When we talk about healthcare we talk about the patient care, however, we forget that patient care is fulled by physicians. US healthcare system has been facing physician shortages across specialties and practice areas. The problem is acute for OB-GYN specialty, according to the American Congress of Obstetricians and Gynecologists (ACOG) continues to project a shortage of up to 8,800 OB-GYN physicians in 2020.

Legion Healthcare Solutions (LHS) is working with various payers to ease the system burden on OB-GYN physicians. OB-GYN practice has gone under a myriad of changes, with a length of procedure to define rules for reimbursements/ payment posting, majority of procedures are interlinked and out of pocket for a patient.

“OB-GYN billing has seen changes over last five years, it even differs based on the states so at Legion we continuously monitor both state and federal regulations. We have a majority of the claims coming in which are pregnancy-related and in some cases emergency, making the billing difficult for us. We usually keep verification of benefits as the first step when the patient walks in; this actually helps us to communicate with the patient as to what their insurance company covers and what is not.”

– OB-GYN Billing Lead at Legion

Verification of benefits even helps cover the various procedures that might be required by the patient in the future, Legion believes in communication and an open system for billing.

Patient Payment

Patient bills major chunk of total healthcare costs, as most of the healthcare burden, has shifted from insurance companies to patients. With the rollout of the Affordable Care Act (ACA), OB-GYN providers have seen major changes in terms of care service and billing. The majority of the patients are now insured under the new act but we have larger deductibles and higher premiums. Legion conducts patients' insurance verification to understand what cost would be covered by insurance and what will be covered by the patient. Patient bills make a significant part of OB-GYN practice revenue, hence we deploy a dedicated team working with each OB-GYN practice so that they have complete communication before the visit.

Patient under Care Coding

Whether it's antepartum care, delivery care, or postpartum care, OB-GYN physicians will be at the forefront of providing complete care to the patient. For Antepartum and /or postpartum care codes include 59425, 59426, and 59430. Use of CPT code 59514 only for the cases that have Cesarean delivery. Legion understands this complicated requirement of coding while you’re already managing the patient care. Usually, if a patient comes in with a pregnancy-related case the complete procedure is done with an OB-GYN facility, known as Global to Delivery.

Verification team working 24/7 to provide all the patient insurance information within 48 hours.

Analytics-based solution for all claims to determine which claims need to be appealed and resubmitted. The analytics-based solution help keep the AR days below 45.

OB-GYN Certified coding experts work on all the claims.

API-and RPM-based solution to improve patient communication and care.