Gastroenterology Reimbursements: Tackle Denials by Year-End

1
(No Transcript)
2
Gastroenterology Reimbursements Tackle Denials
by Year-End
As the year draws to an end, are you finding it
challenging to boost reimbursements for your
gastroenterology practice? If claim denials and
delayed payments are cutting into your revenue,
now is the time to take action. Gastroenterology
billing is complex, and claim denials can drain
your revenue. To overcome these challenges, it is
crucial to understand the root causes of claim
denials in gastroenterology billing and how to
address them effectively. Why Are Claim Denials
a Common Issue in Gastroenterology
Billing? Gastroenterology billing involves
complex procedures and coding, from colonoscopies
to endoscopies. The use of specific codes like
CPT 45378 (diagnostic colonoscopy) and CPT 43235
(upper GI endoscopy) requires precision and
up-to-date knowledge of coding regulations. Claim
denials in gastroenterology can arise due to
coding errors, insufficient documentation, or
failure to meet payer requirements. Industry
reports reveal that nearly 10-15 of claims in
gastroenterology practices face denialsleading
to significant loss of gastroenterology
reimbursements. Reducing these claim denials is
essential to boost gastroenterology billing and
maximize reimbursements before year-end.
3
Gastroenterology Reimbursements Tackle Denials
by Year-End
5 Proven Strategies to Boost
Gastroenterology Reimbursements and Reduce
Denials 1. Optimize Coding Accuracy Accurate
coding is the backbone of reducing claim denials.
Ensure that your billing staff is well-trained on
the latest coding updates, and regularly review
the accuracy of codes used for common procedures.
Implementing claim-scrubbing software can flag
potential errors before submission, help improve
claim acceptance rates, and reduce
rejections. 2. Enhance Documentation Practices
4
Gastroenterology Reimbursements Tackle Denials
by Year-End

• In gastroenterology, incomplete or inaccurate
  documentation is a leading cause of denials.
  Providers must ensure that documentation fully
  supports the codes being billed, especially for
  complex procedures like therapeutic endoscopies.
• Practical tips include using standardized
  templates for documentation and conducting
  regular audits. These steps help ensure that
  every claim is backed by proper
  documentationincreasing the chances of
  reimbursement.
• 3. Monitor Revenue Cycle Management (RCM) KPIs
• Tracking Revenue Cycle Management (RCM) Key
  Performance Indicators (KPIs) is critical to
  boosting gastroenterology billing and
  improving reimbursements. Important KPIs include
• Claim Denial Rate The percentage of claims
  denied out of the total submitted.Formula
  (Total Denied Claims / Total Submitted Claims) x
  100.
• Days in Accounts Receivable (A/R) Measures how
  long it takes to collect payments.Formula
  (Total Accounts Receivable / Average Daily
  Charges).
• First Pass Resolution Rate The percentage of
  claims successfully paid on the first
  submission.Formula (Claims Paid on First
  Submission / Total Claims Submitted) x 100.

5
Gastroenterology Reimbursements Tackle Denials
by Year-End
Focusing on these KPIs can reveal bottlenecks in
your billing process and provide actionable
insights to reduce denials and improve cash
flow. 4. Aggressive Follow-Up on Aged Accounts
Receivables (AR) Old AR can be a hidden drain on
your practices revenue. Implementing aggressive
follow-up procedures for claims aging beyond 90
days is essential for improving gastroenterology
reimbursements. By focusing on recovering old AR
through consistent follow-ups and re-submitting
denied claims, you can prevent revenue loss and
improve cash flow before year-end. 5. Leverage
RCM Services to Reduce Denials Outsourcing
gastroenterology billing services to a
professional RCM provider like Medical Billers
and Coders (MBC) can significantly boost
gastroenterology billing by reducing claim
denials. MBC offers services such as claim
scrubbing, denial management, and AR follow-up to
ensure faster collections and fewer rejections.
By utilizing their expertise, practices can
streamline billing processes and recover more
revenue by year-end.
6
Gastroenterology Reimbursements Tackle Denials
by Year-End

• Handing over your gastroenterology billing
  services to MBC provides you with the benefit of
• Accuracy and Maximized Collections MBC ensures
  precision in coding and billing, which reduces
  denials and maximizes reimbursements.
• Data-Driven Insights Analyze and benchmark your
  practices performance for continual improvement.
• Streamlined Documentation Consistent processes
  that ensure your claims are backed by accurate
  documentation.
• Dedicated Account Manager Receive regular
  updates on your practices billing performance.
• Value-Added Solutions Custom dashboards and
  forecasting tools help you plan for future
  growth.
• Cost-Effective Solution Outsourcing to MBC is
  more affordable than maintaining an in-house
  billing team, potentially increasing revenue by
  10-15.
• Tackle Denials and Boost Gastroenterology
  Reimbursements by Year-End!
• Contact MBC today to unlock expert
  gastroenterology billing solutions tailored to
  your practices needs.
• FAQs

7
Gastroenterology Reimbursements Tackle Denials
by Year-End
1. How can gastroenterology practices reduce
claim denials? A Gastroenterology practices can
reduce claim denials by ensuring accurate coding,
complete documentation, and utilizing
claim-scrubbing software to flag potential errors
before submission. 2. What KPIs should
gastroenterology practices monitor to improve
reimbursements? A Key RCM KPIs include claim
denial rate, days in A/R, and first-pass
resolution rate. Monitoring these metrics helps
identify and resolve billing inefficiencies. 3.
What compliance regulations should
gastroenterology practices follow for accurate
billing? A Gastroenterology practices must
adhere to HIPAA and Centers for Medicare
Medicaid Services (CMS) regulations to ensure
accurate billing and avoid penalties. Following
these guidelines helps maintain patient privacy
and proper coding practices for clean claims. 4.
What are some common CPT codes used in
gastroenterology billing? A Common CPT codes for
gastroenterology include 45378 for diagnostic
colonoscopy, 43239 for upper GI endoscopy with
biopsy, and 91110 for small bowel capsule
endoscopy. Accurate coding is crucial for
avoiding claim denials and ensuring proper
reimbursement.
8
Gastroenterology Reimbursements Tackle Denials
by Year-End
5. What is the impact of old AR on
gastroenterology practices? A Old AR ties up
revenue, reducing the practices cash flow.
Aggressive follow-up and timely collections are
essential for recovering aged accounts receivable
and boosting year-end revenue.