Maximizing Your Revenue Through GI Billing Services

According to Becker’s review, there are 13 specialties seeing decline in reimbursement rates, and gastroenterology is one of them. Moreover, a survey in the American Journal of Gastroenterology stated that reimbursement for bioscopies and colonoscopies have dropped by around 38% in the last 15 years. It is because the GI billing process is a very difficult process because of several codes and modifiers. Though GI billing is full of rules and complexities, the important step is to master the basics, which include authorization, core procedures and documentation to make sure no claim denial occurs. These fundamentals are considered as one of the major foundations for improving the clinic’s RCM process.

The Role of Prior Authorization

Prior authorization is one of the major pain points for gastroenterology practices. As there are several colonoscopies with EGD, polypectomy and capsule endoscopy, payers need prior approval before rendering services. So, missing authorization results in claim denials. The best practices to manage the PA process include:

• Verify the authorization needs for different procedures and payers.
• Document all the authorization numbers in the patient’s medical records.
• Establish workflow for resubmissions and renewals when authorizations expire.

Managing the PA process takes significant time and coordination; that’s why the providers take the help of outsourced GI billing services. The right company can streamline the PA process, and flag all the missing information before claims get out.

Documentation: The Foundation for Clean Claims

Detailed and accurate documentation is the foundation of proper gastroenterology billing. Each patient entry needs to support all the medical necessities and capture the subtle specifics of all the performed procedure. For instance, document whether a colonoscopy has been performed to screening procedure versus the diagnostic procedures to understand the impact it has on the clinic’s reimbursement process. It has been observed that there are several components of documentation which include:

• Diagnostic Versus Screening colonoscopy: There needs to be a documentation process to understand whether a screening colonoscopy procedure is covered under preventive care or if a colonoscopy is diagnostic.
• Level of All Small Details: Documentation notes need to capture number, location, and also the size of biopsy sites, polyps and any type of therapeutic interventions performed.
• Linking Diagnosis to Procedure: Each and every CPT code needs to be supported by an appropriate ICD-10 code in the medical record. So, without this clear link, payers may deny claims for lack in medical necessity.

Core Coding Challenges and GI Procedures

Colonoscopies and endoscopies are the heart of every gastroenterology practice. Because of the high procedural volume, it is important that these processes need to be billed accurately to make sure no claim denial occurs. There are several coding pitfalls for these core procedures including incorrect modifier usage, confusion amongst diagnostic coding and failing to capture all the add-on codes for biopsy like procedure. That’s why the outsourced GI billing services establish clear protocols and stay updated with the coding changes to make sure no issue occurs.

Knowing Your Payer Mix

Knowing all your payers and how they behave is a critical part of coding. The commercial payers like Medicaid and Medicare reimburse differently and impose their own authorization rules. However, when you analyze all the payer's performance, it can highlight several trends including high denial rates, delayed payments, and lesser reimbursement for high-volume processes. So, when gastroenterology practices can understand their payers' requirements, they can renegotiate contracts, prioritize appeals, and strengthen the RCM process. That's one of the main reasons these providers turn to outsourced experts to make sure no claim-related issue occurs.

Understanding the Denial Reasons

Denials are one of the major reasons for revenue leakage in gastroenterology billing. Though these reasons cannot be totally eliminated, they needed to be thoroughly analyzed, categorized, and reduced. Denials don’t just reduce the reimbursement; they lead to a huge administrative burden which costs clinics billions of dollars. The major denial reasons include missing authorizations, incorrect documentation and modifier usage, duplicate claims, and patient eligibility issues. These reasons offer compelling insights into the reasons for revenue cycle breakdown.

Taking the Right Step

There are several key components in gastroenterology billing which include accurate documentation, precise billing codes, using all the HCPCS codes, modifiers and place of service, and finally, compliance with the payer needs. Here, the outsourced GI billing services come who can reduce your operational costs by 80% and have over 100’s of client references in case you want any. Moreover, they also reduce the AR bucket by 30% and provide robust reporting according to the client’s needs. These services don’t have any binding contracts or restrictive clauses. They also help with other specialties such as DME, urgent care, orthotics and prosthetics, infusion, cardiology, and many more specialties. If you want to streamline your billing process, it might be a feasible option to outsource GI billing services in that matter.