The providers, teams, and communities that make up Women's Health organizations work hard to meet the underserved needs of women and address areas of research and care that are lacking across a woman’s healthcare journey. These organizations provide care across a broad spectrum of services — ranging from wellness and preventative care to specialized procedures and surgeries.
Because these teams provide all types of care for all types of women at every stage of their healthcare journey, medical billing and coding can be incredibly complex. In this blog, we’ll dive into some of the reasons why billing is so complicated in Women's Health and how revenue cycle teams can address these challenges with developments in RCM technology.
The Spectrum of Women’s Health Services
Women's Health organizations provide a variety of services across a woman’s lifelong healthcare journey. These can include (but are certainly not limited to):
- Routine Gynecological Exams and Preventative Checks
- Prenatal and Postnatal Care
- Fertility Treatment
- Reproductive Health
- Menopause Management and Related Treatments
- Surgical Procedures such as Hysterectomies, Myomectomies, etc.
- Cancer Screening and Treatment
- Wellness Exams
Billing and Coding Complexity in Women’s Health
For revenue cycle teams, billing and coding in Women's Health is incredibly complex. This is due to a variety of reasons, spanning from the vast range of services provided, to the intricacies in what is vs. is not covered by different payers for services.
Let’s look at fertility clinics, for example. Not all infertility related treatments are covered by insurance. These types of treatments often require multiple services such as diagnostic tests, IVF procedures, and more. When coding for fertility treatment, accuracy is extremely important. Nuances in the diagnosis, care, and treatment provided can dictate whether a procedure will be covered or a claim will be denied. Prior authorization is often required for many of these treatments as well, which can be time consuming and tedious. This poses additional challenges for revenue cycle teams in fertility, because these clinics have a large overhead, and are very expensive to run — which means timely reimbursement is essential. Fertility treatments can have a high price point, so the related claims often have a very high value associated with them. If these claims are denied or delayed in reimbursement, the practice can be missing out on a large portion of the revenue that they owed.
The different services offered at Women's Health organizations all have nuanced coding requirements that can be detailed and unique. For example, in addition to ICD-10 and CPT codes, certain procedures may require the use of modifiers or have specific bundling rules that add an additional layer of complexity to the coding process. Some procedures will also require prior authorization or eligibility checks. Lastly, the different stages of care being serviced require detailed documentation from providers, which is no easy task when your practice is both busy and understaffed — a reality that many healthcare providers in the U.S. are facing today.
Error Prone Billing Practices
Because of the complexity associated with billing and coding, the risk of billing errors is heightened in Women's Health. The errors could be as simple as a typo, an incorrect code being used, a lack of documentation, or a lack of prior authorization, to name a few. This potential for error increases the rate of denied claims and slows down reimbursement.
Not only do these errors result in denials that impact reimbursement and speed to cash, but they are also quite resource intensive. Managing the complexity associated with this billing requires an experienced billing team that is up to date on current practices and policies, and has the bandwidth to not only submit claims, but to look for denial trends, understand the root cause of denials, detect underpayments, and contest claims accordingly. That's where revenue cycle technology can play a major role in Women's Health.
Intelligence for Women’s Health
Adonis Intelligence was built for teams facing these exact challenges. Intelligence offers AI-driven alerts, comprehensive dashboards and custom reporting, underpayments detection and management, denial trend analysis, payer policy change tracking, and more. Together, these features enable revenue cycle teams at Women's Health organizations to proactively predict and prevent denials, stay on top of prior authorization requirements, and ensure sufficient documentation is provided so that claims are submitted accurately the first time.
With a tool like Adonis Intelligence, revenue cycle teams in Women's Health are maximizing reimbursements, driving speed to cash, and staying on top of the complex and ever-changing regulations that make up billing and coding in Women's Health.
While Women's Health organizations work to address the cap that exists in women's healthcare across the country, Adonis intelligence is working on the backend to ensure that these organizations are collecting the revenue that they deserve to continue providing best in class care for women at all stages of their healthcare journey.
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