From Financial Struggles to a 40% Revenue Increase: A Nevada OBGYN Practice's Transformation

Medical Billing Case Study

Article by: BillingFreedom

A Nevada-based OBGYN clinic with a consistently growing patient base faced a silent yet serious challenge. Its billing process was quietly draining revenue. Despite delivering high-quality care and maintaining substantial patient volume, behind the scenes, claim denials, underpayments, and mounting accounts receivable were beginning to undermine financial performance. The in-house billing team, though committed, was stretched thin by the complexities of OBGYN coding, payer-specific guidelines, and evolving documentation standards. Minor oversights, such as incorrect modifier usage or delayed charge entry, were snowballing into significant revenue losses.

Discover How Billingfreedom's Billing Solutions Turned Challenges Into Profitability Within Three Months

Over time, the pressure began to escalate. A significant portion of the clinic’s accounts receivable remained unpaid well past standard timeframes, and reimbursements for essential services, including prenatal care and surgical procedures, were frequently incomplete or delayed. Coding inconsistencies and incorrect modifier usage also contributed to a rising volume of denials. It became clear that the issue was not just a billing backlog but a lack of specialized, proactive revenue cycle oversight tailored to the unique complexities of OB/GYN care.

That’s when BillingFreedom stepped in.

Instead of providing a short-term solution, our team performed a comprehensive audit of the clinic’s revenue cycle operations. We identified missed opportunities related to global surgical period management, corrected CPT-level coding discrepancies, and ensured the appropriate use of modifiers to support clean and compliant claims. With every part of the billing process realigned through a specialty-focused approach, the clinic experienced not only fewer denials but also a complete transformation in how revenue was recovered and protected.

The result was a measurable impact: a stabilized revenue cycle and a 40% increase in collections within just three months.

Client Overview

This Nevada-based OB/GYN clinic has built a strong reputation for delivering personalized, high-quality women’s healthcare. With a steadily growing patient base that ranges from routine check-ups to complex prenatal care and surgical procedures, the clinic remained consistently busy. However, beneath this growth, a silent but severe financial strain was taking shape. Despite the high patient volume, revenue failed to match the clinic’s efforts.

An Overwhelmed In-House Billing Team

Billing was handled entirely in-house by a small, dedicated team. While committed, they lacked the specialized expertise needed to navigate the complexities of OBGYN medical billing. The team struggled to stay current with the following:

• Continuously changing payer requirements
• Complex OB package coding
• Inability to conduct detailed claim analysis or identify revenue-draining trends
• Critical compliance requirements for procedures are overlooked due to time constraints.

Despite their dedication, the overwhelmed and understaffed team lacked the necessary competency and time to handle the intricate demands of OBGYN billing, resulting in delayed payments, claim denials, and significant monthly revenue losses.

Complex OB/GYN Billing That Wasn't Being Managed Correctly

The clinic’s billing challenges were widespread and deeply embedded across several key service areas.

• Prenatal and delivery services: Billing across trimesters was inconsistent, with global periods often initiated prematurely and essential visits left unbilled or denied.
• Surgical and Out-of-Office Procedures: Many procedures were either not submitted or incorrectly coded, leading to substantial missed reimbursements.
• Annual exams and wellness visits: Common combinations of CPT codes were regularly denied or only partially paid due to modifier misuse.
• Claims with Multiple CPTs: Encounters involving three or more CPTs frequently resulted in partial payments. In many cases, only a portion of the codes were reimbursed due to documentation gaps or improper linking.
• Modifier-Related Denials: Critical modifiers specific to OB/GYN care, such as 22, 25, and 52, were used inconsistently or incorrectly. These errors often led to denials that went unaddressed due to a lack of structured follow-up.
• Documentation Gaps:The frequent absence of documentation, including sterilization consents, NOP’s and OB contracts, often resulted in full claim rejections rather than just payment delays.
• Appeals and Follow-Up: : A formal system was not in place to prioritize, track, or escalate denied claims, resulting in lost revenue that could have been recovered through timely rework.
• These breakdowns not only disrupted cash flow but also pushed key performance indicators beyond acceptable thresholds. Issues such as aged accounts receivable (A/R) over 120 days, incorrect modifier usage, and missed global billing logic reflected systemic inefficiencies that were costing the clinic both time and money.

Revenue at Risk

The financial consequences of these systemic issues became increasingly evident with each passing month.

• Aged A/R over 120 days exceeded 34%, far above industry benchmarks, with a significant portion ultimately deemed unrecoverable.
• Claim denial rates remained high, particularly for encounters involving bundled codes, global periods, or missing modifiers.
• Underpayments routinely went undetected due to the absence of structured reconciliation processes and performance benchmarking.
• Delays in reimbursements disrupted the clinic's cash flow, creating operational strain and limiting its ability to invest in staff, technology, and patient care.

Without specialized oversight and analytics, revenue leakage was not only persistent but also untraceable, placing long-term financial health at serious risk.

Beyond Billing: The Strain on Patient Care

As the internal billing team remained consumed with managing rejections, resubmissions, and manual reconciliations, the clinical side began to feel the pressure. Staff was pulled in multiple directions, and the clinic's leadership struggled to maintain a balance between financial sustainability and patient satisfaction.

At this point, the clinic leadership knew they needed more than just a temporary fix. They required a specialized billing partner who understood OB/GYN workflows deeply, someone who could step in, uncover the revenue gaps, and help restore control to their revenue cycle.

