Is Your OBGYN Billing Company Protecting Your Global Maternity Revenue?

-
Image
Global maternity billing is one of the most complex areas of OBGYN billing . A single pregnancy episode can include prenatal visits, delivery services, postpartum care, laboratory work, ultrasounds, and numerous payer-specific requirements. When any part of the global package is documented, coded, or billed incorrectly, practices risk claim denials, delayed reimbursements, underpayments, and revenue leakage. In 2026, payer scrutiny surrounding global maternity claims continues to increase. Medicare, Medicaid, commercial insurers, and managed care organizations are placing greater emphasis on documentation accuracy, medical necessity, modifier usage, and compliance with global obstetric billing guidelines. This raises an important question for every practice owner: Is your OBGYN Billing Company truly protecting your global maternity revenue? The answer depends on more than claim submission. A high-performing billing partner should deliver specialized OBGYN Billing Services , comprehensi...
Post a Comment

Eliminating Skilled Nursing Facilities (SNFs) Medical Billing Complication

-

 

eliminatingskillednursingfacilitiesmedicalbillingcomplication.jpg

Medical billing for Skilled Nursing Facilities has undergone metamorphic changes ever since the Balanced Budget Act of 1997 came into effect in 1998. One of the significant requirements under the new legislation is that Skilled Nursing Facilities are not permitted to unbundle services administered by contracted healthcare providers. As a result, most of the services provided to Medicare beneficiaries are to be bundled together and billed by SNFs under the Prospective Payment System (PPS) in one consolidated claim. The SNF concerned is then responsible to pay for contracted services out of the per diem rate that it earns for caring for a Medicare beneficiary.

Eliminating Skilled Nursing Facilities (SNF) Medical Billing Complication

While this imposition may have helped reduce potential fraud and abuse due to double billing by healthcare providers, SNFs have certainly had a hard time understanding:

  • What services are covered under consolidated billing
  • What is billable under Medicare Part A
  • What is billable under Medicare Part B
  • State-specific Medicaid protocols and Methodologies for SNFs Medical Billing
  • Commercial health insurance plans and their dynamics

Though most of the services offered to a resident under Medicare Part A are allowed to be included in the consolidated billing, certain services deemed costly or requiring specialization must not be appended with the consolidated billing. Generally, physician’s professional services; certain dialysis-related services, including covered ambulance transportation to obtain the dialysis services; certain ambulance services, including transporting the beneficiary to the SNF initially, transporting from the SNF at the end of the stay (other than when involving transfer to another SNF), and transporting round-trip during the stay temporarily offsite to receive dialysis or certain types of intensive or emergency outpatient hospital services; erythropoietin for certain dialysis patients; certain chemotherapy drugs; certain chemotherapy administration services; radioisotope services; and customized prosthetic devices are excluded.

The services that are excluded under Medicare Part A should be billed under Medicare Part B, which allows medically necessary services to be reimbursed under the ‘Fee For Service’ (FFS) system. It is possible that SNFs may not have been entirely thorough with these procedures, resulting in billing inefficiencies.

Even as most SNFs need to bill Medicare Part A and Part B, SNFs could operate under the state-specific Medicaid ambit. And, because each of the 50 states in the U.S. may have its own Medicaid program, SNFs should invariably have to bill under their state-specific Medicaid rules and regulations. This region-specific compliance too may have had a considerable impact on SNF billing.

To learn more about Eliminating Skilled Nursing Facilities (SNFs) Medical Billing Complication, click here: https://bit.ly/3W5s5re  Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

Comments

Post a Comment

Popular posts from this blog

Is Your Neurology Billing Outsourcing Helping or Hurting You at Year-End?

-
Image
  As year-end approaches, neurology practices face a crucial decision: Is your billing outsourcing truly improving your financial performance, or silently affecting your revenue? Neurology billing is complex due to time-based coding, modifier usage, high documentation requirements, frequent audits, and prior authorization challenges. If your billing partner lacks neurology-specific expertise, it may lead to claim denials, revenue loss, and compliance risks. Signs Your Neurology Billing Outsourcing Is Helping If your billing partner is performing well, you will see: • Reduced denial rates for neurology codes (EEG, EMG, Botox, Nerve Conduction Studies) • Faster reimbursements and fewer delays from payers • Active recovery of old AR beyond 60, 90, or 120+ days • Accurate CPT, ICD-10, and modifier usage for neurology procedures • Clear billing reports, denial analysis, and revenue insights • Compliance with Medicare, commercial payers, and documentation standards Warning ...
Read more

How Hidden OB-GYN Billing Errors Are Quietly Costing You Millions Each Year

-
Image
  The Silent Revenue Leak in OB-GYN Practices Most OB-GYN practices don’t realize they’re bleeding money. Not in dramatic, headline-grabbing ways, but quietly, steadily, month after month. The phones are ringing, appointment slots are full, deliveries are happening, and yet the numbers never seem to match the effort. Sound familiar? This is often the first sign of hidden OB-GYN billing errors working behind the scenes. These errors don’t announce themselves. They don’t crash your systems or send angry alerts. Instead, they slip through claims, hide in coding nuances, and quietly shave thousands—or millions—off your annual revenue. OB-GYN billing is uniquely complex compared to other specialties. Between global maternity packages, split billing scenarios, high-risk pregnancy coding, and ever-changing payer rules, the margin for error is enormous. A single missed modifier or incorrectly bundled service might seem insignificant on its own. But when repeated across hundreds or thousand...
Read more

The #1 Reason ASCs Lose Revenue from Medicare Claims (And How to Fix It)

-
Image
Ambulatory Surgical Centers don’t lose Medicare revenue because of low case volume. They lose it because of one recurring, preventable failure: Incorrect coding and documentation for Medicare’s ASC-specific payment rules. This single issue triggers denials, underpayments, delayed reimbursement, and permanent write-offs — especially at year-end. If your ASC’s Medicare revenue feels unpredictable, this is why. The #1 Revenue Killer: Not Billing Medicare the “ASC Way” Medicare does not treat ASCs like hospitals or physician offices. Yet many ASCs still: Use hospital-style assumptions Miss ASC-only payment rules Underestimate Medicare’s bundling logic The result? Claims get paid less than expected — or not at all. Where Medicare ASC Claims Go Wrong 1. Incorrect CPT eligibility for ASC payment Not every CPT code is payable in an ASC setting under Medicare. Common mistakes: Billing procedures not on Medicare’s ASC approved list Assuming “covered in hospital” = “covered in ASC” Missing annual...
Read more