Evaluating Billing Companies for OB/GYN
OB/GYN billing outsourcing requires a company that understands the global obstetric package, can manage antepartum visit tracking, knows when complications are separately billable, and handles the preventive vs. problem visit split common in gynecology. A billing company strong in general medical billing but unfamiliar with global OB coding will either leave money on the table by not billing for complications or create compliance issues by unbundling services included in the global package.
Criteria 1: Global OB Package Expertise
Ask the billing company to explain the global OB package: what is included, what is separately billable, how they track antepartum visits, and when they submit the global claim. Ask for their process when a patient transfers mid-pregnancy. A company that cannot immediately explain the difference between 59400, 59425, 59426, and 59430 does not have OB billing expertise.
Criteria 2: Complication Billing Identification
OB complications that are separately billable outside the global package represent significant revenue that requires clinical judgment to identify. The billing company should have a process for reviewing antepartum visit documentation to flag potential complication charges: gestational diabetes management, preeclampsia monitoring, preterm labor evaluation, and non-routine diagnostic studies.
Criteria 3: Split Visit Coding
GYN well-woman visits that include problem evaluation require split coding with modifier 25. The billing company should apply modifier 25 consistently when documentation supports both services and should flag visits where the split is not clearly documented. Ask about their modifier 25 audit process and denial rate for split visits.
Criteria 4: Pricing
OB/GYN billing outsourcing pricing typically ranges from 6% to 8% of collections. The global OB package complicates percentage-based pricing because a single delivery claim generates $2,000 to $3,500 in revenue with one claim submission, while GYN visits generate $130 to $190 per claim. Some billing companies charge different rates for OB and GYN claims. Evaluate total annual cost under both scenarios.
Criteria 5: Cash Flow Reporting
The billing company should provide OB-specific reporting: expected deliveries by month, estimated global OB revenue pending, antepartum visit counts by patient, and complication charge identification reports. Standard A/R aging reports do not capture the unique cash flow dynamics of OB billing where revenue is earned over months but billed at a single point.
Red Flags
Avoid billing companies that submit global OB claims more than 14 days after delivery, that cannot explain when antepartum complications are separately billable, or that have no existing OB/GYN clients. Also avoid companies that do not track antepartum visits per patient, as this tracking is essential for correct global package billing and complication identification.