The US fertility market is growing at a fast pace and is expected to grow to USD 8.7 billion by 2033.  

It is evident that the market is bringing numerous opportunities for the providers in upcoming years.  

Unfortunately, despite this growth the providers are still struggling with humongous workload and administrative complications.  

The labor shortage in the healthcare industry is nothing new and it is constantly affecting the growth of practices. Let aside the intricate maze of fertility billing and coding solutions. 

In this situation, you need a holistic approach that can transform your practice’s revenue while giving you a competitive edge to serve the utmost quality to your patients.  

To find the correct strategy for your practice, you need to understand the process loopholes first. 

Since the introduction of Assisted Reproductive Technology (ART) in 1960 and after first birth by ART in 1978, the fertility treatment sphere has seen an unprecedented growth. However, the specialty is always plagued with the issues regarding revenue generation and maintaining a seamless operation.  

Here are some of the unique challenges of fertility billing process. 

 The treatment of infertility entails a range of procedures as other specialties like obstetrics and gynecology are also interwind with this. As a result, there are a range of complex services that are provided by the clinics. This further leads to humongous documentation and coding requirements, which are difficult to cope with.

Fertility treatments are not always covered by the insurers. In fact, depending on the state, the reimbursement rate changes for the same services. The process of navigating complexities of fertility billing including prior authorization and appeals process, can be both daunting and time-consuming.  

The broad range of services involved within the specialty is a major reason for coding complexities. However, there is another reason that makes it more problematic: z-codes. These can be used in any healthcare setting as a first-listed or second listed diagnosis code. These are used to report factors that influence a patient’s health or reasons to seek healthcare services.  

For instance, Z31.81 is used to encounter for male factor infertility in female patient.  

Understanding and implementing these essential codes along with ICD-10 and CPT codes are essential for accurate reimbursements.  

The success rates of fertility treatments can vary greatly. Also, services and procedures offered by the clinics are also variable. This can create a ground of mistrust among patients and providers and upon failure, patients might ask for refund or dispute charge. This indeed will make the revenue cycle more complicated.  

Fertility treatments are constantly updated with new methods, technologies and regulations. As a result, not only are you burdened with more clinical responsibilities but also with administrative responsibilities.  

In this situation, you must take care of the following areas in your fertility clinic- 

• Data collection, management and transition
• Documentation and coding 
• Operational efficiency 
• Regulatory compliance 
• Insurance verification and prior authorization 
• Overhead costs 
• Privacy and confidentiality 

Understanding insurance coverage guidelines and refining prior authorization are a good start towards efficient fertility billing.  

Always review the policy documents and verify insurance coverage and benefits of your patients. Considering the authorization, you need to ensure streamlined documentation for the procedures. From patient’s demographic information to medical necessity of the procedures should be present within the documents.  

Many clinics offer flexible payment options which increase patient convenience and simultaneously make it easier to collect payments. This not only reduces the chances of bad debt but also improves patient experience.  

Always stay updated with the regulatory changes within the industry to avoid audits, fines and penalties. Also, adherence to regulatory compliance will ensure you have a streamlined process in your clinic and obtaining reimbursements will be easier.  

 With resource constraints, skyrocketing wages and increasing administrative burden, it is better to outsource your fertility clinic billing solutions to a revenue cycle management organization.  

With our industry best practices and professional billers and coders, we can elevate your clinic’s productivity, efficiency, and cashflow.  

To eliminate the gridlocks in revenue generation, all you need is a team of experts specialized in fertility billing. We can provide you with just that while offering you scalability.  

While you are worried about increasing wages and overhead costs, our experts work from a completely remote position for you at just $7 per hour.  

This not only makes our services cost-effective for your practice, but also, you can invest your valuable time in patient care, as we work as an extended operational arm for your clinic.  

Want to transform your fertility clinic billing solutions?  

Call us at (646)-661-7853 today! Our experts will be glad to provide you with more information regarding the services.