#193 The 90-Day Plan for 2027 OB Billing

Q1 2027 cash flow crisis. That is what is waiting for every OB practice that does not have a plan in motion by October. Not because the codes are hard. Because the time ran out to prepare for them. Knowing what is changing and being ready for it are two completely different things. In the OB Global Coding Series finale, Dr. Heather Signorelli walks through the exact ninety-day month-by-month plan to be ready on January 1, 2027 — payer contracts in July, EHR templates and workflows in August, provider training and shadow audits in September, refinement through Q4. 

Month 1 · July · Payer contracts: 

Your contracts reference specific CPT codes. When 59400 and 59510 disappear January 1, those contracted rates disappear with them. Identify your top five payers by maternity volume. Reach out to each provider rep with a written timeline question. Model your current revenue per episode before negotiating. Use the ACOG payer advocacy toolkit. Submit written notice of intent to renegotiate before July 31 to get into the Q4 queue. 

Month 2 · August · EHR + workflows: 

Systems first, people second. Rebuild prenatal, postpartum (inpatient and outpatient), and labor management templates. The labor management templates are built from scratch since 59080 – 59083 have no legacy. Build the multi-provider attribution protocol, the same-day postpartum hard stop, and the modifier TH automation. 

Month 3 · September · Provider training + shadow audits: 

Mandatory training for all clinical staff. Show providers their own notes and the dollar difference between what they wrote and what they could have written. Run shadow audits monthly: twenty prenatal notes, ten labor management, ten postpartum rounding. Track results by provider. Brief the front desk on the patient-facing talking points. September 1 is the ACOG testing date — NOT a payer compliance deadline. Submit test claims to your top three payers and watch what comes back. 

Q4 · Refinement, not crisis: 

October: follow up with payers for written fee schedule confirmations. November: CMS finalizes RVUs — update your revenue model with real numbers. December: billing team readiness check. January 1: go live. The practices that did the Q3 work transition smoothly. The ones that did not are scrambling. 

The reframe: 

The elimination of the global OB codes is not a threat to your practice. It is a correction. OB/GYN has been undercompensated for the complexity of maternity care for thirty years. That ends January 2027, if you are prepared.

RESOURCES BLOCK 

• Save your seat: Live OB/GYN Global Codes Update Webinar (July 7, 2026, 4:00 PM ET) · eligibility.natrevmd.com/obgyn-global-updates-webinar 
• Book a 1:1 with Dr. Signorelli · calendly.com/heather-natrevmd/ 
• Full series playlist: EP188 · EP189 · EP190 · EP191 · EP192 (https://natrevmd.com/podcast/#) 
• Practice Revenue Leak Scorecard · eligibility.natrevmd.com/nrm-revenue-scorecard-v3 
• Payment Posting Audit Checklist · eligibility.natrevmd.com/payment-posting-checklist 
• RECOVER Diagnostic Quiz · natrevmd.com/quiz 

