Stop Losing $$$ on Well Woman Exam Claims — CPT Coding Best Practices for Gynecology Practices

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Well-woman exams sound simple. They’re not. Gynecology practices lose thousands every year because payers deny, downcode, or bundle these visits due to coding errors, missing documentation, or confusion between preventive vs. problem-oriented care . If your practice is seeing unpaid or underpaid Well Woman claims, here’s the reality: It’s not the payer. It’s not the patient. It’s your coding workflows—and they’re costing you real money. Below is the no-nonsense breakdown of how to stop revenue leakage immediately. Why Gynecology Practices Keep Losing Money on Well-Woman Exams Most losses happen because of wrong CPT/ICD pairing , incorrect use of preventive codes, and failure to separate problem visits from preventive services. Top revenue killers: 1. Using the wrong preventive CPT code Common mistakes include: Billing 99381–99397  is incorrectly based on age Missing counseling or preventive components that justify higher-level codes Treating a preventive exam...
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Price Transparency for Durable Medical Equipment

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Price transparency refers to the extent to which information is obtainable. It is when all parties in trading are aware of the product pricing i.e. awareness and knowledge of the bid price and asks price at various price levels, along with the quantities of any good or service involved. This also results in discrepancies in the billing and coding, thus affecting revenue cycle management.

DME refers to equipment such as oxygen supplies, wheelchairs, knee braces, etc. It has to be prescribed by a medical practitioner and the person buys this equipment from a DME provider or sometimes, the doctor himself calls a DME company for delivering it straight to the patient's home. This is where the price transparency has a catch. A knee brace could cost anywhere from a range of $250 to $1500 from two different DME companies. DME billing then gets erroneous due to double bills and unsuitable expenses.

Effects of Price Transparency-
DME billing takes a course on patients also as sometimes insurances have a set limit on what they can pay for the DME equipment. If the cost goes beyond that limit, the patient ends up paying himself. Overpayments occurring in DME billing are mainly due to price transparency being available on the web and various catalog prices. Again, due to changes in methods of production, market variations, and product innovations, Medicare ends up paying much more overall for DMEPOS (paying the market price for dressings-surgical but overpaying for wheelchairs). Especially in expensive and specialized medical devices, there are very few competitors; devices such as implantable cardioverter defibrillators (ICDs), pacemakers, etc. fall under the label of "differentiated oligopoly" category. Manufacturers do not set a single price for such products and charge different prices from different buyers (sellers have control over the prices they sell at).

To get more information about Price Transparency for DME click here: https://bit.ly/3SQ7rYZ.

Location: United States

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