Gastroenterology billing services have their own set of unique challenges. These challenges can perplex even the most seasoned medical billing professionals.
So much so, that a report by The Huffington Post estimates that error rates in GI billing could be as low as 30-40 percent and as high as 80-90 percent for certain procedures.
From intricacies in medical coding requirements to the nuances of billing multiple payers, there is little doubt that GI billing services are far from simple.
Thus, for the purposes of this article, let’s look into the most common billing and coding challenges that force GI practices to consider alternatives to in-house billing and coding operations.
The coding confusion in gastroenterology billing services
GI procedures encompass a wide variety of treatments, each with its own set of coding requirements including Current Procedural Terminology (CPT) codes, International Classification of Diseases (ICD) codes, and Healthcare Common Procedure Coding System (HCPCS) codes. The accurate assignment of these codes is pivotal for successful billing and reimbursement.
Medical coding professionals that fail to stay updated about changes in gastroenterology billing and coding regulations can bring down accuracy of billing and coding operations drastically, impacting reimbursement rates for GI practices.
Gastroenterology medical billing: Multiple payers, multiple rules
Another major hurdle in medical billing services specific to GI is the task of billing multiple payers. Each payer, be it Medicare, Medicaid, or private insurance companies, has its own set of rules and regulations. This necessitates a thorough understanding of each payer’s specific policies and procedures to ensure accurate billing.
Medical coding of services that fails to adhere to guidelines for health plans often result in rework and additional operational costs associated with it.
Health plan coverage challenges in gastroenterology billing operations
Health plan coverage limitations are another significant hurdle in billing for GI procedures.
Some procedures may require prior authorization or may not be covered by certain payers. This can lead to claim denials and appeals, which can be time-consuming and costly. It’s always advisable to determine insurance coverage and potential out-of-pocket costs before every patient visit.
Additional challenges in gastroenterology billing
Apart from the ones mentioned above, gastroenterology billing also faces challenges like changing regulations, frequent updates in billing rules, and the need for coordination with other providers.
Moreover, many GI procedures require pre-authorization from insurance companies, and failure to obtain this can lead to claim denials.
The solution: Outsource gastroenterology medical billing services
To get around these hurdles, it is crucial to have a knowledgeable and experienced billing staff that can stay up-to-date with the latest billing rules and codes, and communicate effectively with insurance companies and other providers.
Partnering with a trusted and HIPPA-compliant medical billing outsourcing company, can provide comprehensive gastroenterology billing services, including claims management, medical coding, denial management, patient billing, and detailed reporting.
This can help GI practices improve their revenue cycle management, increase collections, and reduce administrative burdens.
For more information on our “30-day free transition”, cost per FTE for medical billing services, or to simply know more about streamlining gastroenterology billing services, please contact Sunknowledge Services Inc., a healthcare RCM company with nearly two decades of rich industry experience.