Texas OB-GYN Billing: Recover Medicaid Managed Care Underpayments Before the Filing Deadline

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OB-GYN practices in Texas are losing significant revenue due to Medicaid managed care underpayments that go uncorrected before filing deadlines expire. These underpayments often remain hidden within high claim volumes, and without proactive follow-up, they turn into permanent revenue loss. Texas has one of the largest Medicaid populations in the country, with multiple managed care organizations (MCOs) administering benefits. While this expands patient access, it also introduces complexity in reimbursement. Each payer applies different fee schedules, edits, and payment rules, making it difficult to track whether claims are paid accurately. This is why many providers rely on specialized OB-GYN billing services and medical billing services in Texas to identify and recover lost revenue. Why Medicaid Managed Care Underpayments Occur Underpayments typically happen when payer systems apply incorrect fee schedules, misinterpret coding, or bundle services that should be reimbursed separa...
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Top 5 Procedures Where ASCs Are Losing Money

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Ambulatory surgical centers have certainly been a revolution. However, there are some surgical procedures wherein the physicians working at the facility have been subjected to a pay cut or the revenue generated for their procedures has not been fully paid. Well, various reasons hamper the revenue cycle of ASCs, but the most problematic region for the losses is improper medical billing and coding structure. Yes, you heard that right, because this has become a falling trend where the in-house accounting department is finding it difficult to verify and code the perfect procedures while tackling the prerequisite of healthcare providers as well. While procedures like the spine, orthopedic surgery, and ophthalmology are known as top revenue generators, specialties like plastic surgery, oral surgery, and urology regularly face revenue losses. In this Blog, Here we discussed the list of procedures where ASCs are losing money.

Here is a List of Procedures Where ASCs are Losing Money:

Gynecology

What Makes it Appalling:

With a 12 percent undesirable rate on the Healthcare Appraisers review, gynecology ties with podiatry, GI, and ophthalmology as the loss-making procedures, yet it has lower rates than the others. Gynecologists who still do obstetrics are part-time specialists, so they have a low surgical volume, to begin with, and afterward, a bit of that work is completed at the hospital and not the ASC. This leads to a lower bottom line for the ASCs.

Many gynecologists have dropped deliveries and are focused on surgery. They could be an aid to the ASC if they perform the procedures at the center and not at the doctor’s office.

Podiatry

What Makes It Poor:

Podiatry as a profession is already slipping below many new procedures that have replaced certain feet and ankle surgeries. Because of their low volume, they’re not a decent source of income for ASCs. A busy podiatrist performs just 80-100 cases a year. Podiatry makes up a normal of 4 percent of all cases in ASCs, as surveyed by VMG wellbeing. Though a turnaround of sorts could be managed by outsourcing the medical billing and coding facility, an increase in patient numbers solely depends on the management of the Podiatry services of the facility.

To know more about the Top 5 Procedures Where ASCs Are Losing Money, click here: https://bit.ly/3ZzAJyr Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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