Challenges And Their Solutions by BillingFreedom

When BillingFreedom conducted a comprehensive assessment of the Nevada-based OB/GYN clinic’s billing operations, it was evident that the issues were complex and deeply rooted in both workflow and internal systems. Below are the challenges and their solutions that were impacting the practice’s revenue cycle:

High A/R Over 120 Days (>30%)

Challenge: A significant portion of the clinic’s accounts receivable—over 30%—remained uncollected beyond 120 days, far exceeding the MGMA benchmark of 12%, leading to cash flow constraints.

Solution: BillingFreedom implemented a rigorous follow-up workflow for aged claims, prioritized payer outreach on unresolved cases, and optimized patient collections. Within 90 days, accounts receivable (A/R) over 120 days dropped significantly, improving financial predictability.

Global Period Billing Errors

Challenge: Services related to prenatal, delivery, and postpartum care were inconsistently tied to the correct global periods, resulting in bundling errors and denials.

Solution: A custom global tracking protocol was introduced, mapping each OB episode to its respective 000, 010, or 090-day timeline. The denial rate on post-op encounters dropped, aligning closer to the <2% KPI.

Incorrect Modifier Usage (22, 25, 52, 57, 59)

Challenge: Frequent modifier misuse or omission triggered claim rejections, particularly for wellness exams, bundled procedures, and surgical add-ons.

Solution: BillingFreedom trained the internal team on modifier rules and built automated checks into the claim scrubber. Modifier-related denial volume decreased, enabling coding audit accuracy to surpass the 95% target.

Initial Denial Rate >7%

Challenge: A high initial denial rate reflected weaknesses in documentation, eligibility verification, and coding practices.

Solution: BillingFreedom introduced front-end claim scrubbing, eligibility pre-checks, and real-time coding audits. Denials dropped by over 30%, moving the clinic closer to the <5% benchmark.

Lag in Charge Entry (>96 Hours)

Challenge: Delayed charge capture created filing delays and reimbursement gaps.

Solution: New workflows and accountability dashboards ensured over 95% of claims were submitted within 96 hours, meeting industry benchmarks and accelerating cash flow.

Documentation Deficiencies & Down-coding

Challenge: Missing or vague provider notes led to downcoding of E/M levels and outright claim denials for OB services.

Solution: A pre-bill documentation audit process was implemented to validate notes before submission. Coding accuracy in monthly audits surpassed 95%, meeting CMS and MGMA standards.

Revenue Leakage from Underbilling

Challenge: Services such as infusions, time-based CPTs, and minor procedures were often missed or undercoded.

Solution: Revised superbills and coder-driven chart reviews ensured a capture rate of over 98% for all billable services, reducing leakage and improving per-encounter revenue.

Clean Claim Rate (CCR) Below 90%

Challenge: A high volume of rejections and edits indicated a low clean claim rate, resulting in an increased administrative burden.

Solution: Enhanced front-end claim validation and improved payer mapping increased the CCR above 90%, aligning with MGMA benchmarks.

Net Collection Rate (NCR) <91%

Challenge: The clinic was collecting less than 76% of the allowed amounts, signaling underpayments or ineffective follow-up.

Solution: BillingFreedom tracked payer reimbursements against contract rates, reworked underpaid claims, and implemented fee schedule reviews to ensure accurate billing. NCR improved, trending toward the 91%+ range seen in top-performing practices.

Days in A/R >35

Challenge: The average number of days in accounts receivable (A/R) exceeded the 35-day benchmark, delaying revenue realization.

Solution: Aging buckets were monitored daily, with prioritized work queues for high-dollar and overdue claims. Days in A/R fell within targeted ranges by the third month of engagement.

Achieving a 40% Revenue Boost: BillingFreedom’s Impact on a Nevada OB/GYN Practice

Within just three months of implementing BillingFreedom’s strategic RCM solutions, the Nevada-based OB/GYN clinic experienced clear and measurable improvements across revenue, billing operations, and financial stability.

• 40% increase in overall revenue within three months, driven by accurate coding, reduced denials, and faster collections.

• Accounts receivable (A/R) over 90 days have been reduced significantly, improving cash flow and financial predictability.

• Claim denials decreased by 30%, thanks to better modifier usage, cleaner documentation, and proactive edits.

• 25% increase in reimbursement for out-of-office procedures through the correct coding of surgical and external services.

• 15% growth in collections for annual exams and preventive visits, due to proper CPT combinations and modifier application.

• 98% of all billable procedures were successfully captured, minimizing revenue leakage from underbilling.

• 95% or more of claims are submitted within 48 hours of service, accelerating reimbursement cycles.

• The clean claim rate improved above 95%, reducing manual rework and payment delays.

• Net Collection Rate (NCR) approached 98%, matching top MGMA-performing benchmarks.

• Days in A/R dropped below 35, signaling improved billing efficiency and follow-up processes.

• The full adoption of electronic billing eliminated paper-based errors and expedited claim processing.

• Superbill and coding template optimization helped align billing with updated payer policies.

• Profit margins improved by revising fee schedules for supplies and services to match allowable reimbursements.

Ready to Transform Your Practice? Contact Us Now

 

Client Testimonial

"Before BillingFreedom, our billing system struggled with denials, delayed payments, and aged A/R. Their team quickly corrected modifier issues, improved global period tracking, and optimized our coding process.
In just a few months, we saw a 40% increase in collections, a significant drop in denials, and smoother cash flow. Now, our revenue cycle runs efficiently, and we can focus entirely on patient care."
- Nevada OB/GYN Practice

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. 

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