How to Reduce Denials in a Gastroenterology Practice

Gastroenterology is a specialized branch of medicine that has changed substantially in recent decades. This is, in fact, a clear sign of the ordinary American’s changing lifestyle. The rise in gastrointestinal illnesses has compelled the public to seek expert medical attention, focusing the healthcare sector’s emphasis on Gastroenterology practices.

One of the challenges that gastroenterologists in the US face is the lack of proper payment methods, which results in higher denials. This can spell bad news for any gastroenterologist or related practices, which is why gastroenterologists in the US are recommended to outsource to medical billing experts.

It goes without saying that medical billing for a gastroenterology practice may be a critical contribution to clinic profitability since certain medical codes apply to gastrointestinal treatments. According to statistics, most practices have a claim settlement ratio of 60 to 70 percent and do not follow up adequately on refused claims.

Reducing Denials:

Reducing denials in a gastroenterologist practice is not easy, but it does not have to be difficult either. The only thing that gastroenterologists need to be aware of are some of the steps that a gastroenterologist medical billing service can take to ensure fewer denials and a smoother payment approval process:

Step 1

As a gastroenterologist, you need to keep a keen eye on your practice’s claim settlement and rejection rates, which could indicate a problem in your system, and suggest that it’s time to outsource to medical billing experts. The first step in dealing with claim denials is to raise awareness of your Gastroenterology practice’s settlement ratio. Most GE practices lose a significant percentage of their revenue due to claim denials, and they aren’t even aware of it. It is estimated that with proper follow-up in less than 48 hours, almost 90% of cases declined for claim settlement can be resubmitted and reimbursed by the insurance. However, in most cases of unsuccessful claims, most GE practitioners are unable to attain such a quick turnaround time. This is just one of the reasons why claim settlements should be recorded and reported on a regular basis by your staff or medical billing service provider.

Step 2

Determine the source of the rejection. Once you’ve determined your Gastroenterology practice’s claim denial ratio, the following step is to discover the gaps in your medical billing businesses and determine the reasons for a denial. The majority of claims are refused because of a lack of process, improper coding, erroneous diagnosis, or insurance coverage. All of these issues may be solved by simply making the necessary modifications to your medical billing process and closely reviewing each claim before it is submitted.

Step 3

Examine the modifications to the Gastroenterology coding system, which is constantly changing or being updated. This is mainly because, as a gastroenterologist, you will conduct operations including gastroscopy, colonoscopy, ERCP, and sigmoidoscopy, among others. These treatments are also covered by CPT and HCPCS codes, which are changed on a weekly basis. Keeping that in mind, the best approach to prevent claim denials is to keep your EMR or medical billing process up to date with current coding changes.

Step 4

It goes without saying that gastroenterologists need to start encouraging the use of pre-authorization for their patients. One of the major reasons a gastroenterologist practice should adopt this strategy is that for the patient to receive insurance coverage, many insurance carriers demand pre-authorization of services. If a procedure is not pre-authorized, insurance companies will deny later claims based on improper processing.

As a result, you should encourage your gastrointestinal medical billing staff to do case pre-authorization for all of your patients and make sure that the medical billing service you hire does the same to ensure that your gastroenterologist practice is HIPAA compliant.

Step 5

Another important step for any gastroenterologist’s practice is to maintain insurance-specific records. While your GE practice may be careful about medical billing, but standardizing the claim filing and settlement procedure is tough mainly because of a diverse clientele. This also includes Medicare, Federal care, Medicaid, and numerous private insurance providers. To incorporate changes in your system, you must monitor each insurance provider’s revenue contribution and claim settlement method and outsource to medical billing experts who can ensure that your billing approvals are on track.

Changes to Medicare in 2021

Staying on top of the latest changes and additions to Medicare rules and regulations for gastroenterologists can help to significantly decrease the number of denials that are faced by a gastroenterologist practice. Keeping that in mind, the following are some of the major changes to Medicare that gastroenterologists need to be aware of to reduce billing complications and denials:

• Medicare proposes to maintain the current values for esophagogastroduodenoscopy (EGD) with biopsy (43239) and colonoscopy with biopsy (45385).
• Medicare proposes to increase the price for scope video system equipment (ES031) to around $70,000, which is also good news.
• Due to budget neutrality regulations, this may not be reflected in payments for all E/M codes.
• According to the revised Medicare plans, cuts to GI reimbursements could be about 4%, depending on the services of the practice.

JBF Medical Billing, LLC. is an experienced and reliable billing service exclusively for Gastroenterologists and Gastroenterologist-related practices. What makes this service unique is that we offer it specifically for gastroenterologists and gastroenterologist-related practices. This means that your medical billing is being taken care of by the experts. Our medical billing software links easily to most of the EHR (electronic health records) software that physicians use.

JBF Medical Billing LLC is also a proud member of the American Gastroenterological Association (AGA), the American Association of Healthcare Administrative Management (AAHAM), and the American Medical Billing Association (AMBA), so you can rest assured all of your Revenue Cycle Management and HIPAA Compliance are taken care of by the experts.