these modifiers led to rejections and reduced payments.
Furthermore, the practice faced a high claim denial rate, primarily driven by documentation errors and inaccurate patient information. This caused delays in payment and created a costly cycle of appeals and resubmissions. Finally, the frequent changes in coding and billing regulations presented an ongoing challenge as the staff needed to stay updated, leading to further claim denials and missed revenue opportunities. Addressing these challenges requires a proactive approach to billing practices, regular staff training, and implementing effective technology solutions.
| Challenge | How We Overcame It | Solution Provided |
|---|---|---|
| Complex Coding Issues | Implemented advanced billing tools to enhance accuracy for OB/GYN coding. | It ensured accurate coding for prenatal care, deliveries, and surgeries, reducing claim denials. |
| Global Period Management | Introduced precise tracking mechanisms for global period & antepartum services. | Correctly billed services provided outside the global period to capture all reimbursements. |
| Incorrect Use of Modifiers | Trained staff on the proper application of critical modifiers. | Improved reimbursement rates and reduced claim rejections. |
| High Claim Denial Rates | Accurate coding & auditing and detailed documentation, and prior-authorizations. | Drastically lowered claim denial rates, resulted in faster payments. |
| Changes in Coding and Billing Regulations | Stayed updated with regulatory changes and provided ongoing staff training. | Ensured compliance with the latest billing guidelines, optimizing revenue collection. |
From Revenue Loss to Profit. BillingFreedom Success Story.
At BillingFreedom, we stepped in to tackle these pressing issues head-on. Our team first identified and corrected recurring coding errors by leveraging advanced medical billing tools for OB/GYN medical billing services' unique needs. We ensured accurate coding for procedures like prenatal care, deliveries, and surgeries, significantly reducing claim denials. We implemented precise tracking mechanisms to address the global period billing issues, ensuring services provided outside the global period were billed correctly.
We also trained the office staff on essential guidelines and guided them to navigate the prior authorization process for specific procedures. Additionally, BillingFreedom’s RPA (Robotic Process Automation) enabled claim scrubbing technology to minimize errors before submission, drastically lowering the claim denial rate. We ensured compliance and optimized revenue collection by staying updated with regulatory changes and adjusting the billing process accordingly.
As a result of BillingFreedom’s intervention, the practice saw a substantial increase in revenue, faster payment cycles, and reduced A/R days, transforming the practice from a financial struggle to profitability.
Results Provided By BillingFreedom
As a result of our targeted efforts at BillingFreedom, the Nevada-based OB/GYN practice experienced significant improvements in financial performance:
- The practice's overall revenue increased by 30%+.
- The amount of accounts receivable over 90 days was substantially reduced.
- 100% electronic billing implementation streamlined processes and accelerated revenue reimbursements.
- Successful adjustments to pricing and fee schedules improved profit margins on medical supplies.
- Claim denial rates decreased by 30% through enhanced coding accuracy and modifier usage.
- Reimbursements for out of office procedures, surgeries and deliveries, increased by 25% after addressing billing inconsistencies.
- Improved consistency in annual exam billing led to a 15% rise in collections.
- Updated superbills, minimized coding errors, and expedited claims processing.
These strategic improvements transformed the practice's financial health, enabling it to transition from a state of loss to a profitable operation.
BillingFreedom is your trusted partner in restoring financial stability for OB/GYN medical billing practices, ensuring they thrive and succeed in today’s complex healthcare environment.
For more details about our exceptional ob/gyn billing services, please don't hesitate to email us at info@billingfreedom.com or call us at +1 (855) 415-3472. Your financial tranquility is our priority!
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