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 denials––leading to significant loss of gastroenterology reimbursements.
Reducing these claim denials is essential to boost gastroenterology billing and maximize reimbursements before 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
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 documentation––increasing 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.
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 practice’s 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.
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 practice’s 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 practice’s 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 practice’s needs.
FAQs:
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.
5. What is the impact of old AR on gastroenterology practices?
A: Old AR ties up revenue, reducing the practice’s cash flow. Aggressive follow-up and timely collections are essential for recovering aged accounts receivable and boosting year-end revenue.
