A large number of endoscopies and colonoscopies make the management of Gastroenterology (GI) billing processes highly challenging. Moreover, detailed documentation requirements often become a reason for financial drain for Gastroenterology specialists. Setting up an efficient billing system with trained expertise transforms billing processes into a high-speed revenue generation engine. Specialized gastroenterology billing services ensure clean claim submissions. As a result, GI doctors boost their revenue by up to 20% to 30%, reduce stress, and focus on patients.
Effortless Claim Management for GI Specialists
The increasing number of patients increase administrative workload for digestive health physicians. The increasing demand for specialized care in gastroenterology hit a record high. A rise in gastrointestinal disorders is pushing the global GI market to $93.8 billion by 2032. As the number of patients continues to grow, the workload on revenue cycle management (RCM) intensifies. Maintaining claim accuracy while ensuring timely reimbursements becomes harder for gastroenterologists.
Specialized gastroenterology medical billing services efficiently handle coding, documentation, and claims submission. They ensure accurate coding for Endoscopic Retrograde Cholangiopancreatography (ERCP) and motility studies and submit clean claims. Minimizing the chances of errors and claim denials. Billing experts enhance the efficiency of claim management with these strategies:
- Expert billers perform regular audits to ensure perfect documentation.
- Actively respond to claim denials, identify errors, correct them, and resubmit within the required timeframe.
- Integration of the Electronic Medical Record (EMR) with the billing software eliminates the need for manual data entry. Significantly reducing administrative workload.
- Creation of a simple dashboard enables GI doctors to analyze their financial health.
Moreover, billing experts for stomach and intestine doctors also perform real-time eligibility checks before practices perform procedures. It clarifies patients’ coverage plan, benefits, and denials, and saves their time. The use of automated claim scrubbing software automatically identifies the billing errors before claim submission. Improving the financial stability of endoscopy experts is the primary purpose of their services.
Core Challenges in Gastroenterology Billing
Gastroenterology specialists often face different clinical environments, making billing more complex. For example, during a routine colonoscopy screening, doctors may discover a polyp and need to remove it. Moreover, GI-specific codes are highly technical and require meticulous attention. A minor coding error and wrong use of a modifier can lead to instant claim denial. Understanding these challenges can help medical practices overcome challenges and speed up payments.
Modifier Misuse
A modifier is often a two-digit code. Billers use it while claim submission to explain important details about the procedure. For example, they use Modifier -51 when a doctor performs two or more than two procedures. Forgetting to add this modifier can result in revenue loss for endoscopy experts. Similarly, Modifier -59 defines that the healthcare practices performed procedures on two different anatomical sites. Writing the wrong modifier may lead to claim denial. The right use of modifiers accurately describes the exact nature of the procedure to insurance companies and payers.
Bundling and Unbundling Errors
The National Correct Coding Initiative (NCCI) sets strict rules for billing procedures together. Healthcare practices must combine related services for billing when rules permit. While unbundling is charging codes separately when rules require them to be billed together. However, payers consider unbundling a billing error and a fraudulent activity. Simultaneously, increasing the chances of claim denials and external billing audits.
Documentation Gaps
Insurance companies expect bowel disease doctors to submit clean documentation. Those must reflect the only services the practice delivered. Incomplete and unclear documents cause payment delays or claim denials. The documents must include the following information:
- Documents must include clinical and procedural findings.
- Define notable abnormalities in the documents.
- Include the doctor’s treatment.
- Write the reason for the procedure.
Sometimes hepatologists do not add enough details, such as mentioning treatment and findings. They also skip writing scope details or the digestive tract they checked. Poor documentation lead to claim denials and revenue loss.
Eligibility and Pre-authorizations Issues
Some procedures in gastroenterology billing require approval from insurance companies before offering treatment. More than 50% of patients struggle to obtain pre-authorization because insurance companies take too long to respond. Moreover, each insurance company has different rules to manage authorization requests. As a result, patients’ treatment faces delays.
Moreover, eligibility issues occur when coverage gaps exist or when records do not align with reality. Early eligibility verification maintains record accuracy, reduces the chance of claim denials, and improves overall revenue.
Outsourcing gastroenterology revenue cycle management ensures patient coverage before appointments and manages insurer requirements. Assisting gastroenterologist physicians to get faster approvals.
Compliance Issues & Legal Violations
Healthcare practices must follow healthcare laws and regulations, such as the Health Insurance Portability and Accountability Act (HIPAA). Failing to comply with these rules can result in legal and financial penalties. Some of the common HIPAA violations are:
- Sharing patient information without consent.
- Storing patients’ data in an unprotected manner.
- Patients’ records get accessible to unauthorized staff.
Such violations of HIPAA can result in fines for gastroenterology practices under several US healthcare laws and regulations. Those can include criminal charges, loss of license, and hefty fines.
A professional gastroenterology billing company uses encryption to protect patient information from unauthorized access. They limit staff access to only necessary information. Moreover, expert billers strictly follow HIPAA security standards.
How Professional Billing Services Simplify Claim Submission?
