How GI Billing Services Tackle Complex Billing Process?

Gastroenterology billing is considered a never-ending challenge. It is because there are complex codes, constant updates, and different payer-specific requirements. But the thing is, if this billing is done right, it can not only save your staff's headaches but also boost your practice's revenue. So, let's dive into the daily challenges of gastroenterology billing and how the GI billing services can tackle these challenges.

Reasons Why Gastroenterology Billing is challenging

There are several challenges providers face, starting from complicated procedures to bundling confusion. Let's dive into the challenges one by one:

Complicated Coding and Procedures: Colonoscopies, Biopsies, and Endoscopies, the list of these procedures goes on. However, each procedure comes with unique ICD and CPT codes. Always remember that one tiny mistake can cause claim denials.

Insurance Hurdles: Each and every insurance company has its own rules and regulations. Whether it's getting PA approval or proving medical necessity, it's a full-time job to keep up with these requirements.

Continuous Rule Changes: You think you have figured out everything in the billing process, right? Suddenly then the payer policies or coding guidelines change, hence causing major issues. So it can be considered that it often feels like you’re running on a treadmill, constantly moving but never catching up.

Confusion in Bundling: Sometimes you can face several issues in bundling codes. So, always remember, mistakes will cost you not only claim denials but also reduce patient satisfaction. However, if you don't want to focus on this process, it can be a good option to hire a gastroenterology billing service that can take care of this.

Best Practices of GI Billing Which You Can Follow

There are several best practices for GI billing, which start from mastering coding to staying on top of the denial management procedure. Let's dive into these one by one:

Mastering the Accurate Coding Process

Coding is not only about entering numbers; it can be considered the foundation of your revenue cycle. So, your healthcare staff needs to use the latest ICD and CPT codes to make sure no claim denial occurs. You need to train regularly on coding updates and cross-check each code with the procedure notes to ensure accuracy.

Don't Skip the Benefits and Eligibility Verification

Have you ever experience rejection in claims for not checking on insurance covered. Don't waste time processing claims without verifying eligibility. You need to verify coverage ahead of time before the patient enters the exam room. So, determine their insurance details, deductibles, and copays before the patient visit, and also know how to use automated tools to speed up this process.

Make Prior Authorization Your Best Friend

Every clinic hates dealing with the prior authorization process, but my friend, you're not alone. You need to identify each procedure that needs upfront prior authorization service. Your staff also need to submit all the needed documents to prove all the medical necessity. Finally, you need to keep a checklist for each and every payer to ensure nothing gets out of sight.

Be Extremely Cautious With Your Claim Submission Process

Submitting claims isn't just a simple task; it's an art. So, you need to double-check each error before submitting. After that, you need to attach all the relevant documents, like lab results or procedure notes. Finally, use the electronic claim submission process to avoid delays. Always remember that a simple typo in the policy number or patient's name can lead to claim rejection. If you don't want to deal with all these, GI billing services are there to help.

Staying on Top of Denial Management Procedure

Even the best processes can also deny claims. However, the art of making claims is to do that using proper technologies at the right time. So, you need to keep a denied log and also the reason behind it. You have to resubmit the claim within the given time frame. Finally, use denials to fine-tune all your future submissions.

How Can Technology Streamline This Process?

If you can correctly use technology, it can be a game-changer for your billing process. So, you need to get the right software that was explicitly designed for the gastroenterology procedure. This software can cover everything from coding to tracking claims. However, if you don’t want to train your experts on using these tools, you can take help from outsourced companies. Apart from that, tools like prior authorization and eligibility checks can also save a lot of time while reducing errors. Finally, you need to monitor all the important metrics, such as denial rates and accounts receivable days.

Should You Outsource to GI Billing Services?

Outsourcing can be an excellent option if billing feels like a constant battle. So, there are several reasons for outsourcing, such as the experts process your claims and you get paid faster. Finally, your staff gets free time to improve patient care. Before hiring a partner, check if they can reduce your operational costs by 80% and have over 100 client references. They can reduce your AR bucket by 30% within one month, and these GI billing services also provide dedicated account managers at no extra cost. They provide customized reporting according to the client's protocols, and they also don't have any binding contracts or restrictive clauses. It has also been observed that these RCM companies also help with other specialties such as DME, orthotics and prosthetics, urgent care, gastroenterology, cardiology, infusion, and many more specialties. They are fully HIPAA compliant so that they can protect patient data. So, it can be a good option to hire outsourced services that can streamline your billing process.