OBGYN Underpayments in H1 2026: How Much Revenue Did Your Group Leave on the Table?

-
Image
For many OB/GYN groups, the biggest financial threat in the first half of 2026 was not claim denials—it was underpayments. Claims were approved, payments were posted, and revenue appeared to arrive normally. Yet a significant percentage of those payments may have been lower than the contracted amount, leaving thousands of dollars unrecovered. Underpayments are particularly dangerous because they often go unnoticed. Unlike denied claims, they do not create an obvious work queue. Unless payments are compared against payer contracts and expected reimbursement schedules, practices may never realize revenue has been lost. As commercial payers, Medicare Advantage plans, and managed care organizations increased reimbursement scrutiny during H1 2026, many OBGYN groups experienced growing variance between expected and actual payments. This is why more providers are investing in specialized OBGYN billing services,  comprehensive medical billing services , advanced RCM services , and proactiv...
Post a Comment

Overcoming DME Billing Challenges with a Medical Billing Service

-

 

overcomingdmebillingchallengeswithamedicalbillingservice.jpg

There is a distinctive difference between billing for Durable Medical Equipment (DME) services and other clinical procedures – durable medical equipment services are ancillary to the primary clinical purpose, and their admissibility is subject to certain conditions. One of the best ways to overcome the DME billing challenges is outsourcing the DME billing services and RCM system.  Physicians since long have found these conditions tricky and challenging to understand, and often either been denied or underpaid for DME services, which may either have been

  • Deemed medical unnecessary,
  • Uncertified by Medicare/Medicaid/private health insurers,
  • Beyond the permissible reimbursement level
  • Lack of solid grounding in the Healthcare Common Procedure Coding System (HCPCS), which governs level II codes designated for DME equipment and supplies

While physicians have the right to recommend DMEs as part of clinical treatment, they will have to back their recommendation with sufficient proof of them being medically necessary. Proving medical necessity alone will not suffice; it is equally important to know whether or not a patient’s health insurance coverage supports DME services. With Medicare, Medicaid, and even certain private insurance schemes cautious about supporting exorbitant DMEs, physicians would do well to verify whether or not patients’ health plans support DMEs.

Reimbursements are subject to the condition that physicians or patients source the admissible DMEs from payer-recognized vendors or manufacturers. While this condition may endorse payers’ commitment toward quality DMEs that last long and are competitively priced, physicians will certainly be put through the process of identifying Medicare/Medicaid/private insurer-recognized vendors or manufacturers.  What is more interesting is that Medicare has designated certain pharmacies that can only supply admissible DMEs. Therefore, physicians’ task of identifying and sourcing DMEs has certainly become more complex than ever.

DMEs have grown to be clinically superior and functionally perfect these days. While appreciation of quality has facilitated clinical efficiency and patient well-being, the price has been a major issue. Payers have not been all that receptive to the idea of supporting DMEs that are not operationally viable. Medicare/Medicaid too has its reservations against highly-priced DMEs and has put a ceiling on DMEs reimbursements.  Physicians, therefore, need to be aware of these restrictions while encountering patients that require DMEs well beyond their insurance eligibility.

To learn more about Overcoming DME Billing Challenges with a Medical Billing Service, click here: https://bit.ly/3MV7IKB  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