Certified billing professionals are experts in coding. At the same time, they ensure they document each procedure with absolute precision. They translate clinical work into specific Current Procedural Terminology (CPT) codes. Using advanced technology, they automate data entry, code checking, and compliance before sending claims. Speeding up reimbursements, preventing rejections, while reducing errors. Here’s how professional billers make claim submission easier:
Ensure accurate specialty coding
Professional billers match each diagnosis and procedure with the correct International Classification of Diseases, 10th Revision (ICD-10) codes. Highlighting the medical necessity to minimize the chances of claim denials. Moreover, if a claim misses important information, the billing team quickly fixes and submits it. Such a proactive approach turns complex billing processes into a smooth and reliable system.
Upfront Verification
The services of a gastroenterology medical billing company help medical practices verify patients’ insurance coverage before appointment confirmation. Preventing denied claims that occur due to insurance inactivity. They verify benefits in real-time, identifying high deductibles or expired policies before a practice starts a procedure.
Clean Claim Submission
Professional billers use three step scrubbing process before claim submission. They use advanced software to catch typos, missing codes, or insurance errors before submitting a claim. It improves the claim approval rate to 98%, ensuring the practice receives payments on time. This strategy also helps healthcare professionals to develop predictable revenue streams. In this way, the gastroenterology billing services company helps healthcare practices to stop endless resubmissions.
Outsourcing billing processes allows healthcare providers to achieve higher first-pass clean rates, reduce denials, and improve overall workflow.
Dynamic Denial Management
Smart handling of denied claims helps healthcare practices to recover revenue as soon as possible. Each claim denial gives a lesson to handle billing more efficiently in the future. A professional GI billing team finds the reason for claim denials and fixes the errors. They resubmit the claim immediately to the insurance company to prevent revenue loss. Moreover, they update the system so the same mistake does not happen again.
Benefits of Partnering with a Gastroenterology Medical Billing Company
Partnering with a specialized gastroenterology billing company enhance efficiency of billing processes. The expert billing services reduce the administrative burden on the healthcare staff while saving them from excessive paperwork. At the same time, expert services offer better proficiency in writing medical codes, managing revenue collection, and maintaining compliance standards. Here are the reasons that answer why outsourcing medical billing matters for your practice:
Boosting the Revenue Growth of a Healthcare Organization
Professional billing services for GI doctors reduce Accounts Receivable (A/R) days significantly. Accurate claim submissions with proper coding increase overall collections up to 30%. It also maximises reimbursements and improves operational efficiency. Billing professionals also actively follow up on unpaid and denied claims, ensuring gastroenterologists receive payment for each service they deliver. Enabling healthcare practices to see more patients and focus more on their treatment.
Reduces Administrative Burden
Gastroenterology coding and billing services reduce the administrative stress of healthcare staff. Outsourcing transfers billing responsibilities to specialized experts, improving work-life balance for healthcare providers. GI practice billing solutions providers handle all communication with insurance companies and payers on behalf of healthcare providers. Contacting insurance adjusters to clarify claims and resolve denials to ensure timely payments. Saving healthcare staff from managing phone calls and paperwork. Efficient communication between insurance companies and medical billers keeps the revenue cycle smoother for healthcare practices.
Technology Integration
Technology integration of the electronic health record (EHR) with GI billing services minimizes billing errors while speeding up reimbursements. Using tech tools in daily tasks transforms the overall revenue cycle. Data flows automatically from clinical notes to the billing platform. Eliminating the need for manual data entry while speeding up claim processing.
Compliance Risks Mitigation
Strategic gastroenterology revenue cycle management protects healthcare professionals from legal and financial risks. Assisting them in maintaining compliance in the modern healthcare environment.
Professional billers stay updated with the latest Centers for Medicare & Medicaid Services (CMS) rules and payer policies. Ensuring each claim aligns with proper documentation while maintaining compliance with strict HIPAA protocols.
How to Select the Best Gastroenterology Medical Billing Services
Not all billing companies can deliver services that meet the requirements of gastroenterology specialists. Therefore, while selecting a billing partner, practices must consider that they have the following qualities:
- Ensure the gastroenterology billing company has the specialty-specific expertise. Their coders must hold certification from the American Academy of Professional Coders (AAPC).
- The outsourcing billing partner must have a proven track record of a high first-pass clean claim rate. They must know the methods of documenting GI procedures to maximise practice revenue. Moreover, a gastro billing service provider must have experience in working with specific gastroenterology software.
- Must provide a real-time dashboard to maintain transparency. Enabling healthcare practices to track collection rates, denial trends, and profitable procedures.
- Esophagus and gut specialists must select scalable billing services for gastroenterologists. So, it supports the financial and operational growth of healthcare practices.
Conclusion
Expert gastroenterology billing services simplify claim processing, easing worries of administrative tasks for healthcare providers. At the same time, the professional billing services improve cash flow while ensuring faster reimbursements. They use correct codes and modifiers to reduce claim denials and minimize the chances of external audits and regulatory penalties. GI billing specialists also perform regular internal audits to identify revenue leaks, helping practices to maintain financial stability.
Partner with Physicians Revenue Group, Inc. to simplify your GI billing, maximize revenue, and secure the financial health of your practice today.
