Why OB/GYN Practices Wait So Long to Get Paid (and Why 2027 Raises the Stakes)

Reviora Healthcare LLC | Guaranteed Revenue Partner

A patient who starts prenatal care with you this fall will deliver in 2027, after the billing code your practice has leaned on for years no longer exists. You’re delivering months of care today that many practices won’t invoice until after delivery, and the rules for billing it change mid-pregnancy. That’s earned cash sitting in limbo.

Why does OB/GYN billing take so long to get paid?

Because the global obstetric code folds most of a pregnancy into one billable service. The AMA describes it as a single code that effectively represents nine months of care. Bill it as one claim, and the payment clock starts late.

MGMA’s 2025 DataDive definitions use this exact scenario: a practice opens an account when a patient enters a prenatal program and doesn’t invoice until after delivery. That isn’t sloppy billing. It’s how the model works.

Does your Days in A/R number show the whole delay?

Not on its own. Days in A/R is the average time between billing a claim and getting paid, and MGMA’s definitions say a charge enters A/R only when the invoice is submitted. Months of prenatal work can sit outside the metric entirely. mgma

A healthy-looking A/R number can coexist with a stack of unbilled OB episodes, so track both.

Payers aren’t helping. In MGMA’s July 28, 2026 Stat poll, 32% of medical group leaders said days in A/R were higher than a year ago. Those reporting increases cited slower payment, initial denials, downcoding, records requests, and lengthy appeals. The poll drew 203 applicable responses across specialties, so treat it as a directional signal, not an OB/GYN benchmark.

Who pays for deliveries, and why does it matter?

Mostly commercial plans and Medicaid, and each sets its own rules. The CDC’s National Center for Health Statistics reports that private insurance covered 51.8% of 2024 deliveries and Medicaid 40.2%. MGMA notes that Medicare covers a limited share of maternity care, so how Medicaid and commercial payers adopt new coding may matter more than Medicare’s choices. cdcmgma

Payer billing and payment policies can vary, which means your timelines will too.

What changes on January 1, 2027?

The global codes disappear. The AMA’s CPT 2027 update deletes 17 maternity codes, adds 12, and revises six, with 59400, 59510, and 59610 among those deleted. Prenatal and postpartum visits will be reported per encounter using standard office-visit (E/M) codes.

That creates a documentation problem. MGMA’s Heather Signorelli, DO, notes that a light prenatal note carried no financial penalty under global billing, but each visit must now stand on its own as a billable encounter.

Medicare adds uncertainty. MGMA reports CMS is considering optional Medicare G-codes that would preserve a global payment option. That’s proposed, not final. The AMA expects CMS’s final rule in early November.

What should OB/GYN practices do before the cutoff?

Build a baseline now. MGMA recommends tracking days in A/R, clean claim rate, denial rate, net collection rate, and reimbursement per delivery by payer for the rest of 2026, so you can tell in March whether a dip is the transition or an older problem.

MGMA also advises counting patients due on or after January 1, getting each payer’s transition rules in writing, auditing prenatal documentation, and checking contracts that name deleted codes.

This is where specialist-led RCM earns its keep. Reviora runs on Expert-Led Technology: human specialists lead, and technology supports them. For OB/GYN groups, the areas to watch are claims and denials, A/R recovery, and billing and coding. We approach them through our OB/GYN RCM work, part of our broader specialty RCM services.

Our Managed Outcomes Agreement is a written, contractual performance agreement built on five benchmarks. A Benchmark Recovery Protocol activates after two consecutive missed months. See The Reviora Guarantee for how it works.

Want a second set of eyes on your OB baseline before January? Book a 30-minute Free Consultation, or visit Get Started.

FAQ

What is the global OB package in medical billing?
It’s a single CPT code, such as 59400, that bundles routine prenatal care, delivery, and postpartum care into one claim. The AMA says it effectively represents nine months of care as a single service.

Is CPT 59400 going away in 2027?
Yes. The AMA is deleting 59400 and 16 other maternity codes effective Jan. 1, 2027, replacing them with per-visit E/M codes plus new labor management and delivery codes. Any Medicare G-code option is still proposed, not final.

How do I bill a pregnancy that spans 2026 and 2027?
MGMA’s summary of CPT guidance says 2026 prenatal services stay under 2026 rules while 2027 encounters move to E/M reporting, and payers may add their own requirements. Get each payer’s guidance in writing. The AMA also publishes a transition-date FAQ.

What are good days in A/R for an OB/GYN practice?
Rather than chase a generic target, compare against MGMA DataDive peer data and your own pre-2027 baseline. Remember that uninvoiced OB charges don’t count toward the metric until they’re billed.

This article is educational and isn’t coding, billing, or legal advice. Confirm requirements with your payers and compliance counsel.

Reference

• American Medical Association. CPT® 2027 Maternity Care Services code changes. Updated Sep. 17, 2026. https://www.ama-assn.org/practice-management/cpt/cpt-2027-maternity-care-services-code-changes
• Signorelli H, DO. 5 steps OB/GYN practices should take for the 2027 maternity coding transition. MGMA, Aug. 20, 2026. https://www.mgma.com/articles/obgyn-2027-maternity-coding-chn
• MGMA. 2025 DataDive Definitions Glossary (A/R, Collections, Payer Mix). https://www.mgma.com/getkaiasset/8dd9987a-755a-4943-a5bc-98a5690ff99e/2505-D33056D-2025%20MGMA%20DataDive%20Definitions%20Glossary-Letter-V3-NM.pdf
• Harrop C. Days in A/R holds steady for most practices, but payer pressure persists in 2026. MGMA Stat poll of July 28, 2026 (203 applicable responses), published July 30, 2026. https://www.mgma.com/mgma-stat/days-in-a/r-holds-steady-for-most-practices-but-payer-pressure-persists-in-2026
• Osterman MJK, et al. Births: Final Data for 2024. National Vital Statistics Reports 75(2), CDC/NCHS, June 9, 2026. https://www.cdc.gov/nchs/data/nvsr/nvsr75/nvsr75-02.pdf