Many gastroenterologists desire to run a successful practice with constant cash flow. But practicing in an industry with a lot of regulations and medical claims to be submitted before getting paid for every service can be a very difficult task.
Reducing revenue losses and maximizing reimbursement in gastroenterology often feels impossible to achieve due to the constant changes in coding, multiple gastroenterology billing requirements, and ever-changing insurance policies.
The best way for gastroenterologists to ensure they are paid at the right time is by outsourcing their coding and billing processes to professional gastroenterology billing services.
In this blog, we will dive into the complex topic of gastroenterology billing process and help you manage it effortlessly. By the end of this blog, you will have a clear understanding of how gastroenterologists can stop revenue loss.
The Basics of Gastroenterology Medical Billing Explained
Gastroenterology is a highly specialized field in healthcare that takes care of people with stomach and digestive problems. Doctors in this profession find out what’s wrong and give treatment to help with issues such as stomach pain, heartburn, or bowel problems.
Gastroenterology medical billing is the process of accurately using the right codes and processes to represent services provided by a gastroenterologist to let insurance companies know about the treatments a patient received.
Why Gastroenterology Billing is Unique
Unlike other healthcare providers, gastroenterologists earn most of their revenue from carrying out clinical procedures. These can be in the form of treatments or tests that diagnose and treat problems related to the digestive system.
However, procedures are not the only way, they also earn from seeing patients during regular visits. This includes the first time a patient comes in with a digestive problem, follow-up appointments to see how a patient is doing, and consultations where they discuss test results or plan treatments.
All this makes their billing process more detailed and very complex, which can be confusing if not handled carefully. Every procedure has a specific code that must be used for billing and documentation requirements.
For example, CPT code 45378 is used to represent a screening colonoscopy during billing, and CPT code 45380 is used for a diagnostic colonoscopy. Although the two procedures are similar, they are billed differently, and their reimbursements are not at the same rate.
Therefore, when gastroenterologists use these codes interchangeably, their medical claims will without a doubt be denied by insurance companies.
Any mistake at any point during the process can make gastroenterologists lose the money they ought to receive for services rendered to their patients.
Common Reasons for Revenue Loss in Gastroenterology
- Incorrect Coding
One of the most common reasons for lost revenue is using the wrong medical codes when billing insurance companies. In gastroenterology, many procedures are very similar but have different billing codes.
This is mainly to let insurance companies know what services were provided and why. Using the wrong code to represent a procedure or diagnosis can result in rejection of your medical claim.
- Missing Medical Necessity
Even if the right code is used, insurance companies also want to see why the procedure was necessary. For example, a colonoscopy medical claim can be denied if the patient’s symptoms are not clearly documented in medical records. Ensuring thorough and complete documentation helps explain the treatment provided to support the DME billing process.
- Insurance Verification Errors
Before providing any service, it’s important to confirm that the patient’s insurance is active and covers the planned procedure. When a gastroenterologist ignores this step or doesn’t check properly, they risk performing procedures that the insurance won’t cover. This often results in surprise bills for patients and unpaid claims for the practice. It also leads to frustration and can hurt patient satisfaction.
Strategies to Reduce Revenue Loss and Improve Reimbursement
- Ensure Accurate Coding Every Time
No matter how seamless every step in your DME billing process is, using the wrong codes will still lead to claim rejection. Every procedure and diagnosis have its unique code and applying them correctly is the only way to receive faster reimbursement.
To avoid this, it is important to organize training for your coding team regularly and use coding software that is specific to gastroenterology practice.
- Document Patient Journey Clearly
Even if your coding is accurate, the insurance company can still reject your claims if there is an error during the documentation process. Always ensure every detail about your patient is correct, and each medical procedure is thoroughly explained.
- Optimize Pre-Authorization Process
Some gastroenterology procedures such as capsule endoscopy or advanced endoscopic procedures require pre-authorization from the insurance company before they can be performed for the patient. Ignoring or skipping this step will definitely lead to claim rejection which can affect the practice’s RCM. To avoid this, gastroenterologists must ensure their staff know which procedures need pre-authorization and submit every required document for faster approval.
- Verify Patient Insurance Eligibility
Before treating any patient, it is mandatory to first ensure they have insurance coverage for the procedure they need. By verifying the insurance eligibility, both parties are very clear about what the patient is responsible for paying and what is covered by the insurance company. This process makes the patient's journey easier, avoids billing issues, and reduces the chance of non-payment.
- Bill for The Services Provided
Sometimes, procedures performed during patient visits are accidentally left off the bill. This happens due to workflow errors or poor communication between clinical and billing staff. To prevent this, create a checklist of all common procedures and services. Use tools within your EHR system to ensure that every service that might have been missed is charged.
- Appeal Denied Claims
Claim denials are very common but ignoring them continuously can lead to slower cash flow and affect the practice's revenue over time. Every insurance company has a specific time frame to appeal denied claims.
To handle this, have a dedicated team that is responsible for reviewing denials, fixing issues, and resubmitting them within the deadline.
- Improve Revenue Cycle Management
Managing every step of your billing from scheduling appointments to collecting payments is known as Revenue Cycle Management. This can be done accurately by investing in the right RCM software or partnering with a billing company with many years of experience in gastroenterology.
- Outsource to Billing Experts
If managing your medical billing is becoming too complex or time-consuming, outsourcing to a billing company will relieve you of all the stress. Professional medical billing companies have trained coders, denial management experts, and compliance specialists who can handle the entire process.
The Key Takeaway
From the above points, it is clear that billing in gastroenterology requires a lot of attention to detail and expertise to get faster reimbursement. Gastroenterology billing services are the best way to handle all these challenges and bill smarter.
With Eminence RCM by your side, you gain a trusted partner that understands the challenges of your field and has the tools and technology to overcome them. From boosting reimbursement and reducing denials to ensuring compliance and improving your entire revenue cycle, we are here to help your practice thrive.
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