COBGC Payer-Specific Guidelines 1

Question 1

What are Medicare OB/GYN billing guidelines?

Accepted Answer

Specific rules for coding and billing OB/GYN services to Medicare including global package rules and screening coverage

Answer

Medicare has specific guidelines for OB/GYN services including well-woman exams, screening frequencies, and global package requirements.

Question 2

How do commercial payers differ from Medicare in OB coding?

Accepted Answer

Commercial payers may have different global package rules, covered services, and prior authorization requirements

Answer

Each commercial payer may have unique policies for OB service coverage, authorization, and billing.

Question 3

What is prior authorization for gynecologic procedures?

Accepted Answer

Obtaining payer approval before performing certain procedures to ensure coverage

Answer

Many payers require advance approval for surgical and diagnostic procedures to verify medical necessity and coverage.

Question 4

What are bundled payments in OB/GYN?

Accepted Answer

A single payment covering all services related to a specific episode of care

Answer

Bundled payments combine multiple related services into one payment, requiring accurate tracking of included and excluded services.

Question 5

What is credential verification for billing?

Accepted Answer

Confirming that the provider is properly credentialed with the payer before submitting claims

Answer

Providers must be credentialed with each payer to submit claims and receive reimbursement.

(COBGC) Certified Obstetrics Gynecology Coder Practice Test