New ACOG Guidance: Revised Prenatal Care Guidelines to Address Maternal Health Crisis

For nearly a century, prenatal care in the United States has followed a one-size-fits-all approach—12 to 14 in-person visits, regardless of a patient’s unique circumstances. But as maternal health challenges grow and millions face barriers to care, this outdated model is being reexamined. In a groundbreaking move, the American College of Obstetricians and Gynecologists (ACOG) has released new guidance promoting a more personalized and flexible approach. With a focus on early assessments, social support, and telehealth, this shift marks a critical step toward making prenatal care more responsive, equitable, and effective for today’s diverse population.

Care Delivery Procedure for Average-Risk Pregnancies

ACOG’s new recommendation updates the care delivery model for average-risk pregnancies, moving beyond outdated practices to prioritize efficiency, personalization, and accessibility, ensuring that every patient receives the appropriate care at the right time.

The primary objective of this new approach is to promote equitable care by addressing the upstream factors that contribute to the disproportionate maternal morbidity and mortality rates, particularly among marginalized populations. 

ACOG recommends that clinicians screen for social determinants of health, such as race, ethnicity, gender identity, education, and employment, and address these factors using two key strategies: assistance and adjustment.

Assistance involves providing resources to support patients, while adjustment means adapting care delivery to make it more accessible. By screening for these factors early in pregnancy, healthcare providers can ensure that any unmet needs are identified and addressed promptly, allowing for more appropriate referrals and resources to be provided as necessary.

Care Delivery

The core principle of this new model is the customization of care. Once the needs assessment is completed, the next step is personalizing the care plan based on the patient's specific medical and social circumstances. Tailoring care can include:

• Referrals to Community Resources: Connecting patients with relevant community organizations to support their social and health needs.
• Adjusting Visit Schedules: Modifying visit frequency and format to meet the patient's specific needs and preferences, ensuring care is both effective and accessible.

This individualized approach helps provide the most relevant and timely care, especially for those with unique social needs.

Streamlined Visit Schedules

The traditional prenatal care schedule involves frequent in-person visits, with appointments scheduled every four weeks until 28 weeks, every two weeks until 36 weeks, and weekly visits thereafter. The new model proposes a streamlined approach, focusing on necessary visits to improve pregnancy outcomes. While some patients may still need frequent visits, others can benefit from a reduced frequency of in-person care, such as:

• Targeted Visits: Visits should focus on critical services and tests that are known to improve pregnancy outcomes, rather than following a fixed schedule.
• Longer Visits: When visits occur, they may be more comprehensive, allowing for detailed conversations about health, care, and any concerns.

This approach allows for more efficient use of time and resources for patients and healthcare providers.

Incorporation of Telemedicine and In-Home Monitoring

In light of the pandemic, telemedicine has become a vital tool in healthcare and plays an essential role in this new model. Clinicians are encouraged to offer telemedicine visits when appropriate to reduce travel time and enhance accessibility. Additionally, in-home monitoring of certain pregnancy parameters (such as blood pressure or fetal movements) is encouraged, as it can help reduce the frequency of in-person visits.

• Benefits of Telemedicine and Remote Monitoring:
  • Increases patient access to care, especially in rural or underserved areas.
  • It provides a more convenient and flexible option for patients, reducing the travel burden for every visit.
  • Ensures that essential care and monitoring can still occur without compromising patient safety.

Benefits and Challenges

While the new model offers several benefits, it also comes with challenges. The primary benefits include:

• Increased Access to Care: Streamlined visits and telemedicine options make engaging more patients with prenatal care easier.
• Reduced Burden on Patients: Fewer in-person visits reduce the time and travel required, improving overall patient satisfaction.
• More Efficient Care: Focuses on the most essential aspects of prenatal care, leading to better outcomes with fewer unnecessary appointments.

However, there are some challenges to be mindful of:

• Infrastructure Barriers: Some areas may lack the technological infrastructure for telemedicine, and rural areas may struggle with reliable broadband access.
• Resource Limitations: Some institutions may not have the resources or staffing to provide community referrals or remote monitoring services.
• Political and Systemic Barriers: The political climate and current healthcare infrastructure may create challenges in addressing the social determinants of health, especially for marginalized populations.

Core Principles of the New Prenatal Care Model

Rooted in compassion and modern care standards, these core principles lay the foundation for a prenatal care model that meets people where they are—clinically, socially, and emotionally.

Patient-Centered Care

This principle emphasizes the importance of designing prenatal care around each individual's unique needs, preferences, and values during pregnancy. Rather than following a rigid schedule of visits and interventions, care should be responsive to the patient's unique medical history, lifestyle, and concerns. Patient-centred care fosters trust, improves communication, and ensures that clinical decisions align with what matters most to the care recipient.

