Wondering how to unlock the potential of your gastroenterology billing services? Our comprehensive guide is here to answer all your billing queries. Learn everything from endoscopies to CPT codes.
Overview of Gastroenterology Billing Services
Gastroenterology billing services are specialized for billing and coding your gastroenterology practices. Gastroenterology is a branch of medicine that deals with the digestive system and its disorders. Its billing services manage the procedures conducted to treat those disorders.
They include endoscopies, colonoscopies, and other gastroenterological treatments. You have to assign accurate codes to those treatments. There are insurance claims and pre-authorizations as well that you must handle.
Hospitals also have to address any challenges that come with billing services. You want to improve your revenue cycle and reduce claim denials. Addressing them helps with that and provides financial efficiency. It is important to be an expert in gastroenterology coding.
You must also understand its intricacies. Compliance with industry standards should also be ensured. This specialty deals with gastrointestinal tract diseases. This includes all the organs along the alimentary canal. You must deal with billing all the services related to them.
How Does Gastroenterology Billing Help?
Proper gastroenterology billing brings a lot of benefits to your revenue. You must practice thorough revenue cycle management as well. The process involves tracking your reimbursement claims. You have to monitor the days in your accounts receivable.
It refers to the average number of days needed to collect pending payments. You can aim to keep the days in accounts receivable below 50. Most practices are able to work around 30 to 40 days. Billing also ensures that you have received those payments.
Your adjusted collection rate should be at least 95%. Gastroenterology billing also follows up on denied claims. The denial rate represents the percentage of claims denied by insurance companies. You can track this amount for a certain period.
Consider your practice doing well if your denial rate is below 5%. Billing services also treat your payment plans correctly. Such plans give your patients more time to pay for gastroenterology billing services. But keep in mind that they can also increase your days in accounts receivable.
Hospitals usually bypass this by adding separate accounts for patients on payment plans. Separate accounts keep your calculations simple. There are accounts involved in the collection as well. These ones are written off to current receivables.
You can calculate the days in your accounts receivable for accuracy. This can be done with and without collection revenue. In this case, you have to be careful of credit impacts. You may fail to subtract credits from your receivables.
You may get a false impression that your practice is doing better than it really is. Gastroenterology billing also increases your payer reimbursement speed. You may get some reimbursements more quickly than others. This can decrease your days in accounts receivable.
How to Measure Performance of Gastroenterology Billing?
You can measure how your gastroenterology billing is performing with insurance aging reports. You can receive them from your billing department. An ideal period is a monthly basis. These reports show you the total duration of your claims to be paid. But it can be tough to check if those reports are even accurate.
Receiving payments does not always mean you are getting the maximum amount possible. Gastroenterology billing provides good aging reports. They can accurately show the performance of your medical billing staff. This way, you can get a better idea of following up on patient accounts and insurance claims.
Challenges in Gastroenterology Billing
It can get challenging for hospitals to stay updated on the ever-changing standards. These standards apply to your medical coding and billing services. Insurance companies set these standards to release payments for gastroenterology practices.
Failure to stay updated results in inaccurate and outdated information in your claims. And you may end up with claim rejections and delays. They can impact your hospital’s revenue and operational efficiency.
Changes in Healthcare Regulations
The Centers for Medicare & Medicaid Services tend to change their regulations a lot. And you may face difficulties in adapting to those dynamic regulations. These regulations are specific to gastroenterology.
It means that they are important. You may encounter compliance issues that can risk financial penalties. Your service delivery might also get disrupted. These challenges can affect your financial health.
Hospitals also have to grapple with claim denials from insurers. You might also have to deal with insurance denials. They pose a significant challenge for hospitals that provide gastroenterology billing services.
A lot of time and resources are required to identify denial reasons. You may even have to appeal and rectify those issues. These practices can strain your hospital resources. This way, you can find yourself incurring a lot of financial losses.
Ensuring Medical Necessity
Another challenge for hospitals is ensuring the medical necessity of gastroenterological procedures. Their medical necessity determines their eligibility for reimbursements. You can find it challenging to ensure they meet the criteria for medical necessity.
Hospitals may fail to justify the necessity of their procedures to insurers. In such cases, your claims fall under inaccurate documentation. And insurance companies deny those claims. As a result, your reimbursements and financial stability take a hit.
Complicated Patient Collections
You may also be unable to manage the patient collection process properly. It can get complicated for your gastroenterological services. It has an intricate nature and poses a serious challenge for hospitals.
You can find it difficult to manage the financial responsibilities of your patients. They primarily include copays and deductibles. This challenge can lead to delayed or incomplete revenue collection. As a result, your entire financial performance can be affected.
Benefits Of Outsourcing Gastroenterology Billing Services
1. Dedicated Billing Managers
Outsourcing companies have dedicated billing managers just for your billing services. They can conduct audits to check for missing and invalid documents. These managers also assign your work to experienced and skilled coders.
They are usually certified with the AAPC and updated on CPT, ICD-10, and HCPCS codes. They are also knowledgeable about NCCI edits. It enables them to assign accurate codes to complicated procedures.
2. Quality Support
Outsourcing companies provide quality support to ensure your clinical documents are accurately recorded. They also verify your charge entry process before claims submission. Their verification ensures your submitted claims follow the rules of major insurance. They include Medicare, Medicaid, Workers’ Compensation and Personal Injury.
