Ob-Gyn Coding Alert

Rapidly getting bills out to payers is becoming more critical for many ob/gyn practices. Cash flow issues are getting bigger every day, says Cynthia Thompson, senior consultant and coding expert with Gates, Moore & Co., a medical practice management consultant firm based in Atlanta. With declining reimbursement, payers scrutinizing claims, and competitive contracting, practices are being forced to operate closer to their margins. Therefore, a practices ability to ensure a positive cash flow is increasingly tied to its ability get services quickly coded and off to payers. This article will help coders, billing supervisors, and practice mangers assess their billing and coding processes, identify delays, and increase their efficiency.

Find the Problem

1. Understand your process. When assessing how fast or slow a service is turned into a bill, ob/gyn practices need to first consider that coding and billing is a key business process that includes various players and systems within a practice, cautions Thompson. No matter how large or small a practice, each has its own unique process for turning services into bills. She also cautions that there is no clear benchmark for how fast a service should be coded and billed. We like to say as soon as possible, she says. Hopefully within 24 hours of the completion of the service, but that depends on so many variables that are clinic specific.

Before any efforts are made to speed up or change your billing and coding procedures, they must be understood. A useful method is to make a flow chart of exactly what takes place in the billing process. Start the chart with what occurs in the front office when insurance information is verified. Then, move through the provision of the service. How, exactly, is the information documented, posted and conveyed to the coder, and finally, sent off to the payer? Actually writing and drawing out your process will help illuminate the interconnectedness of each part.

Note: Ob/gyn practices may need to make two charts: one to track office activity and another to track hospital activity.

Subsriber benefit: See bound-in insert (pages 1-3) for examples of flow charts that can be instituted in your practice.

2. Identify process delays. With the flow chart in hand, you can now begin to pinpoint where bottle necks and delays are occurring in the process. Remember, you should try toidentify problems, not peopleand solicit the input of everyone involved. Some common delays stem from:

Incomplete insurance verification in the front office

Hospital activity that is not supplied by the physician to the coder in a timely manner

An encounter form that is not clear or easy to use for both provider and coder

Information from provider that is incomplete or illegible

Volume of [...]