Global OB billing collapses months of care into a single claim submitted after delivery. When care transfers, coverage changes, or a complication falls outside the package, it has to be taken apart into itemized visits — and that decision is made months after the visits happened.
The global obstetric package bundles routine antepartum care, delivery, and postpartum care into a single billable event. When a pregnancy runs its expected course it is elegantly simple. When it does not, the package has to be taken apart correctly.
What is inside and what is not
Routine visits, delivery, and routine postpartum care are inside. Outside are services unrelated to the pregnancy, complications requiring additional management, and additional testing beyond routine.
The line between "routine" and "complication" is where most disputes sit, and it is a documentation question rather than a coding one.
When the package breaks
- Transfer of care. The patient moves practices mid-pregnancy. Neither provider delivered the full package, and each bills the portion they provided.
- Coverage change. Insurance changes mid-pregnancy, which is common and is exactly the situation a single claim spanning months handles worst.
- Delivery elsewhere. Antepartum care by one practice, delivery by another.
- Pregnancy loss, where the package does not complete.
The timing problem
Because the claim is submitted after delivery, the filing clock and the coverage question both look back across months. A coverage change eight months earlier surfaces now, and the payer who covered that period may have a filing window that closed long ago.
The practical control
Track antepartum visit counts and coverage status throughout the pregnancy rather than reconstructing at the end. If coverage changes, decide immediately how the package will be split — not after delivery, when the options have narrowed.
Verify coverage at every visit, not just intake
The global package hides nine months of coverage risk behind one claim. A patient who changes plans in month four generates a problem nobody sees until the claim is submitted in month nine.
An eligibility check at each antepartum visit costs seconds and is the only thing that surfaces the change while it is still actionable.
Count the visits as you go
If the package breaks, you bill what you provided — and that requires a running count of antepartum visits by date, available at billing time.
Reconstructing it from the chart months later is possible but slow, and it happens at exactly the moment a filing deadline is closest.
Decide the split before the transfer completes
When care transfers, both practices are billing portions of the same pregnancy. Agreeing who bills what, and confirming the visit counts, prevents duplicate claims and the denials that follow them.
That conversation is far easier at the point of transfer than after both claims have been rejected.
What falls outside the package
Complications of pregnancy, unrelated problems, additional imaging beyond routine, and management of conditions such as gestational diabetes are generally separately billable. Practices routinely absorb these into the global claim and lose the revenue silently.
Identify them as they occur rather than at delivery, because reconstructing which visits addressed a complication nine months later is unreliable.
Multiple gestation and delivery method
The delivery component varies with method and with multiple gestation, and the correct code depends on facts recorded at delivery. A claim built from a template rather than from the delivery record is the version that underpays.
Postpartum care is part of it
The package includes routine postpartum care, which means the claim is not complete until that care is delivered or the patient is lost to follow-up.
Submitting at delivery and never revisiting is common, and it leaves the postpartum component unaccounted for in either direction — either billed and not delivered, or delivered and never captured.
Common questions
- What is included in the global obstetric package?
- Routine antepartum visits, delivery and routine postpartum care. Complications, unrelated problems and additional imaging are billed separately.
- When does the global OB package break?
- When care transfers between practices, the patient changes coverage mid-pregnancy, the pregnancy ends early, or complications require care outside routine antepartum management.
- How do I bill when a patient transfers care?
- Itemize the visits you actually provided rather than billing the global package. Each practice bills its own portion, which requires knowing how many visits you delivered.
- Why is the timing a problem in OB billing?
- The claim is submitted after delivery, so a coverage change from month three surfaces at month nine — after the filing window on those early visits may have closed.
- What is the control that prevents OB billing losses?
- Verifying coverage at every antepartum visit, not just at the first. A coverage change caught in month four is fixable; the same change found at delivery frequently is not.
Denials Piling Up?
We handle the revenue cycle end to end — coding by certified coders, claim submission, denial management and appeals, and A/R follow-up, with six reported numbers every month.