OB/GYN billing
Specialty
A nine-month billing episode running alongside episodic gynaecologic care.
Problem landscape
Where ob/gyn revenue actually breaks
These are the failure points we look for first, in this discipline specifically.
The global package hides the work until the end
Most obstetric revenue is billed once, after delivery. Everything that goes wrong across nine months — coverage lapses, missed visit counts, unrecorded transfers — surfaces as a single denial on the largest claim of the episode.
Mid-pregnancy insurance change and transfer of care
When coverage or provider changes mid-episode, the global package must be unbundled into antepartum, delivery and postpartum components with accurate visit counts. Practices that bill global anyway are denied; practices that unbundle without documentation are underpaid.
Visit-count accuracy over nine months
Antepartum-only codes are counted in ranges. If a scheduling no-show or an outside-visit record is missing, the code selected does not match the record the payer reconstructs.
Ultrasound, non-stress testing and separately billable services
Imaging and antenatal testing sit outside the global package, but only with correct indication, frequency and component treatment. This is the most commonly under-captured OB/GYN revenue line.
Preventive gynaecology versus problem-oriented visits
A well-woman visit that becomes a problem evaluation needs the same modifier discipline as primary care, plus screening-versus-diagnostic accuracy on cytology and related lab orders.
Surgical gynaecology and global periods
Hysterectomy, laparoscopy and in-office procedures carry their own global periods, which overlap awkwardly with obstetric episodes for patients seen for both.
Interactive model
The shape of ob/gyn revenue
An interactive illustration of the dynamic that defines billing in this specialty.
Move through the pregnancy and toggle a transfer of care to see how the billing decision at the end of the episode changes.
Pure Billing workflow
How we run ob/gyn revenue cycle
The operating model is consistent; the controls inside it are specialty-specific.
01
Episode ledger opened at confirmation
A tracked obstetric episode is opened at the first confirmed prenatal visit, holding payer, expected delivery date, visit count and any transfer events in one place.
02
Coverage re-verification through the episode
Eligibility is re-checked on a defined cadence, not once, so plan changes and coordination-of-benefits shifts are caught before they invalidate the global claim.
03
Outside-the-global capture
Ultrasound, antenatal testing and problem visits unrelated to pregnancy are identified and billed as they occur rather than being absorbed into the package.
04
Package assembly and unbundling decision
At delivery, the episode ledger drives the decision: global, or component billing with documented visit counts and transfer rationale.
05
Episode-level denial review
Denials are traced back to the point in the episode where the record broke — coverage, counting or documentation — and the front-end step is corrected for the next cohort.
Relevant services
What we typically run for this specialty
How this specialty is staffed
OB/GYN accounts are run by a named team that works this discipline daily — charge entry and coding review, payer-specific scrubbing, denial root-cause follow-up and AR recovery, all inside your existing EHR and practice management system.
Get an OB/GYN Revenue Health Check
A structured review of your ob/gyn denials, AR ageing and front-end workflow — with findings specific to this discipline.
Coding & Charge Posting
Coding and charge posting handled with specialty context, so documentation,
Prior Authorization
Authorization requests initiated, tracked and documented so procedures are not
Eligibility Verification
Coverage, benefits and patient responsibility checked before the visit,
