Buried global-package carve-outs and modifier denials cost Women's Health practices recoverable revenue every day.
Women's Health runs episode-based obstetrics, high-volume well-woman visits, and complex gynecologic surgery side by side, global-package carve-outs, modifier-25 rejections, and missing surgical auth. Manual billing teams catch a fraction of the errors. Ember catches all of them.
Trusted by specialty groups and health systems
Where Women's Health revenue leaks
The denial patterns Ember was built for
Women's Health revenue spans episode-based obstetrics, high-volume well-woman visits, and complex gynecologic surgery, and each carries its own denial trap. Buried carve-outs, modifier-25 rejections, and missing surgical auth compound into systematic underpayment. Ember closes each gap.
01 · Global OB package
Carve-out and split-care antepartum visits buried in the global fee.
The global obstetric package bundles routine antepartum, delivery, and postpartum care, but transferred, early-ended, or complicated pregnancies should be carved out and antepartum visits counted individually for split care. Bill the global when you shouldn't and you bury services the package would otherwise pay separately. Ember tracks each episode and bills the right way.
59400 · 59510 · 59425 · 5942602 · Preventive + problem
Same-day well-woman and problem visits denied on modifier 25.
When a well-woman exam also addresses a clinical problem, a preventive code pairs with a problem E/M under modifier 25, but payers routinely deny one of the two when documentation or the modifier doesn't hold up. Each denial drops a fully earned service. Ember validates modifier 25 against the note so both visits are paid.
99385 · 99213 · Mod 25 · G010103 · Gyn surgery & auth
Surgical bundling errors and missing pre-auth on procedures.
Hysterectomy, laparoscopy, and other gynecologic surgery carry bundling edits, global periods, and prior-authorization requirements that vary by payer. A missing auth or a bundled add-on turns a high-dollar procedure into a denial or an underpayment. Ember secures auth up front and applies the correct surgical edits before submission.
58571 · 58661 · 58150 · 76830Three engines.
One source of truth.
Ember connects clinical documentation, payer policy, and contract terms into a single intelligence layer. Built for the global OB episodes, modifier rules, and surgical authorizations Women's Health billing requires.
01 · Foundation
Data Engine
Bridges the clinical and the financial. Unifies documentation, coding decisions, payer policy, and contracts across every visit, episode, and procedure.
R. Delgado
Encounter #G-58120
02 · Audit
Coding Engine
Reviews 100% of encounters against national standards, payer-specific policies, your internal guidelines, and your payer contracts. Every flag carries a rule citation.
Append modifier 25 — note supports separate E/M
NCCI / payer policy · confidence 0.96
03 · Recovery
Appeal Engine
Reads CARC and RARC codes, identifies the applicable policy and contract terms, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.
Re: Claim #G-58120 · Denial CO-97
The problem-oriented E/M is significant and separately identifiable from the preventive service per CPT modifier 25 guidance and contract §4.2…
Audit upstream.
Appeal downstream.
Two workflows do most of the work for Women's Health practices. The first prevents denials before they happen. The second recovers the ones that slip through.
Pre-bill audit
Catch the missing modifier before the claim leaves.
Ember reviews every encounter against coding standards, payer policy, and your contracts. Modifier-25 gaps, global OB miscounting, and surgical bundling errors are flagged before submission.
- 1
Ingest the encounter
Pulls visit notes, OB episode records, operative reports, and authorization status from your EHR and practice management system.
- 2
Validate against rules
Checks global OB package carve-outs, antepartum counts, modifier 25 on preventive + problem visits, and surgical bundling against each payer's specific policies.
- 3
Recommend with citation
Returns the suggested correction tied to the exact payer policy, NCCI edit, or contract term.
- 4
Educate the provider
Coding patterns drive clinician-level coaching, so documentation and modifier capture improve across every provider.
Append Mod 25 + recount antepartum visits
NCCI / payer policy · confidence 0.97
+23%
Clean-claim rate
100%
Encounters reviewed
+5%
Net collection rate
Automated appeals
Pull. Review. Push.
When a denial occurs, Ember identifies the root cause, retrieves visit notes, operative reports, and OB episode records, references payer policy and contract terms, drafts the appeal, and tracks it through adjudication.
Modifier 25 denial
Surgery medical necessity
Global OB bundling
Hysterectomy auth missing
Modifier 25 appeal
-57%
Denial rate
-45%
Cost to collect
+9.3%
Net revenue per visit
The full revenue cycle
From eligibility to adjudication. Covered.
Audit and appeals are the workhorses, but Ember protects Women's Health revenue at every stage of the cycle.
Eligibility Verification
Confirms active coverage, maternity benefits, and preventive-visit eligibility before the visit, and flags coverage gaps before they become billing problems.
Prior Authorization
Identifies which surgeries, imaging, and procedures require pre-auth, generates the required documentation, and submits through payer portals, before scheduling.
AI Medical Coding
Reviews 100% of encounters, global OB, preventive + problem visits, and gynecologic surgery, against national standards and payer rules before claims submit.
Pre-bill Audit
Predicts and prevents denials before claims go out, catching modifier-25 gaps, antepartum miscounts, and surgical bundling before they generate write-offs.
Denial Management
Full appeal lifecycle for every Women's Health denial type, modifier, bundling, medical necessity, and auth failure, tracked to adjudication.
Underpayment Recovery
Parses contracts to model what each visit, episode, and procedure should pay, then surfaces line-item underpayments at scale.
Episode and procedure Women's Health revenue, recovered
-57%
denial rate
-45%
cost to collect
100%
encounters audited
3 days
to first results
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
Frequently asked questions
Everything you need to know about how Ember fits into your revenue cycle.
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
See what your Women's Health practice is leaving on the table
Bring us 30 days of denial data. We'll show you where the revenue is and exactly how Ember would recover it.