A 90+ day A/R balance is rarely caused by one bad claim. For an OBGYN practice, older A/R can build quietly across global maternity billing, gynecologic procedures, prior authorizations, payer eligibility, coding edits, postpartum services, and unpaid patient balances. One claim gets denied. Another is underpaid. A third is waiting on medical records. Before anyone notices, a significant portion of the practice’s revenue is sitting in an aging bucket instead of the bank account.
That is why simply “working the A/R” is not enough.
The real question is: Why did the claim reach 90 days in the first place?
For OBGYN practices in 2026, there is another reason to take this seriously. The specialty is preparing for a major change in maternity billing beginning January 1, 2027, when the traditional global maternity CPT structure will be replaced with more granular reporting for antepartum care, labor management, delivery, and postpartum care.
If your practice already has aging A/R, now is the time to find the workflow problems behind it.
What Makes OBGYN A/R Different?
OBGYN revenue cycles combine routine office visits with procedures, surgery, maternity care, ultrasounds, contraception, postpartum care, and payer-specific requirements.
That creates multiple points where revenue can stall.
A claim may be coded correctly but denied because an authorization was missing. A procedure may be medically necessary but require documentation to support a modifier. A maternity claim may be affected by how care was transferred between providers.
CMS’s 2026 NCCI guidance reinforces that procedure-to-procedure edits and modifiers must be supported by the actual clinical circumstances; modifiers should not simply be added to bypass an edit.
So when OBGYN A/R crosses 90 days, the solution starts with claim-level root-cause analysis, not just another round of payer calls.
1. Global Maternity Billing Problems Can Create Long-Running A/R
Maternity billing remains one of the biggest areas to watch.
Global obstetric billing can involve multiple prenatal visits, delivery, and postpartum care under one payment structure. Problems arise when the patient’s care changes, another provider becomes involved, the patient transfers care, or services fall outside what the payer considers part of the global package.
ACOG specifically notes that payer policies vary and that some Medicaid programs use global maternity codes while others use per-visit billing or a combination of approaches.
That variability can turn a coding issue into an A/R issue.
What to check:
- Was the correct maternity billing method used for the payer?
- Did the patient transfer care?
- Were services actually included in the global package?
- Were separately reportable services identified?
- Does the documentation support the claim?
- Was the correct provider and date information submitted?
The 2027 Change Makes This Even More Important
The traditional global maternity codes are scheduled to be deleted beginning January 1, 2027. The new framework separates maternity care into antepartum, labor management, delivery, and postpartum services.
ACOG has also recommended that health plans begin transitioning to E/M reporting for antepartum visits no later than September 1, 2026, although practices must follow each payer’s actual transition policy.
For an OBGYN practice, this means 2026 A/R should be reviewed with the 2027 transition in mind. Your billing team should know exactly which payer rules apply to patients whose maternity care crosses calendar years.
2. Prior Authorization Issues Can Leave Procedure Claims Sitting
Gynecologic procedures can generate substantial revenue, but they can also create expensive A/R when authorization requirements are missed.
Depending on the payer and procedure, issues can involve:
- Missing authorization
- Incorrect authorization number
- Wrong provider or facility information
- Date-of-service mismatch
- Procedure changes after authorization
- Authorization not updated after a change in the treatment plan
- Documentation that does not support the authorized service
The problem is not always that staff failed to obtain authorization. Sometimes the authorization exists but does not match what ultimately appears on the claim.
That is why an OBGYN A/R review should connect the authorization record to the final claim, not simply check whether an authorization number exists.
CMS also notes that prior authorization requirements and processes continue to evolve across Medicare Advantage, Medicaid/CHIP, and Marketplace plans. Beginning in 2026, impacted payers have specified timeframes for standard and expedited prior authorization decisions.
3. Coding and Modifier Errors Can Push Claims Into Older A/R
OBGYN practices frequently bill combinations of E/M services, procedures, surgeries, ultrasounds, and other services on the same date or within related global periods.
That creates opportunities for:
- NCCI edits
- Bundling denials
- Incorrect modifier use
- Global-period conflicts
- Duplicate-service denials
- Medical-necessity issues
- Incorrect diagnosis-to-procedure relationships
CMS’s NCCI program specifically uses procedure-to-procedure edits to prevent inappropriate payment when services should not be reported together. Appropriate modifiers may allow payment in qualifying circumstances, but CMS emphasizes that the clinical circumstances must support their use.
For older A/R, don’t just ask, “Why was this denied?”
Ask:
“What coding or documentation issue caused this claim to become collectible only after an appeal?”
That question gets closer to the root problem.
4. Eligibility and Coverage Changes Can Create Avoidable A/R
OBGYN practices often see patients throughout pregnancy and postpartum care. Insurance coverage can change during that period.
