Gastroenterology is a focused field of medical service that has evolved dramatically over the past few decades. This in effect is a clear symptom of the changing lifestyle of an average American. Rise in gastric disorders have forced the populace to seek specialized medical attention and this has increased the focus of healthcare sector on Gastroenterology practices. With specific medical codes applying to gastroenterology procedures, billing for a GE practice can be a crucial contributor to clinic profitability. Statistically, most practices only enjoy a claim settlement ratio of 60%-70% and do not follow up effectively for the denied claims. This leads to loss of revenue to the tune of 18% -20% for an average GE practice.
You can reduce claim denials by following these simple steps in your Gastroenterology Medical Billing Services –
- Step 1 – Monitor claim settlement and rejection ratio First step in addressing claim denials is generating awareness about settlement ratio of your Gastroenterology practice. Most GE practices lose a major portion of their revenue in claim denials and are not even aware of the actual denial ratio. 90% of the cases denied for claim settlement can be resubmitted and reimbursed by the insurer with effective follow up in 48 hours. But most GE practitioners fail to achieve such efficient turnaround time due to lack of records of failed claims. Thus essentially recording and reporting of claim settlement should happen on a regular basis.
- Step 2 – Identify cause of denial Once you become aware of the claim denial ratio of your Gastroenterology practice, the next step is to identify the gaps in your medical billing companies and establish the causes of denial. Most claims are denied on grounds of process failure, incorrect coding, incorrect diagnosis or lack of coverage by insurer. All these problems can be addressed by simply incorporating required changes in your medical billing process and monitoring every claim before submission.
- Step 3 – Review coding changes for Gastroenterology Gastroenterology practitioners perform procedures such as gastroscopy, colonoscopy, ERCP, sigmoidoscopy, etc. In addition to ICD 9 codes, these procedures are also covered by CPT and HCPCS codes which are updated at a regular interval and the best way to reduce claim denials is to update your EMR or medical billing process with current coding changes on a weekly basis.
- Step 4 – Encourage pre-authorization Many insurance carriers require pre-authorization of service in order for the patient to avail insurance coverage. Without pre-authorization of procedure, insurance cover providers reject subsequent claims filed on the grounds of incorrect processing. Therefore, you must encourage your gastroenterology medical billing team to conduct preauthorization of each case.
- Step 5 – Maintain insurer wise records Your GE practice may be cautious in monitoring its medical billing but due to versatile payer mix including Medicare, Federal care, Medicaid and many private insurance carriers it becomes very difficult to standardize the claim filing and settlement process. Therefore, you must monitor the revenue contribution and claim settlement procedure of each insurance provider to integrate changes in your system.
Medicalbillersandcoders.com is a medical billing expert that can help your GE practice achieve minimal claim rejection and improve clinic profitability. They offer services of billing experts who not only understand specific coding requirements of Gastroenterology but also recognize and fix the causes of claim denials.