Transcript

SPEAKER_00 0:04

Really, every OB practice that does not have a plan in motion by really October, so it's July at the time of this recording, really could be in trouble. And so we have been laying out the changes and making sure that you guys all have a plan. Welcome to Nat RevMD, a podcast where we share tips on optimizing medical billing and improving practice efficiency so you can have the business of your dreams. I'm your host, Dr. Heather Signarelli, founder of Nat RevMD. Let's get started. All right, so we're here today to talk about the Q1 2027 deadline for OB coding changes. So this is the last of our series. We've done five of these episodes. So if you haven't listened to those, head on back and listen to those in order. Again, the codes are not all new. They're not going to be super hard, but the biggest thing that's going to be important is for you guys to understand the uh documentation needs in order to make sure that you are capturing those level four, level five visits when it qualifies so that you keep the revenue steady. So if you've been through the series, you know what's coming, right? So we have talked about the antipartum visits are going to move to the EM. The labor management has its own set of codes, really for the first time in history. The delivery codes are slightly restructured. Obviously, postpartum is now unbundled and you're going to be using those EM codes. And so you understand all of this today. So today's episode is really going to be talking about how to interpret this and make a plan coming for the future. So obviously, if you're waiting until January to start updating your templates, training your providers, negotiating contracts if necessary, you're going to face a cash flow crisis in January. And so, really, we're going to be talking through the steps to make sure you understand what is needed in order to prevent that. Again, this is not hard. You can do this, but we want to make sure that you are prepared. So this is the action episode. So we're going to talk about a 90-day plan month by month to be ready for that January 1th. January 1. So month one for you know this recording is July. Payer contracts, month two is August, which is really EHR templates and workflows. Month three, which is in September, which is really all about provider training and shadowing audits. So then Q4 then becomes the refinement period, not this, oh crap, I haven't done anything. So if you're listening to this in July, you have 90 days. So let's spend the next, you know, few minutes making sure that none of them are wasted. All right. So one of the things that I want to make sure that you understand first is really laying out an estimate of what you get paid from a global fee perspective. So is that $2,500 per global fee? Is that $3,500? Is it $1,500? What is that range? I wouldn't spend a ton of time, you know, getting every global fee. I would try and just take your average. So if you pull all of your OB volume and what is that average per click, a global fee rate? Or alternatively, you could take your top T top three payers by volume. Again, you're trying to get an estimate. Okay. So this allows you to think through is my revenue goal 2,500, 3,500, 1500 on a per OB patient perspective? Because we're going to need to back into how to calculate the number of times that you see a patient, both from an antipartum perspective. Obviously, we've got delivery codes that we don't yet know what those are going to cost or what those fees were going to be is a better way to state that. And then you've got labor management fees and postpartum fees. So we're trying to get capture what is the volume of times that you see those patients from an antipartum perspective. We can put in some estimate numbers with regards to labor management. And then postpartum care, again, whether that's in the hospital or outpatient again is going to be those EM codes, whether, and so you're going to have to know what those current average reimbursement rates that you get for a 99213, 99214, all the way through your inpatient codes as well. And so the model here is really understanding okay, if I see a patient 12 times, 15 times, 11 times, and I estimate out what I think the CPT codes are going to be on each of those visits, and I know approximately what that average reimbursement is for those CPT codes, then I can calculate what I think my revenue is going to be on a per OB patient perspective under these new rules. And I recognize we don't have labor management codes, we don't have delivery code reimbursement rates yet, but I would put in different rates so that you can have a range so that you can start to understand, okay, am I kidding close or am I out of the ballpark completely? And you could model this into those patients with uh low risk, average risk, or even high risk or high complicated patients so that you have three different models. And ACOG did give out some new guidelines around how to manage patients in each of those buckets and the number of visits that they recommend, et cetera. And so we are going to be giving a tool for how to plug this in to your current rates. And that allows you to understand, okay, how close am I to capturing that average global payment that I get today? And this allows you to estimate impact to your revenue come quarter one. And I recognize that some of these fees we're not going to have. So again, it's starting with a range. And okay, if you get $900 for the delivery or if you get $500 for the delivery, what does that model out? Again, most of the codes, the EM codes, both inpatient and outpatient, you're going to know, right? So you're going to know those average rates already. You're going to know your average global rate. Again, those delivery and labor management is going to be a question mark, but um, that can be what we leverage in payer contract and payer discussions to understand, okay, what is their plan for these codes? And do you have an opportunity to negotiate those if necessary? So, really, that first part of this is really what is your volume of OB patients? What is that average on per OB patient? And then modeling out the low risk, average risk, and medium risk or high risk patients. I would just do three. So low, average, high risk patients, and then how many visits do you see those patients, both antipartum and postpartum? And then using those ranges of delivery management and labor management codes so that you can come up with an estimate of how close am I going to get from a revenue perspective. And that is going to allow you to understand, okay, do if if I'm expecting a whole bunch of 99214s, how do I get my providers ready to document? So that really first month is really looking at pulling that data together and understanding what revenue estimates would look like next year. The next is going to be really getting a plan with your providers on what this new model looks like from a workflow perspective, right? So month one, July is really all about pulling the data together to see what revenue could look like. Month two is really reaching out to your providers, seeing if you can get any information around timing of your codes getting put into the system, working with your EMR vendor to get codes and understanding of when those codes are going to be loaded from a practice management software. And then the third month is really going to be working with your physicians and your mid-levels on two things. So it's going to be workflows, right? So does your workflow change based on this new model when it comes to managing laboring patients or OB patients in general in your practice? How does that impact compensation models that you have? Because if you pay your, you know, group on commission and today you have only certain individuals, you know, delivering in the hospital, how does that change your attribution of revenue to everybody who's now being able to bill for those codes individually? So