OBGYN Practice Revenue 200% Increased
We began working with an OBGYN practice in January 2025. The physician was extremely frustrated because her income had been declining every month. To make matters worse, the previous billing company terminated the practice’s software access and refused to provide patient records or billing reports.
We were only able to access the system for two days, but during that short window we discovered that 30%–50% of claims had been written off due to insurance rejections.
Quick Snapshot
Background
Medicaid patients represented a significant portion of this OBGYN practice’s patient base.
However, nearly all Medicaid claims were being rejected. Delivery claims were routinely written off, and claims were being submitted with fundamental errors that prevented reimbursement.
Without immediate intervention, the practice faced continued revenue loss and long-term damage to cash flow stability.
The Challenges
- All Medicaid claims rejected (Medicaid patients are a major portion of the practice)
- Delivery claims written off due to incorrect billing
- Claims rejected because incorrect NPI was submitted
- Claims denied due to “unspecified diagnosis”
- Claims denied for incorrect modifier usage
- Claims submitted to inactive insurance plans
- Claims denied due to missing referrals or authorization
Our Strategy and Solutions
FC Billing immediately implemented a structured recovery and compliance plan focused on stopping revenue loss and restoring proper billing workflows.
- Credentialing: Within one week, we successfully credentialed both the physician and the group with Medicaid.
- Delivery Claims Recovery:
- We worked with the office manager to identify all delivery claims.
- We contacted payers, tracked unpaid claims, corrected errors, and resubmitted them.
- Correct NPI Usage: We created a “cheat sheet” listing all participating insurances, clearly noting whether claims required the physician NPI, group NPI, or both.
- Diagnosis Accuracy:
- We reviewed all superbills for proper diagnosis support.
- Claims requiring clarification were placed on hold while the physician added detailed documentation.
- We also notified the physician anytime services were billed with unsupported diagnoses.
- Modifier Correction: We verified correct modifiers (such as TC, 26, 59, etc.) and informed the physician when corrections were needed.
- Insurance & Patient Follow-Up: For rejections due to inactive insurance, COB updates, or missing information, we immediately contacted both the office and patients to resolve issues and rebill claims.
- Authorization & Referral Alerts: We flagged patients requiring referrals or authorization so the office could obtain prerequisites before services were rendered.
Results
The impact of these corrections was rapid and measurable:
- By early March 2025, the practice’s revenue increased by over 200%.
- We created a bundled-services cheat sheet to prevent unnecessary write-offs and adjustments.
- We provided insurance LCD guidance for commonly billed procedures, giving the doctor immediate coding clarity.
- Claims are now submitted faster, more accurately, and with fewer holds.
- Payments are consistently coming in much quicker.
Conclusion
This case demonstrates how systematic billing errors, credentialing gaps, and workflow breakdowns can quietly drain a practice’s revenue. Through focused recovery efforts, clear communication, and process correction, FC Billing helped this OBGYN practice regain control of its revenue cycle and achieve rapid financial recovery.
What began as a declining-income situation was transformed into a structured, compliant, and sustainable billing operation with strong revenue growth.
🚀 Denied and written-off claims may still be recoverable with the right approach.
FC Billing specializes in helping growing practices maximize revenue from day one.
