Enjoy Great Revenue Boost with Expert Gastroenterology Billing Services

Gastroenterologists are seeing their payments shrink even though the demand for their services keeps rising. According to Becker’s ASC Review, gastroenterology is among the 13 specialties with declining reimbursement rates, even as more patients are being treated. A study in the American Journal of Gastroenterology also found that payments for colonoscopies and biopsies have fallen by 38% in the past 15 years.

With growing pressure, there’s no room for mistakes in your gastroenterology billing services. It is true that the process is complex but you can only build a strong billing foundation if you master the billing formalities like prior authorization, documentation and other vital components. Your financial foundation can always stay strong when you have a perfect revenue cycle management process in place.

Now, you should know about the vital areas that form the backbone of your billing system.

The vital components of gastroenterology billing services

The overall role of prior authorization

Prior authorization is one of the biggest challenges for gastroenterology practices. You always need prior authorization approvals for the procedures like colonoscopy, EGD, capsule endoscopy, etc. A lot of gastroenterologists often face revenue loss because of missing or incomplete prior authorizations. Your backend team should carefully check payer rules, record PA number and set proper workflows for renewals. Since managing prior authorizations takes time and effort, many practices choose an experienced gastroenterology billing partner. The right partner can simplify PA management, verify eligibility quickly, catch missing details early, and help reduce costly write-offs.

Documentation: The key to ensuring clean claims

Accurate and detailed documentation is the core of successful gastroenterology billing. Every note should clearly show medical necessity and describe the exact procedure performed. For example, stating whether a colonoscopy is screening or diagnostic affects coding and payment. Your backend team must record if it is preventive or diagnostic, particularly when you have performed polypectomy during the screening process. The billing professionals should also capture the location, number, and size of polyps, the site of biopsy, and any performed treatment. Your team must assign accurate diagnosis codes to avoid denials. A gastroenterology practice can always adhere to compliance and secure timely reimbursements with a perfect process of documentation.

The vital gastroenterology procedures coding

You might have already realized that endoscopies and colonoscopies are the frequently performed procedures in your practice and accurate billing for those procedures is highly crucial. The reason is pretty simple- those procedures are done in high volume and you can only maintain a steady revenue stream with accurate gastroenterology billing services. You need to realize that coding is one of the challenging components of your billing process as each procedure has specific rules but modifiers, multiple procedures in one session; frequent coding updates are the elements that make your job difficult. It is really important for you to have clear coding protocols, keep your staff updated and audit each claim regularly to avoid expensive mistakes.

Have a proper understanding of payer mix

Knowing your payers and how they work is just as important as correct coding. We all know that Medicare, Medicaid, and every commercial payer have their own rules for managing authorization, bundling, and preventive services. Medicare may cover a complete screening colonoscopy, whereas a commercial payer may have a cost-sharing rule. Your team can always identify issues like frequent denials and payment delays by tracking the current trends. You can easily focus on appeals, improve contracts and strengthen cash flow when you have a clear understanding of different insurance payers. Most gastroenterologists now partner up with experienced RCM companies that know how to provide clear insights into all payer behavior.

Implement a perfect denial management process

Denials are a major cause of revenue loss in gastroenterology billing as they delay payments, increase workload and cost your practice a hefty amount of money. You are always likely to face denials because of missing PA, poor documentation, wrong modifiers, duplicate claims and eligibility issues. You can actually stay away from denials, improve operational efficiency and safeguard revenue by implementing an effective denial management plan.

The harsh reality is that most gastroenterologists often lack enough budget to maintain an experienced team of billing professionals in-house. Are you one of them? You can simply outsource your gastroenterology billing services to a professional RCM company as their professionals know what it takes to streamline all the billing steps. A professional billing company always allows you to save operational costs by up to 80% and gives a substantial boost to your overall revenue.