Gastroenterology Billing Challenges and Key Strategies to Reduce Denials: An Ultimate Guide

Are you a gastroenterologist struggling to navigate the complexities of billing and coding? If so, you would be aware that running a gastroenterology practice is not just about providing the best patient care and treatment but also entails knowledge of coding requirements, billing challenges, and other processes. As a practitioner who regularly conducts gastroenterology procedures for patients, it is crucial to have a comprehensive understanding of all related codes and practices involved in invoicing insurance companies. This is to receive appropriate payments from insurers, ensure the right treatment outcomes for patients, optimize revenue, and ensure compliance.

Similar to any specialty billing system, gastroenterology billing also poses several challenges you and your staff might encounter that could negatively impact your practice. A few common gastroenterology billing challenges will be explored further along with some strategies to tackle them.

Understanding Gastroenterology Billing Challenges

As a gastroenterologist, it is essential to be aware of the challenges present in billing this practice as it can give you a good picture of how to overcome them and ensure that you get paid for the services you deliver to your patients. Some of the prevalent challenges include:

Lack of Proper Documentation

Maintaining proper documentation serves the core foundation of accurate gastroenterology coding and billing. The documents must include detailed descriptions of patient encounters, diagnoses, treatment plans, and procedures performed. Ensuring the accuracy of all information above will not only support appropriate code selection but also reduce the risk of claim denials.

Complex coding requirements

Gastroenterology billing encompasses a few complex CPT (Current Procedural Terminology) codes, some of which include:

• Esophagoscopy (43235)
• Colonoscopy (45378)
• Endoscopic Retrograde Cholangiopancreatography (ERCP) (47420)
• Evaluation and Management (E/M) codes for office visits (e.g., 99213, 99214)

Proper code selection is mandatory to ensure accurate reimbursement and adherence to billing regulations.

Claim submission errors

Errors in claim submissions automatically translate to instant rejections and some of the errors that can be committed include incorrect provider information on claims, wrong CPT codes, incorrect demographic information, and late submission of claims. Errors of this nature will take a major hit on your overall practice revenue and will even pose a health risk for your patients.

Lack of training and education

In some cases, gastroenterology practitioners and staff members may not keep themselves updated with the latest billing trends, coding conventions, and submission protocols that are relevant to gastroenterology. This is a major challenge as the lack of knowledge and expertise will make it difficult for them to handle the claims process efficiently, which will potentially result in claims being rejected.

Regulatory compliance

As a healthcare provider, complying with regulatory requirements is mandatory to ensure the highest patient safety standards. Overlooking this factor can lead to severe legal consequences that can not only impact your practice but also jeopardize your patient’s treatment. However, this can also be a challenge, since there are several compliance rules to follow and keep track of.

In a recent Gartner Survey, it was revealed that around  required assistance in finding relevant information when they didn’t meet a compliance requirement. This shows that the lack of knowledge of medical billing regulations is also a problem that needs to be addressed.

Key Strategies For Reducing Denials and Delays in Gastroenterology Billing

Here are some of the key strategies that you can implement to streamline the billing process, maximize reimbursements, reduce claim denials, and improve your healthcare practice’s revenue cycle management:

Establishing efficient workflows

It is important to enforce uniform gastroenterology billing procedures to handle prior authorization requests with maximum precision and efficiency. To facilitate this, you can assign dedicated teams within your practice to oversee these requests and handle them with utmost care. This also ensures proper accountability as any issues with documentation or compliance can be tracked and rectified instantly.

You can implement electronic claims submission systems and conduct regular audits of claim data to identify bottlenecks in the billing process and ensure timely follow-ups on outstanding claims.

Educating staff and patients

The medical billing landscape is constantly evolving, which mandates continuous education and training for gastroenterology billing staff. Possessing thorough knowledge of industry trends, technological advancements in billing, regulatory changes, CPT codes, etc. is imperative and this can be achieved through staff development programs, billing seminars, and also by collaborating with billing associations for valuable resources. Additionally, educating patients about their insurance coverage and payments will also be effective in solving billing disputes and improving collections.

Analyzing denial patterns

Conducting regular audits and analysis of claim denials will help you identify the root causes of the problem. Some of the common reasons behind rejected claims include late claim submission, lack of insurance eligibility, filing of duplicate claims, etc. By gaining a comprehensive understanding of denial patterns, you can take preventive measures accordingly to ensure this does not happen again.

Comprehensive documentation

As always, proper documentation with updated and accurate patient information is essential to support claim submissions, justify the services provided, and demonstrate the necessity for patient treatment. Also, ensure that your physicians, staff members, and coders receive training and education on coding practices and maintaining accurate documentation to prevent any errors in that arena.

How Does Atlantic RCM Help Address Gastroenterology Billing Challenges?

Atlantic RCM pioneers in providing billing and coding services specifically tailored for gastroenterology practices. Our team of in-house experts ensures accurate coding, timely claim submission, and efficient revenue cycle management to optimize the financial health of your practice. Our billing services include the following:

• Accurate Coding through procedure coding, diagnosis coding, and compliance.
• Claim Submission leveraging electronic claims, document reviews, and claim tracking.
• Denial Management by offering denial analysis, appeal management services, and prevention strategies.
• Accounts Receivable Management by generating aging reports, persistent follow-ups on unpaid claims, and accurate payment posting.
• Patient Billing and Support by generating billing statements, handling patient inquiries, and setting up payment plans.
• Reporting and Analytics through regular financial reports, analysis of key performance indicators, and generating customized reports to meet your needs.

With Atlantic RCM, you can maintain operational efficiency and achieve financial sustainability in your practice. Contact us today for more comprehensive insights on our Gastroenterology billing and coding services and how we can help you give the best medical treatment and care for your patients.

Atlantic RCM is one of the leading multi-specialty medical billing companies in USA that serves 25+ major medical billing specialties. Our experts work across your practice in billing, collections and account receivables management, to help you succeed.

Get in touch with the leading medical billing outsourcing company to learn more. Call us at (469) 501-1500 or write to us Info@atlanticrcm.com