A patient may move between:
- Commercial coverage
- Medicaid
- Medicaid managed care
- Marketplace coverage
- Employer-sponsored plans
- Secondary insurance
If eligibility is not verified correctly for the date of service, the claim can move into denial or patient responsibility.
This is particularly important for maternity care because a single patient can generate claims across many months.
A/R recovery should therefore include an eligibility review, not just a claim-status check.
5. Medical Records and Documentation Can Hold Up Payment
Some claims do not fail because the service was incorrectly billed. They fail because the payer wants additional documentation.
For OBGYN practices, that can include operative reports, procedure notes, ultrasound documentation, medical records, or supporting information related to the diagnosis and service.
When a records request sits unanswered, the claim continues aging.
A practical A/R workflow should track:
Payer request → date received → records requested internally → records received → submission date → payer response.
Without those checkpoints, “pending medical records” can become a 90-day-old balance before anyone realizes the claim was never completed.
6. Patient Responsibility Can Become the Hidden 90+ Day Balance
Not every old balance is an insurance denial.
Deductibles, coinsurance, copays, and non-covered services can move to patient responsibility after insurance adjudication. If statements are unclear or follow-up is inconsistent, these balances can remain open for months.
For an OBGYN practice, patient financial communication is especially important when services involve multiple encounters or procedures.
Your team should be able to distinguish between:
- Insurance A/R
- Patient A/R
- Pending insurance coordination
- Incorrectly transferred balances
- True self-pay responsibility
Otherwise, staff can spend valuable time chasing balances that require a completely different collection strategy.
How to Recover OBGYN A/R That Has Already Passed 90 Days
Once a claim reaches 90 days, the goal should not be to work the oldest claim first simply because it is old.
Prioritize based on recoverability and financial impact.
Start With the Highest-Value Buckets
Separate your 90+ day A/R into categories:
1. Denied claims
Determine the exact denial reason and whether an appeal or corrected claim is appropriate.
2. No-response claims
Verify submission history and payer status before resubmitting.
3. Underpaid claims
Compare the payer payment against the contracted or expected reimbursement.
4. Documentation requests
Identify what the payer needs and close the request rather than leaving it in pending status.
5. Patient balances
Move appropriate balances into a structured patient collection workflow.
6. Global maternity claims
Review the underlying maternity episode, provider involvement, payer policy, and applicable billing rules.
Don’t Let 90-Day A/R Become the Starting Point
The strongest OBGYN revenue cycle is not the one that recovers the most old claims.
It is the one that prevents today’s claims from becoming tomorrow’s 90+ day A/R.
That means monitoring denial reasons, authorization failures, eligibility issues, coding edits, payer response times, underpayments, and unresolved documentation requests before they become chronic problems.
For 2026, OBGYN practices also have a bigger issue to prepare for: the transition to the new maternity care CPT structure in 2027. AMA and ACOG have published extensive guidance because the change will affect how maternity services are reported across antepartum care, labor, delivery, and postpartum care.
That makes 2026 the year to clean up the revenue cycle before the next billing model arrives.
OBGYN 90+ Day A/R Self-Assessment: Where Is Your Revenue Getting Stuck?
Use this checklist to identify potential gaps behind aging OBGYN A/R, including maternity billing, coding, authorization, payer follow-up, denials, and payment collection.
| 90+ Day A/R Check | Status |
|---|---|
| Are 90+ day claims segmented by denial reason, payer, claim type, and dollar value so your team knows exactly where aging revenue is concentrated? | ☐ |
| Are global maternity claims, delivery claims, and postpartum services reviewed for the correct billing methodology, payer requirements, and applicable global-period rules? | ☐ |
| Are recurring coding, modifier, NCCI, and medical-necessity denials being identified and corrected at the workflow level rather than appealed one claim at a time? | ☐ |
| Are payer follow-ups, medical-record requests, appeals, and timely-filing deadlines actively tracked until each aging claim reaches a final resolution? | ☐ |
| When the same type of claim repeatedly reaches 90+ days, does your practice identify and fix the upstream cause instead of continuing to rebill or appeal the same issue? | ☐ |
Find the Root Cause Behind Your 90+ Day A/R
Unchecked items can point to opportunities to improve OBGYN claim accuracy, denial prevention, payer follow-up, maternity billing, underpayment recovery, and A/R performance.
The goal isn’t simply to work older claims faster. It’s to understand why they became old in the first place and correct the workflow responsible.
If the same denial keeps returning, another appeal may recover one claim, but it won’t necessarily prevent the next one.
The real opportunity is to recover aging revenue while fixing the process that created the aging A/R.
