Gastroenterology Medical Billing

It is imperative for gastroenterologists to understand the basic concepts of the reimbursement system to maintain a financially stable practice. Details of gastroenterology services are habitually sent to third party payers, otherwise known as insurance companies for reimbursement.

Gastroenterology billing claims, like other medical billing procedures, are sent to the insurance companies in the form of codes to make it more convenient to quantify and categorize the services rendered by the practitioner.

Billing for Colonoscopies, Sigmoidoscopies, and other Procedures

Gastroenterology billing is a sensitive billing process that requires an accurate inclusion of data to get the right reimbursement for the services rendered. This specialty billing exposes the practice to potential losses if the diagnostics and procedures are not properly coded.

Colonoscopies, for example, are at certain times tagged inappropriately as sigmoidoscopy procedures, because the documentation that is written to support the procedure only defines sigmoidoscopy technique. To properly define colonoscopy procedures, it is required for the coder to note the procedure as “advancement beyond the splenic flexure.”

Gastroenterology practices are commonly exposed to underpayments resulting from improper coding procedures. Gastroenterology requires a complex billing procedure that would properly identify the type of procedure done on a patient to ensure a fair and accurate payment.

At other times, gastroenterology’s requirements for billing exceeds what medical billing software can do, and as a result, gastroenterology practices enlist the services of medical billing firms to assist in the practice’s billing procedures.

MPMR offers premier gastroenterology medical billing services, and has been providing contracting and credentialing as well to GI practices nationwide.

The top certified coders and medical billing experts at MPMR are highly qualified in GI medical billing. They typically increase revenue steadily and help with practice management as well!

Update System to EMR/EHR

Billing issues in gastroenterology practices can effectively be reduced by applying several steps to ensure that your records are kept accurate and that your billing practices are updated with the current guidelines laid out by the Centers for Medicare and Medicaid Services. Protect your gastroenterology practice from potential losses and adverse auditing outcomes by performing certain internal tasks.

Electronic medical records (EMR) and electronic health records (HER) drastically reduce the time in encoding and decoding medical records. Health records that are kept on paper increases the man hours spent in management. Auditing firms and third party medical records management companies often request medical records to match claims.

It takes precious man hours to locate, fax or mail, and manage paper-based medical records. By using electronic medical records, gastroenterology practices can easily manage medical records and at the same time use a streamlined coding system that most insurance companies use.

Keep Up-to-Date with Coding Changes

Keeping your codes up to date reduces the margin for error when documenting your procedures and diagnostics. Last year, gastroenterology coding was revised to make way for a more accurate method of coding. Make sure that your practice’s billing and electronic medical record management uses an updated ICD-10 PCS coding system.

Keep Regular Compliance Sessions

Gastroenterology billing is no stranger to penalties imposed by insurance companies due to non-compliance and insufficient patient data. A gastroenterology practice should regularly check compliance of the services based on the insurance company’s guidelines and the Health Insurance Portability and Accountability Act (HIPAA) guidelines to prevent losses. A regular compliance check can keep gastroenterology billing staff fine-tuned for maintaining accurate documentation to support claims.

Maintaining Revenue Cycle Management

Revenue cycle management is not just simply performing a self-audit; its role in a practice is to track the claims process at significant points of the process. Gastroenterology providers can effectively act upon any concerns and address any issues that may arise during a point in the claims process to ensure a steady stream of revenue for the practice.

The process includes keeping tabs of all disputed claims, denied claims, unpaid claims, and total revenue collected from the insurance company. Revenue cycle management exposes areas for improvement in the process as well. After all, medical billing is not simply about avoiding audits, it’s also about making sure that the practice is fairly reimbursed and compensated for the service provided.

MPMR offers free consults for GI medical billing services to discuss ways to increase reimbursement. Gastroenterology medical billing is a highly specialized business, make sure you have experts doing it for you!