How to read these case studies
The case studies on this page are illustrative examples. Each one is a composite drawn from the kinds of situations we've encountered across more than eight years of OB/GYN billing, with identifying details removed and simplified. They show how we approach common problems — what we look at, what we fix and what we measure.
They are not promises of a specific result. Every practice starts from a different place: payer mix, state Medicaid rules, provider documentation habits, EHR setup and the age of existing A/R all affect what's recoverable and how quickly. The only honest way to know what's possible for your practice is to look at your own data — which is exactly what our free audit does.
Case study 1: Solo OB/GYN — global maternity billing that had drifted
The situation
A solo obstetrician-gynecologist with a busy obstetric panel had relied on a general billing company for several years. Collections felt lower than the practice's volume suggested, but the monthly report only showed "claims submitted" and "payments received," so it was impossible to tell why.
What the audit looked at
- Every delivery over the prior year matched against the pregnancy's antepartum visit count, payer at each visit and delivery type
- Patients who transferred in or out, or changed insurance during pregnancy
- Separately billable services during pregnancy — ultrasounds, non-stress tests, complication visits
- Time from delivery to claim submission
What we typically find in this situation
- Patients who transferred out after several prenatal visits with no antepartum-only claim (
59425or59426) ever submitted - Global packages billed to the insurance active at delivery, even when a different plan covered most of the prenatal care
- VBAC deliveries billed as routine vaginal deliveries
- Global claims held for weeks after delivery waiting for the postpartum visit, pushing some close to timely-filing limits
What we changed
A pregnancy registry from the first visit; eligibility re-verification during pregnancy; a delivery claim checklist (delivery type, VBAC status, Z37 and Z3A codes); and a rule to submit delivery claims promptly according to each payer's policy. Unbilled antepartum care that was still within filing limits was billed.
What we measured
Unbilled deliveries, open pregnancies by payer, OB claim denial rate and days from delivery to claim submission — reported monthly.
Case study 2: Four-physician group — a denial backlog that kept growing
The situation
A four-physician OB/GYN group had two experienced in-house billers who were overwhelmed. Denials were being resubmitted when there was time, A/R over 90 days was climbing, and the same denial reasons appeared month after month.
What the audit looked at
- Six months of denials, categorized by CARC/RARC code, payer and provider
- A/R aging, with every claim over 90 days checked against timely-filing and appeal deadlines
- Surgical claims compared to operative notes and pathology reports
What we typically find in this situation
CO-97bundling denials on laparoscopic procedures where modifiers were missing — or where the denial was actually correct and the service shouldn't have been billedCO-197authorization denials because authorizations didn't match the CPT code actually performedCO-16rejections from missing data that a claim scrubber rule would have caught- Aged claims that were still recoverable if appealed promptly — and some that were already past the deadline
What we changed
We took over denial management and aged A/R so the in-house team could focus on charge entry and patient-facing work. Every denial was categorized; authorization checks were matched to scheduled CPT codes; scrubber rules were added for the most common rejection reasons; and recoverable aged claims were appealed in order of value and deadline.
What we measured
Denials by reason each month, A/R over 90 days, first-pass acceptance rate and the number of appeals won, lost or pending.
Case study 3: Multi-location women's health group — first-ever coding audit
The situation
A women's health group with several locations and a mix of physicians and nurse practitioners had never had an independent coding audit. Leadership wanted to know whether providers were coding consistently and whether any compliance risks existed.
What the audit looked at
- A random sample of E/M visits per provider, reviewed against MDM and time documentation
- Preventive visits with same-day problem visits and modifier
25 - LARC insertions and whether device J-codes were billed
- Hysteroscopy and laparoscopy claims against operative notes
What we typically find in this situation
- E/M levels that varied widely between providers for similar visits — some below what the documentation supported, a few above
- LARC insertions billed without the device code when the practice had purchased the device
- Modifier
25used inconsistently on preventive-plus-problem visits - Templated notes that didn't clearly document the separately identifiable problem
What we changed
Provider-level feedback sessions with specific examples; updated documentation templates; a charge-capture check for LARC devices; and a follow-up audit three months later. Where the audit identified overpayments, we documented them and recommended the group involve its compliance advisor in the correction process.
What we measured
Coding accuracy by provider at baseline and at re-audit, missed-charge rate for LARC devices and modifier 25 consistency.
The metrics we track for every client
Rather than advertising a single headline number, we report a consistent set of KPIs every month, compared to your own starting point from the free audit:
| Metric | Why it matters |
|---|---|
| Net collection rate | Share of contractually collectible revenue actually collected |
| Days in A/R | How fast claims turn into cash |
| A/R over 90 days | Revenue at risk of never being collected |
| First-pass acceptance rate | Claims paid without rework |
| Denials by reason | Which upstream problems cost the most |
| Charge lag | Time from service to claim submission |
| Open pregnancies & unbilled deliveries | Obstetric revenue waiting to be billed |
You'll see the trend for each one, month over month, along with what we changed and why.
What these case studies have in common
Across very different practices, the same lessons repeat:
- The biggest problems are usually invisible in standard reports. Unbilled antepartum care, undercoded surgery and underpayments don't show up as denials.
- Root causes beat resubmissions. Fixing the eligibility, authorization or documentation step that caused a denial is worth more than any single appeal.
- Provider feedback matters. Specific, respectful examples from a provider's own notes change documentation faster than general training.
- Measurement keeps improvements in place. Monthly KPIs show whether a fix worked — and catch new problems early.
What we don't do
- We don't publish client statistics you can't verify.
- We don't use invented testimonials.
- We don't promise a specific collection increase before seeing your data.
- We don't recommend coding changes that the documentation doesn't support.
Your practice, your numbers
We'd rather show you real findings from your own claims than ask you to trust a statistic on a website. Send us a WhatsApp message to start a free audit — no form, no contract. You'll receive a written summary of what we found, and it's yours to keep whether or not we work together.