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Boosting Revenues and Avoiding Audits by Streamlining your Gastroenterology Medical Billing Process

December 23, 2013

Gastroenterology medical practices have evolved exponentially in the past decade due to changing patient demography. With more and more procedures and treatments coming under the purview of Gastroenterology treatments due to medical advancements, coding changes are also happening at frequent intervals. Given the high frequency of changes, gastroenterology medical billing is also attracting a lot of claim denials and medical audits due to billing errors. To strengthen your medical billing processes and boost your practice revenue, it is important to recognize the billing errors that act as red flags for auditors.

Some of the most prevalent reasons for billing errors that may attract Medicare audits for your Gastroenterology practice are –

  • Selection of incorrect code category – It is difficult to train in-house billing staff or even selecting a third party medical billing services provider that specializes in Gastroenterology coding and billing practices. Due to this, GE practitioners suffer the most when it comes to code selection at the time of billing and filing for claims. Gastroenterology codes undergo frequent changes due to evolving procedures and technologies, and the best way to avoid audits due to incorrect codes is to install a billing system which updates codes on a regular basis.
  • Coding all patients and on same level – Billing all your patients at a higher service level and coding for gastroenterology procedures at the same level is a red flag for auditors. Healthcare regulators overview the level of billing for each medical practitioner on the ground logic that each patient being serviced can’t be ill at the same level. Some patients are in worse conditions than others and must have needed more complex procedures or service level. Therefore, GE practitioners must ensure that unusual congruency in the service billing level must be scrutinized and corrected.
  • Referring to abbreviated CPT codes – Gastroenterology practitioners that rely on in-house coding and billing usually rely on their own limited knowledge of CPT codes and apply it to bill for most services offered by their clinic. However, abbreviated CPT codes may seem similar and have varied distinctions at diagnosis and procedural level. Missing out on these details can cause incorrect or insufficient coding which may in turn lead to medical audits.
  • Bundling of services – Gastroenterology conditions can be often interlinked and lead to bundling of medical services for better care delivery. While a patient may appreciate the added care, at the time of billing, bundling of services can lead to many coding confusions and raise credence related issues leading to customer complaints even. Insurers usually pay extra attention to claims pertaining to bundled services and reject them for lack of documentation or overbilling.
  • Cloning of codes in EMR – Although EMR has improved billing efficiency dramatically, EMR tends to clone frequently used codes and lead to system generated errors especially for procedures such as ERCP, colonoscopies, esophageal dilations, etc. Monitoring and rectifying these errors can further improve your billing efficiency and reduce chances of audit.

Medicalbillersandcoders.com offers you the services of gastroenterology billing experts adept with the dynamics of GE billing. Your GE practice must be equipped to support such complex billings processes which can attract audits and must be able to handle audits effectively. With Medicalbillesandcoders.com as your billing partner, you can boost your revenues, reduce denial rates and avoid repeated audits with efficient medical billing.


Category : Best Billing and Coding Practices