Under quality support, outsourcing companies also assist your patient collections. They help you deal with the payment rules of private and government health insurance as well. This way, hospitals ensure a financially compliant and successful practice. Such companies focus on reducing your accounts receivable as much as possible.
3. Advanced Technology
Outsourcing companies also use advanced technology like web-based software. They use such gastroenterology billing software to work on your practice. It can have significant impacts on your practice revenue and cash flow. You can also get your front-end denials reduced.
Their advanced technology also shifts your focus from denial management to denial prevention. This shift improves your cash flow through efficient payment posting. You can also get your refunds adjusted. The software can also reduce your manual entry concerns.
It increases the number of correct fees and collections as well. Such fees and collections enable you to provide high-quality billing services. You can also increase the collection ratio of your patients. This happens due to faster accounts receivable processes and on-time follow-ups.
4. Scalable Services
The services of outsourcing companies are also scalable. Scalability means they can easily expand your billing services. The expansion is based on the changing needs of your practice. Your outsourcing partner can also adjust your resources as the practice grows. It helps you to manage increased billing volumes.
Outsourcing scalable services means your patients only pay for the services they need. This flexibility can save your costs. You can benefit from it during periods of lower patient volume. You can also avoid the fixed hiring and training costs. These costs are associated with the in-house staff for varying workloads.
How Health Quest Billing Can Help Your Gastroenterology Billing Process?
Health Quest Billing has a team of experts. They have extensive experience and knowledge in gastroenterology billing. They understand everything about this specialty. We use their understanding to provide efficient billing services.
We also provide comprehensive reports on your billing processes. Our reports give you valuable insights into your revenue cycle. With those insights, you can make data-driven decisions to increase your revenue. Our services offer enhanced patient experiences.
We handle your billing processes while you can focus on patient care. We also have 24/7 support for your billing queries and issues. Our team is always ready to assist you. This way, we can ensure smooth and uninterrupted billing operations for your practice.
How to Prevent Gastroenterology Billing Claim Denials?
1. Claims Denial Logs
You can use claims denial logs to maintain your important data. You can take this to the next level with an electronic version of those logs. You can use it to access relevant information across your hospital. You can even archive your documentation with several insurance providers.
This way, hospitals analyze and update their claim denials. Logs also enable you to record your service dates. Other records include demanded amounts, unique claim numbers, and denied medical codes. You can use the logs to easily access them later.
You can also use claim logs to assess your past filing mistakes. With electronic payments, you can save time for every transaction as well. Hospitals can also record their interactions with their insurance partners. This way, they can process their claims well.
2. Incentive Programs
A trained and motivated staff can fix most of the claim filing errors. You may be concerned about the increasing software expenses. So, you might want to consider incentivizing your staff. Incentive programs can reduce your denials.
Incentive measures include offering staff bonuses or time-offs. These benefits promote healthy competition within your staff. Such competitions lead to productive results. You will soon notice a sharp decrease in denials after such measures.
They are cost-effective and efficient solutions to your denial management issues. Hospitals also share vital details about their denial management trends. It helps them contribute well to filling their claims. The key is to reward your staff when they do good work. It will bring you good results.
3. National and Local Coverage Determinations
Hospitals should familiarize themselves with the national and local coverage determinations. Your gastroenterology billing services should follow their guidelines. This regulatory compliance can also reduce the risk of denials.
4. Endoscopy Billing
The level of detail in your billing should align with the type of your endoscopic procedures. For this, you must differentiate between diagnostic and therapeutic procedures. You can use the appropriate codes for those procedures to do that.
What Are The Most Common Gastroenterology Billing Cpt Codes?
1. CPT Code 91200
You have to assign this code whenever you have to perform elastography. This procedure determines whether liver tumors are nonmalignant or benign. You can also differentiate between lesions and normal tissue. The normal shape of tumors is less elastic than normal tissues. Also, nonmalignant tumors are more elastic than cancerous tumors.
2. CPT Code 91299
This code can only be assigned to report specific diagnostic procedures. These procedures are only relevant to the gastrointestinal system. And they also do not have a code of their own.
3. CPT Code 91110
Hospitals can assign the 91110 code to two procedures. These are GI tract imaging and capsule endoscopy. GI tract imaging uses X-ray technology to display 3D images. These images are usually of the gastrointestinal tract and organs.
You can even see any tumorous tissue present inside your patient’s body. Capsule endoscopy involves a capsule. Your patients have to swallow it. It contains two tiny cameras inside. They take pictures of the lining of their bowel. You can use those pictures to look for any issues.
4. CPT Code 91035
This code is assigned to the gastroesophageal reflux test. It uses a pH electrode and a nasopharyngeal catheter. The electrode is placed above the lower esophageal sphincter. It documents distal esophageal acid exposure. You have to correlate it with the reflux symptoms.
The Bottom Line
Gastroenterology billing services have specialized procedures. They include endoscopies, accurate codes, and claims. Effective billing improves gastroenterology RCM. It also reduces your claim denials. Some of the billing challenges include dynamic standards and regulatory compliance.
Outsourced billing for gastroenterology can have a lot of benefits. They include dedicated managers, quality support, and advanced technology. Health Quest Billing offers expertise, reports, and 24/7 support. You can prevent claim denials with logs and incentive programs. Some of the most common CPT codes are 91200, 91299, 91110, and 91035.
Contact us today to revolutionize the financial health of your gastroenterology practice.