Why OB/GYN Practices Are Losing Up to 30% Revenue — And How Specialized OB/GYN Billing Services Fix It

OB/GYN practices face some of the most complex billing challenges in healthcare. From global maternity packages and ultrasound billing to preventive care, modifiers, and payer-specific rules, even small errors can snowball into massive revenue loss.

Industry data shows that OB/GYN practices lose up to 30% of potential revenue each year due to billing inefficiencies, denials, under coding, and compliance gaps.

The good news?
These losses are avoidable—with the right specialized OB/GYN billing services.

The Real Reasons OB/GYN Practices Lose Revenue

1️⃣ Global Maternity Billing Errors

Global OB packages are one of the largest revenue leak sources.

Common mistakes include:

• Incorrect use of global vs split billing

• Missing antepartum or postpartum visits

• Misbilling high-risk pregnancy services

• Incorrect CPT usage (59400, 59510, 59610, 59618)

📉 Result: Underpayments, recoupments, and denied claims

2️⃣ Modifier -25 & Same-Day Visit Denials

OB/GYN practices frequently bill:

• Annual well-woman exams

• Problem-oriented visits

• Ultrasounds on the same day

Improper modifier usage (especially -25) triggers:

• Automatic denials

• Post-payment audits

• Refund demands

3️⃣ Ultrasound & Diagnostic Coding Mistakes

Ultrasound billing is a high-risk audit area.

Revenue is lost when:

• Medical necessity is poorly documented

• Transvaginal vs abdominal ultrasounds are miscoded

• Professional vs technical components are confused

• Bundling rules are ignored

💰 Many practices lose thousands per month here alone.

4️⃣ Preventive vs Problem Visit Misclassification

Billing preventive care incorrectly can:

• Shift cost to the practice

• Trigger payer rejections

• Cause patient billing disputes

Payers closely scrutinize:

• ICD-10 diagnosis linking

• Documentation supporting separate services

• Correct CPT pairing

5️⃣ Prior Authorization & Eligibility Gaps

Missed or delayed authorizations for:

• High-risk pregnancy imaging

• Genetic testing

• Advanced ultrasounds

lead to:

• Claim denials

• Delayed care

• Cash flow disruptions

6️⃣ In-House Billing Limitations

In-house billing teams often struggle with:

• Constant OB/GYN coding changes

• Staff turnover & burnout

• Backlogs in A/R follow-up

• Limited payer-specific expertise

This results in:

• Higher A/R days

• Missed appeals

• Underreported revenue

How Specialized OB/GYN Billing Services Fix These Problems

OB/GYN-Specific Coding Expertise

Specialized billing teams understand:

• Global maternity rules

• High-risk OB coding

• Ultrasound compliance

• Postpartum & extended care billing

This ensures maximum allowable reimbursement—not guesswork.

Cleaner Claims & Faster Payments

With OB/GYN-focused workflows:

• Claims are scrubbed before submission

• Denial trends are addressed proactively

• Clean claim rates exceed 98%

⏱ Faster payments = stronger cash flow.

Aggressive Denial & A/R Management

Specialized billing services:

• Track OB/GYN-specific denial reasons

• Appeal underpayments effectively

• Reduce A/R days significantly

📊 Result: Recovered revenue most practices never chase

Compliance & Audit Protection

With rising payer audits, OB/GYN billing experts:

• Ensure modifier compliance

• Support documentation alignment

• Reduce recoupment risks

🛡 Protects revenue and reputation.

Scalable Support Without Staffing Headaches

Outsourcing eliminates:

• Hiring & training costs

• Coverage gaps

• Dependency on one billing employee

Practices gain predictable performance without overhead.

The Financial Impact of Specialized OB/GYN Billing

Practices that switch to specialized OB/GYN billing services typically see:

• 📈 15–30% revenue recovery

• ⏱ 30–40% faster collections

• 📉 Lower denial and write-off rates

• 😊 Improved patient billing satisfaction

Final Thoughts: Revenue Loss Is Not Inevitable

If your OB/GYN practice is experiencing:

• Declining reimbursements

• Rising denials

• High A/R days

• Staff burnout

…it’s not a clinical issue—it’s a billing strategy issue.

Specialized OB/GYN billing services transform complexity into clarity, protect compliance, and unlock revenue you’re already earning—but not collecting.

Ready to Stop Losing Revenue?

Everest A/R Management Group provides end-to-end OB/GYN Billing & Revenue Cycle Management Services designed to:

• Maximize maternity and ultrasound revenue

• Reduce denials and audits

• Improve cash flow—fast

📞 Schedule a free OB/GYN billing audit today and discover how much revenue your practice is leaving on the table.