Gynecology
OB‑GYN tuned edits, workflows, and contracting support to protect margins.
Common Pain Points We Solve
GYN is uniquely complex because the specialty varies between preventive, diagnostic, surgical, and office-based services.
Coding Errors
- Incorrect use of modifier-25 on preventive + problem visits.
- Wrong diagnosis sequencing (e.g., abnormal bleeding, pelvic pain, PCOS).
- Missed procedure codes for in-office services (IUD insertions/removals, biopsies, colposcopy, endometrial ablation consults).
- Preventive vs. diagnostic confusion → massive denial rates.
- Documentation gaps that don’t support E/M or procedure levels.
Preventable Denials
- Non-covered preventive or family-planning services without prior eligibility check.
- Frequent prior authorization requirements for imaging, procedures, and medications.
- Bundling edits on IUD services and minor procedures.
- Lack of consistent NCCI edit checking leading to denials for “inclusive” services.
- Incorrect referral or PCP assignment for managed care patients.
IUD, Implant & Device Billing Complexity
- Wrong HCPCS codes for devices (Mirena, Kyleena, Liletta, Paragard, Nexplanon).
- Missing NDC or units → automatic payer rejection.
- Incorrect place-of-service or stock/supply coding.
- Failure to track IUD inventory → unpaid claims unnoticed for months.
- Reimbursement rates poorly negotiated or not monitored.
What We Do
Coding Accuracy and Revenue Integrity
- Consistent charge capture for procedures
- Review of modifiers and diagnosis sequencing
- Improved capture of in-office procedures
- Audit of device billing
Denial Prevention & A/R Recovery
- Real-time eligibility, where needed
- Resolve top GYN denial drivers
- Implement payer-specific rules and SOPs
- Conduct aggressive A/R follow-up
Practice Optimization
- Evaluate intake and benefits verification processes for advanced services.
- Build reporting dashboards
- Support credentialing and contracting needs
- Review office workflows
How We Drive Results
Quality Program Enablement
- Help our practices enroll in provider quality incentive programs
- Enhance care-gap closure rates (e.g., breast screening, cervical screening)
- Better reporting.
Benchmarks We Improve
- First-pass acceptance rate & denial prevention.
- Days in A/R, aging >90 days, and patient-pay collection rate.
- Charge capture completeness, including preventive and sick visit add-ons.
- Coding compliance, including modifier use, medical necessity, and E/M leveling consistency
Revenue Optimization
- EMR evaluation for faster documentation and correct code capture.
- Edits and rules for top GYN denial types.
- Dashboards and reporting packages tailored to primary care KPIs.
Outcomes
↓ Takebacks
Audit strength
↑ Allowables capture
Correct contract application
Less admin burden↓
No‑auth denials Tighter front‑end
FAQ
Do you handle surgeries?
Yes — scheduling, precert, and coding workflows.
Maternity care?
Global package rules and documentation coaching.
Can you help renegotiate GYN rates?
We model impact and pursue escalations.
Ready to get started?
Let’s baseline your metrics and build a specialty‑tuned plan.