Women’s health providers encounter distinct financial and coding challenges that significantly influence patient care and the profitability of their practices. The OBGYN medical billing landscape has become increasingly demanding, characterized by intricate maternity bundles and constantly evolving payer regulations. The rise in claim denials, stricter compliance requirements, and the burden of prior authorizations continue to put pressure on both healthcare providers and billing teams. In this guide, we will explore the most critical women’s health billing challenges, present the latest data and industry insights, and outline effective OBGYN revenue cycle management (RCM) strategies designed to streamline workflows, minimize errors, and enhance your revenue cycle.

Common Billing and Coding Challenges That Trigger OBGYN Claim Denials

Accurate billing and coding are the backbone of every successful OBGYN practice, yet even minor oversights can lead to significant OBGYN claim denials and revenue loss. Women’s health services involve complex coding rules, from global maternity packages to multiple-procedure claims, making precision essential. Understanding the top OBGYN coding challenges and errors and how to prevent them can dramatically reduce denials and improve cash flow.

Incorrect or Missing Modifiers

One of the most frequent causes of maternity billing mistakes is the misuse or omission of modifiers. Modifiers communicate critical information to payers, such as when multiple procedures occur in a single encounter or when a service is performed separately from another on the same day.

  • Modifier 59 is commonly misused when distinguishing separate, non-overlapping services.
  • Modifier 26 should be applied only to report the professional component of a diagnostic test, such as an ultrasound.
  • Modifier 51 indicates multiple procedures performed during the same session, but it is often misapplied or duplicated by billing systems.

Incorrect use can lead to bundled denials or payer rejections. Implementing automated coding validation tools and periodic staff refresher training can help ensure modifiers are used correctly.

Unbundled Maternity Services

Maternity care is one of the most complex areas in OBGYN RCM because of the global billing structure. Many payers expect prenatal, delivery, and postpartum services to be billed under a single global package code. However, coding errors occur when providers “unbundle” these services, submitting separate claims for individual visits or procedures that should be part of the global charge.

For example, billing separately for routine prenatal visits or postpartum checkups within the global period can trigger denials and audit flags. To avoid this, ensure your billing staff understands payer-specific global period definitions and any exceptions (such as high-risk pregnancies, missed abortions, or unrelated E/M visits).

ICD-10 Coding Errors and Latest Updates

The release of CMS FY2025 ICD-10-CM updates introduced several new and revised diagnosis codes related to pregnancy complications, gynecological conditions, and fertility care. Failing to update your EHR and coding references to reflect these changes can cause denials or compliance risks.

For example, expanded codes for hypertensive disorders of pregnancy and abnormal uterine bleeding provide greater specificity, but using outdated or non-specific codes (e.g., “O10.9” instead of the correct subtype) can lead to payer rejections or underpayment.

Refer regularly to the ACOG Coding Guidance and CMS ICD-10-CM Official Guidelines to ensure your team codes at the highest level of specificity.

Documentation Deficiencies

Even when codes are correct, inadequate clinical documentation often prevents claims from being approved. Missing details such as trimester, episode of care (initial vs. subsequent), or type of delivery can invalidate otherwise accurate codes. Comprehensive documentation supports the medical necessity of services and safeguards your practice during audits. Encouraging real-time documentation and integrating EHR templates for OBGYN encounters can close these gaps effectively.

How to Prevent Common OBGYN Coding Errors

To minimize OBGYN claim denials and ensure billing accuracy, implement the following best practices in your revenue cycle process:

  • Verify modifier usage carefully. Review modifiers 59, 26, and 51 before submission to confirm they’re applied correctly and only when justified by the procedure and documentation.
  • Stay current with payer-specific global maternity rules. Each insurer may define global periods differently; maintain an updated reference guide for quick access.
  • Update coding resources annually. Refresh your EHR and coding tools with the latest ICD-10-CM (October 1) and CPT (January 1) updates to avoid outdated or invalid codes.
  • Conduct routine coding audits. Schedule quarterly internal reviews to identify recurring denial trends and provide targeted retraining for billers and coders.
  • Enhance documentation quality. Use structured or smart EHR templates that prompt for essential details, trimester, delivery method, and diagnosis specificity to ensure claims meet payer requirements.

Implementing these practical steps helps reduce maternity billing mistakes, improve first-pass claim acceptance rates, and strengthen overall OBGYN RCM performance.

The No Surprises Act: A Growing Compliance Challenge in OBGYN Billing

One of the most significant OBGYN medical billing challenges in recent years stems from the implementation of the No Surprises Act (NSA). While the law was designed to protect patients from unexpected out-of-network bills, it has unintentionally added new layers of administrative burden for providers. For many women’s health specialists, complying with the NSA has become an ongoing struggle, one that directly impacts cash flow, billing accuracy, and overall revenue cycle management (RCM) efficiency.

How the No Surprises Act Complicates Billing Workflows

The NSA prohibits balance billing for most emergency and certain non-emergency out-of-network services, including many hospital-based obstetric and gynecologic procedures. Instead, payment disputes between payers and providers must now go through an Independent Dispute Resolution (IDR) process.

While this system offers fairness for patients, it has introduced delays and administrative hurdles for providers. OBGYN practices are now facing:

  • Extended payment timelines due to IDR backlogs.
  • Increased documentation workload to support every disputed claim.
  • Confusion over payer network status for hospital-based deliveries or procedures.

The result? Longer accounts receivable (AR) cycles, reduced payment predictability, and higher operational costs all challenge the financial health of OBGYN practices.

Compliance Demands and Documentation Pressure

Another layer of difficulty lies in maintaining compliance with the Act’s Good Faith Estimate (GFE) requirement. OBGYN clinics must provide detailed cost estimates to uninsured or self-pay patients before care is delivered. These estimates must include all expected services, associated procedures, and potential out-of-network implications.

Even minor lapses in documentation, such as missing time stamps, patient signatures, or incomplete disclosures, can trigger penalties or payer disputes. Practices must now dedicate additional resources to ensure every patient encounter is properly documented, verified, and stored for compliance audits.

To minimize disruptions and maintain compliance, women’s health practices can implement several key strategies:

  • Automate eligibility and network verification to flag out-of-network risks early.
  • Integrate Good Faith Estimate templates into your EHR system for consistent use.
  • Appoint a compliance coordinator to oversee NSA documentation and IDR submissions.
  • Maintain transparent communication with patients about coverage and potential costs.
  • Leverage RCM software that includes compliance tracking and automated reporting features.

These proactive measures help reduce administrative workload, improve documentation accuracy, and shorten reimbursement cycles, even under evolving NSA requirements.

Turning OBGYN Billing Challenges Into Opportunities With BillingFreedom

Overcoming today’s OB/GYN billing services requires more than coding knowledge; it demands accuracy, awareness of compliance requirements, and proactive revenue management. From frequent claim denials and unintentional coding errors to evolving regulations like the No Surprises Act, even small oversights can cause significant financial damage. 

These setbacks delay payments, increase administrative strain, and limit the time physicians can devote to patient care, the very heart of women’s health practice.

At BillingFreedom, we understand the true cost of billing inefficiencies and the daily hurdles OBGYN specialists face. Our team combines advanced billing technology, certified coders, and deep expertise in women’s health RCM to help practices minimize denials, ensure compliance, and maintain healthy cash flow. With BillingFreedom as your trusted partner, you can confidently focus on patient outcomes while we manage your financial operations with precision and transparency.