that's a big part of this. And then two, it's really training those physicians and providers that the documentation that they have previously been doing for antipartoman, probably postpartum and probably even labor management may not be where it needs to be. And so that's about building your templates, getting an understanding of what you think those, those uh templates and documentation levels need to be. Again, to document, you know, all of the qualities that hit that level four, level five, if that, you know, makes sense, so that you can really make sure that you are getting paid the level that you should be getting paid so that you can so that you can hit those average or even above average rates that you were getting paid from an OB global fee perspective. There is an ACOG payer advocacy toolkit. They have obviously published resources specifically for this for contract conversations, and you'll be able to use those as a framework for what payers recognize. Obviously, if you do need to submit any intent to renegotiate, you're gonna want to see if you're, you know, if that's possible and do that as soon as as you can. Obviously, you're not gonna be able to negotiate effectively for these new codes if you don't know what the old codes were paying you by payer. So that's why we're suggesting starting that in July. If you're listening to this, we do have a webinar that we're gonna be talking through some of this again. And really important to register for that webinar. Again, the show notes will have the link. It's actually going to be led later today as of the release of this recording. So 5 p.m. Eastern, we're gonna be doing this talk with one of our OB certified coders. So questions, you can bring them there. Um, if you can't attend live, we will have it in a downloadable form. So head on over and listen to that or register for that webinar, is what I mean. All right. So I do want to touch on a little bit on the template piece because I think it's important just to have some plan of attack on this. My recommendation and our team's recommendation is really starting with those prenatal templates. Current templates, you know, really are going to help speed up this process. And the new templates really just need to make sure that you're walking out those MDM elements, right? So what problems are addressed, what data is reviewed, what clinical integration is done, management decisions, right? Because this is what's going to carry a lot of weight when it comes to this new model. Then next, just going to be rebuilding those postpartum templates, both from an inpatient rounding perspective, outpatient office, you're going to want to make sure that you have a plan of attack around that same day, rounding issue with where you've got delivery and maybe a rounding visit that's going to be bundled. But if you do a rounding, a different calendar date, right? That's obviously going to be separately billable. So you'll want to go over that with your team and obviously make sure that they understand the MDM framework. Again, this should not be new to anybody. This should be stuff that you guys already know. Just a matter of putting those plans of attack into your antipartum, postpartum cases. So you just really want to make sure that you have the complexity of those visits documented because that's what's going to be the difference between a 99213 and a 99215. Um, obviously, next it's really building those labor management templates from scratch. So, you know, before you just may have had much shorter documentation because you didn't need it. It was bundled. And that's where this is really going to make sure that you're stepping out, you know, the complexity of these patients, because that's what's going to determine uh your rates, right? And so it's going to walk providers through those six straightboard criteria, prompting for complicating conditions that then bumps you up into that complex uh category. And so again, we've gone through that in in previous episodes. Please go check those out. Obviously, talking about any fetal monitoring, strip interpretation, documenting the management decisions. And so having that template for complexity will be very helpful for everybody. And the last note I'll just make mention is that, you know, previously, like I mentioned, really having an idea of workflows of how this model may change, both who is assigned to what phase of a patient's journey and how this may change arrangements that you may have with laborists, et cetera, because again, they will have their own separate billable event. So you previously may have had arrangements where you are compensating them a flat fee outside the global to manage laboring patients. So you just want to think through is that the model that you want to keep? And again, I think once you do your revenue discussion and modeling, that's gonna give you a better understanding of how you want to reimburse folks because they're gonna be billing for themselves now. So that may change, you know, reimbursement models. You're also gonna want to make sure that um the modifier TH, that your EHR billing system is going to have that prompt to add those modifiers again on those antipartum and postpartum codes. Um, I would really make sure that automation is really part of that plan. It's just gonna make everything easier. And, you know, as you guys are thinking through this, you we all know that, you know, documentation habits take real time. And so a one-hour training on this is really not going to, in my opinion, be what changes changes that over time. I think it's really building these templates, having the conversations, you know, this month, so in July, in August, in September again, and then starting to have them document by the end of September these types of using the templates. We're not quite sure how it's going to work in terms of do we drop the EM codes in September and October for these patients that aren't due till next year. I our team is gonna actually submit that question to ACOG. But in the meantime, I think at least having them use the templates and documenting while we try and figure out, okay, do we start dropping the EM codes now or do we wait until January and then go back and resubmit those EM codes for, again, those antipartum visits where a patient is delivering, say next April, because obviously nine months, it's gonna be hitting us here in the fall. So I think really having these conversations now, walking through the templates, implementing the templates, and then doing an audit of some of those codes in the fall is probably really the most important thing to do. ACOG is recommending September 1 for a date to begin testing these modified modifier TH on live claims. We just don't know if that's even going to be, you know, loaded up into the payer files. That's our concern, is that we're gonna get denials because the payers aren't ready for this. So again, reaching out to your payers, having that conversation. Do you plan on having TH? You know, what are the fees going to be for delivery and labor management? These are the some of the things that, again, in that month too, you can start reaching out and having those conversations. All right. So hopefully this has been a helpful series for you guys. For some of our non-OB listeners, if you've made it this far in this episode, um, please share with your OB colleagues. And um hopefully, you know, as you guys are preparing for January, this has been helpful. We hope to see you guys all at the webinar um later on Tuesday, July 7th at 5 p.m. Eastern. Again, registration is in the show notes. And as always, if you are looking for a new revenue cycle management, please head on over to our website at natrevmd.com. Upper right hand corner is um a place where you can go check out more information of us and get a free metric audit. Um, so again, top right hand corner. And we look forward to seeing you guys all at the webinar. Thanks so much.