How Gastroenterology Billing Services Tackle Denials End-to-End?

 Are you finding difficulties boosting reimbursement for your gastroenterology practice? Then you’re not alone because most of the providers face issues with this. However, if delayed payments and claim denials are eating up your revenue, now it’s the time to take the right action. But the issue is gastroenterology billing is a complex affair and claim denials can drain the revenue. So, it is highly important to understand the major causes of claim denials and also their solutions.

The Reason for Claim Denials

The billing process in gastroenterology specialty incorporates complex coding procedures, from colonoscopies to endoscopies. The usage of specific codes such as CPT 45378 which is diagnostic colonoscopy and CPT 43235 which is upper GI endoscopy. These coding processes need to be very precise, and you need updated knowledge of coding regulations to make sure no claim denial occurs. However, the claim denials can arise because of coding errors, improper documentation and failure to meet all the payer requirements. According to several reports, 10-15% of claims in the gastroenterology practice face several denials, which leads to major loss of gastroenterology reimbursements. Hence, reducing these claim denials can be a major step in maximizing the reimbursement process.

How to Streamline Gastroenterology Billing Process?

There are several strategies to streamline the billing process for gastroenterology practice. These strategies are highly important to reduce claim denials which are described below:

Optimizing Coding Accuracy

Accurate coding is considered as the backbone to reduce claim denials. You need to make sure that your billing staff is highly trained with the latest updates in coding and regularly review coding accuracies for common procedures. Hence, implementing claim-scrubbing software can also flag potential errors which helps to improve claim acceptance rates.

Enhancing the Documentation Practice

Incomplete or inaccurate documentation can lead to claim denials in gastroenterology billing. The providers need to ensure that the documentation supports the codes, especially for the complex procedures like therapeutic endoscopies. Some of the tips to improve the billing process also include standardized template for documentation and conducting regular audits. Hence, all these steps ensure that these claims are backed by proper documentation, increasing the chances for reimbursement.

Monitoring RCM KPIs

Tracking the RCM KPIs is essential to boost the gastroenterology billing process and improve the reimbursement procedure. There are several important KPIs to boost reimbursement which include claim denial rate, days in accounts receivable and first pass resolution rate. However, focusing on these KPIs is highly important to provide actionable insights which can improve the clinic’s cash flow.

Aggressive Follow-Up on Accounts Receivable

Old AR can play a major impact in growing your practice’s revenue. However, implementing aggressive follow-up procedures for the aging claims beyond 90 days is essential to get reimbursements. That is why the outsourced gastroenterology billing experts recover the old AR through consistent follow-up and resubmitting the denied claims.

Leveraging the RCM Services

Outsourcing can be a very good option which can reduce the rate of claim denials. These outsourced experts help with maximizing the collection rate and providing data-driven insights. These experts also help with streamlined documentation, dedicated account managers, value added and cost-effective solutions.

Navigating the Payer-Specific Guidelines

The insurance payers have different regulations, guidelines, policies and coverage determination. Hence, the gastroenterology experts stay updated with all the payer-specific coding requirements as well as the healthcare regulations. Hence, to stay updated, you need to regularly review payer contracts, policies and updates to understand all the coverage determinations. Here, you need to proactively leverage all the given resources like the coding manuals and online portals so that they can stay ahead of the policy changes.

How to Choose the Right Gastroenterology Billing Expert?

As there are so many RCM experts out there, how can you choose the right expert for your clinic? Before hiring any billing expert, check if they help with new patient entry, eligibility and benefits verification, prior authorization, medical coding, claims submission, rejection management, payment posting, accounts receivable follow-up, denial management and customer service. The gastroenterology billing experts can reduce your operational costs by 80% and they also have over 100’s of client references. They work with the best in the gastroenterology space and reduce the AR bucket by 30% within one month.

These RCM experts provide robust reporting according to the client’s protocol and they also don’t have any binding contract or restrictive clauses. These companies also help with a 10% buffer resource, and they provide IT managers at very little cost. The companies have less than 48 hours of turnaround time, and they also have low service fees. These experts also help with other specialties such as DME, orthotics and prosthetics, urgent care, gastroenterology, cardiology, infusion and many more specialties. So, if you want to streamline your billing process, it can be a feasible option to have the help of outsourced experts.