Equity and Accessibility

Prenatal care must be equitable and accessible to all individuals, regardless of race, income, geographic location, or insurance status. Many communities, particularly in rural and underserved urban areas, lack sufficient access to maternity services. These guidelines call for reducing disparities by removing structural barriers, expanding care options such as telehealth, and ensuring resources are available to those who most need them.

Shared Decision-Making

Shared decision-making involves a collaborative process between healthcare providers and pregnant individuals. It encourages open discussion of care options, risks, and benefits, allowing patients to actively participate in creating their own care plans. This approach fosters confidence, enhances patient satisfaction, and ensures that care aligns with clinical guidance and patient priorities.

Integration of Social Determinants of Health

Recognizing that factors beyond clinical considerations influence health, these guidelines emphasize the importance of identifying and addressing social determinants of health. This includes screening for challenges such as food insecurity, unstable housing, limited transportation, and restricted access to childcare. Providers can coordinate with community resources to ensure comprehensive support throughout the pregnancy when such issues are identified early.

Addressing Health Equity Through Assistance and Adjustment

The updated prenatal care model is not just about adjusting visit schedules—it’s about transforming how care is delivered to ensure it reaches everyone, especially those who are often left behind. ACOG’s new guidance places a strong emphasis on equity, aiming to reduce the disproportionately high maternal morbidity and mortality rates experienced by marginalized populations.

To achieve this, clinicians are encouraged to screen early for social determinants of health, including race, ethnicity, gender identity, education, employment status, housing stability, and other relevant factors. Identifying these upstream factors early allows care teams to intervene in practical and meaningful ways.

ACOG outlines two key approaches to addressing these challenges: assistance and adjustment. Assistance involves helping patients overcome barriers by connecting them to resources such as social service referrals, community organization partnerships, and curated support lists. Adjustment refers to reshaping how care is delivered, making it more flexible and accessible. This may include reducing the number of in-person visits when appropriate, integrating telemedicine, or offering group care sessions that foster community support and convenience.

These strategies work hand in hand with shared decision-making, empowering patients to take an active role in their care plans. Meeting patients where they are—literally and figuratively—helps rebuild trust in the healthcare system and supports more positive outcomes across diverse populations.

Impact of New Prenatal Care Delivery Model on Medical Billing

As prenatal care shifts toward a more personalized approach, medical billing must adjust to ensure accurate reimbursement and compliance. With the introduction of telemedicine, adjusted visit frequencies, and a focus on social determinants of health, healthcare providers need to understand how to bill for these updated services properly. Here's how the changing care model influences medical billing practices:

Streamlined Visit Frequency and Billing Adjustments

Reducing in-person visits for average-risk pregnancies may require changes in billed visits. By consolidating visits or offering more extended, more comprehensive appointments, healthcare providers will need to adapt their billing codes:

• Fewer Visits: Fewer in-person visits may mean fewer billing codes for routine prenatal appointments. Proper documentation of the services delivered during each visit is crucial to ensure accurate billing for the care provided.
• Bundled Billing: Some visits may be combined into a single, more comprehensive appointment, which could necessitate bundled billing codes for specific packages of services rather than individual visit codes.

Telemedicine and Remote Monitoring Billing

Telemedicine and in-home monitoring have become key components of the new prenatal care model. As a result, there will be a need for specific billing adjustments:

• Telehealth Services: Virtual visits for prenatal care may be billed using specialized telemedicine codes. These codes differ from traditional in-person visit codes and are subject to varying coverage policies across insurers.
• Remote Monitoring: With the increased use of remote monitoring devices (e.g., for blood pressure or fetal heart rate), healthcare providers may need to use separate billing codes for these services to ensure that remote care is appropriately reimbursed.

Potential Challenges in Medical Billing

While the shift to a more personalized care model has many benefits, there are challenges in the medical billing process:

• Insurance Coverage Variability: Different insurance plans may have inconsistent coverage for telemedicine or remote monitoring services, leading to potential billing issues for healthcare providers.
• Infrastructure Gaps: Certain healthcare settings, particularly in rural areas, may lack the infrastructure to support the technology required for telemedicine or remote monitoring, making it more challenging to navigate billing for these services.

BillingFreedom’s Role in Adapting to New Prenatal Care Billing Practices

As prenatal care shifts to a more personalized and efficient model, BillingFreedom provides expert OBGYN medical billing services that ensure accuracy, compliance, and timely reimbursement. With our in-depth knowledge of the changes in telemedicine, adjusted visit frequencies, and the integration of social determinants of health, we support healthcare providers in managing the complexities of the new care delivery model. Our team is experienced in handling the unique aspects of prenatal billing, offering solutions that align with the latest guidelines so providers can focus on patient care while we manage the billing process.

For more details about our exceptional medical 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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