What full-service OB/GYN RCM looks like
Revenue cycle management is everything that happens between a patient booking an appointment and your practice collecting the full amount it's owed. In a general practice that's mostly visit-by-visit. In an OB/GYN practice, it's a mix of three very different billing models running at once:
- Obstetric care billed as global packages or components across a 40-week pregnancy — and, starting January 1, 2027, by phase of care.
- Gynecologic surgery with high-value claims, prior authorizations, NCCI edits and 90-day global periods.
- Office gynecology and preventive care — well-woman exams, problem-oriented visits, LARC insertions, ultrasounds and in-office procedures.
Our RCM service covers every step for all three, staffed by people who have been doing OB/GYN billing for more than eight years.
The OB/GYN revenue cycle, step by step
1. Patient access: eligibility, benefits and authorization
Clean claims start before the patient arrives. We verify eligibility and benefits for scheduled visits, confirm whether prenatal care, ultrasounds and delivery are covered, and secure prior authorizations for surgery and advanced imaging. For obstetric patients we re-verify coverage during the pregnancy so insurance changes are caught before delivery. More on our eligibility verification service.
2. Charge capture and coding
We make sure every service performed becomes a charge — including the ones most often missed in women's health: separately billable ultrasounds, LARC devices and their J-codes, pelvic exam add-ons, non-stress tests, and visits for pregnancy complications. Surgical cases are coded from the operative note and pathology report. See GYN surgery coding and global maternity billing.
3. Claim scrubbing and submission
Claims are checked against NCCI edits, payer-specific rules and our own OB/GYN edit library before submission — diagnosis sequencing, modifiers, place of service, rendering and billing provider details, Z37 outcome codes on deliveries and more. Clean claims go out daily.
4. Payment posting and reconciliation
Electronic remittances are posted promptly and reconciled to deposits. We compare payments against your contracted rates to catch underpayments, which are easy to miss when a payer pays "something" instead of denying outright.
5. Denial management and appeals
Every denial is worked and categorized by root cause. We correct, request reconsideration or appeal as appropriate, and fix the upstream problem so it doesn't repeat. Details on our denial management page.
6. A/R follow-up
Unpaid claims are followed up by age and value. Claims with no response are chased before timely-filing deadlines; aged A/R is reviewed for anything still recoverable.
7. Patient billing
Clear statements, payment plans where appropriate, and courteous handling of patient questions. Obstetric patients in particular appreciate a clear explanation of what their plan covers for prenatal care and delivery.
8. Reporting and review
Each month you'll get a plain-English report and a call to walk through it.
The KPIs we report every month
| KPI | What it tells you |
|---|---|
| Net collection rate | How much of the money you're contractually owed you actually collected |
| Days in A/R | How quickly claims turn into cash |
| A/R over 90 days (%) | How much revenue is at risk of never being collected |
| First-pass acceptance rate | How many claims are paid on first submission |
| Denial rate by reason | Which upstream problems are costing you most |
| Charge lag | How long between the date of service and claim submission |
| Open pregnancies / unbilled deliveries | Obstetric revenue that hasn't been billed yet |
We'll benchmark these against your own starting point from the free audit. We don't publish blanket guarantees, because the right targets depend on your payer mix, specialty mix and how long your practice has been operating. Our guide to OB/GYN billing KPIs explains each metric in more detail.
Systems we work in
You don't need to change software to work with us. We work inside the practice management and EHR systems OB/GYN practices commonly use, including athenahealth, eClinicalWorks, NextGen Healthcare, AdvancedMD, Tebra (Kareo), DrChrono, ModMed and others. If you're choosing a system for a new practice, our practice setup service can help.
Who we work with
- Solo OB/GYN practices that need a full billing department without hiring one
- Small groups (2–5 providers) where the in-house biller is stretched thin or a key person just left
- Larger groups and multi-location practices that want specialist support for denials, A/R or coding
- New practices that need billing set up correctly from day one
- Practices with midwives and nurse practitioners who need accurate rendering-provider billing and incident-to rules
Our focus is independent OB/GYN practices, and we also support other specialties such as cardiology and internal medicine.
RCM software vs. an RCM partner
Many practices compare "OB/GYN revenue cycle management software" with outsourced RCM. They solve different problems. Software provides claim scrubbing, workflows and dashboards; a partner provides the trained people who use those tools every day, keep up with payer rules, and actually work the denials. Most OB/GYN practices already own capable software through their EHR. What they lack is specialist time. Our article on comparing OB/GYN RCM software and outsourced billing breaks down how to decide.
HIPAA and data security
We sign a Business Associate Agreement before accessing any patient information, work inside your systems with individual user accounts, and follow the minimum-necessary standard. Read our HIPAA notice for details.
What onboarding looks like
Switching billing partners is the part most practices worry about. Here's how we keep it smooth:
- Free audit. We review your current claims, remits and A/R so we both understand the starting point.
- Access and BAA. A Business Associate Agreement is signed, and our team receives individual user accounts in your PM system and clearinghouse.
- Payer and workflow review. We document your payers, fee schedule, authorization requirements and current processes, and identify quick fixes.
- Cutover. On an agreed date, new charges flow through our process. Existing A/R is worked in parallel — nothing is abandoned.
- First 90 days. We watch rejections, denials and payment timing closely and meet with you frequently.
- Steady state. Monthly reporting and review calls, with continuous improvement on the biggest denial causes.
Start with a free revenue cycle audit
There's no form to fill out. Message us on WhatsApp and we'll review a sample of your claims, remittances and A/R aging. You'll get a clear list of what's working, what isn't and what we'd fix first — whether or not you decide to work with us. Or estimate your revenue leakage in two minutes.
Frequently asked questions
What is revenue cycle management in an OB/GYN practice?
Revenue cycle management (RCM) is the full process of getting paid for patient care — scheduling and insurance verification, authorization, charge capture and coding, claim submission, payment posting, denial management, accounts receivable follow-up and patient collections. OB/GYN RCM adds specialty-specific work such as global maternity tracking and gynecologic surgery coding.
Should we use RCM software or outsource to an RCM company?
Software gives your staff tools; an RCM company provides the people and process. Many practices already have capable software in their EHR/PM system — what's missing is specialized staff time to work denials, follow up on A/R and keep up with payer rules. We work inside your existing software, so you don't have to choose.
Which KPIs should an OB/GYN practice track?
Net collection rate, days in A/R, percentage of A/R over 90 days, first-pass claim acceptance rate, denial rate by reason, charge lag, and — for obstetrics — the number of open pregnancies and unbilled deliveries. We report these monthly.
How do you price OB/GYN RCM?
Most practices choose a percentage of collections, which aligns our incentives with yours. Flat monthly pricing is available for some practices. We'll give you a quote after the free audit, once we understand your volume and payer mix.
How long does it take to switch billing companies?
Most transitions take a few weeks, depending on system access, payer enrollment changes (if any) and the size of the existing A/R. We plan the cutover so claims keep going out and old A/R keeps getting worked.
Will we lose control of our billing?
No. You keep ownership of your data, your systems and your payer contracts. We work in your PM system and give you full visibility into what we're doing.
