rcm solutions bariatrics facilities

Medical Billing And Revenue Cycle Management Solutions For Bariatric Facilities

Bariatric providers and other healthcare professionals specialize in the management of obesity and related health conditions. At StafGo Health, we specialize in providing comprehensive medical billing and revenue cycle management (RCM) solutions designed specifically for bariatric surgery and weight management practices. Bariatric billing process involves complicated pre-authorization requirements, clear and concise medical necessity documents, and accurate coding across various services like surgery, nutritional counseling, etc. Our team of skilled professionals handles the complete billing process and makes you stay compliant while maximizing reimbursements.

Key CPT Codes Management in Bariatric Billing and Coding

Billing for bariatric procedures needs careful observation of every detail, proper documentation, and use of accurate codes to ensure faster reimbursement. We have coding experts who are efficient in handling commonly used CPT codes, like 43775 (Laparoscopic sleeve gastrectomy), 43644 (Laparoscopic gastric bypass, Roux-en-Y), 43645 (Laparoscopic gastric bypass with small intestine reconstruction), 43845 (Open gastric restrictive procedure), and 43846 (Open gastric bypass), 97802–97804 for medical nutrition therapy, 99401–99404 for preventive counseling, and 96127 for brief emotional/behavioral assessment when managing psychological readiness for surgery. They have a good understanding of applying accurate ICD-10 coding for obesity (e.g., E66.01, E66.9) and associated comorbidities, such as hypertension (I10) or diabetes (E11.9) is also crucial to avoid denials.

Why Outsource Medical Billing And RCM To Stafgo Health For Your Bariatrics Practice?

Managing the complete billing process and revenue cycle operations is a very complex task for bariatric practices. From obtaining pre-approvals to post-operative global periods, each and every step requires a high level of precision. By outsourcing your RCM services to StafGo Health, you will have the advantage of expertise in bariatric-specific billing and insurance requirements, allowing your team to deliver the best care to your patients while we can enhance your revenue outcomes. With the help of our end-to-end support, bariatric practices reduce the number of claim denials, shorten payment cycles, and improve the profitability of the practices.

Common RCM Challenges Faced by Bariatric Practices

Complex Pre-Authorization and Medical Necessity Requirements - Bariatric billing and procedures are very complex in nature; they require detailed documentation, including BMI thresholds, comorbidity history, psychological evaluations, etc. Absent or misplaced, even a single element can result in costly delays and denials.
Bundled Surgical Codes and Global Period Confusion - There are a few procedures that fall under global billing periods, for example, gastric bypass, sleeve gastrectomy, etc. It becomes challenging when it has to bill for related follow-ups or diagnostics. If you apply the wrong codes at the wrong time during this period, the chances of losing money are high.
Frequent Coding and Modifier Errors - Problems caused by incorrect codes and modifiers are very commonly seen. Using the correct CPT codes and modifiers plays a crucial role in Bariatric billing. Error in the application of the correct code and modifier can trigger audits or underpayment.
Denials for Nutritional and Behavioral Counseling - In Bariatrics billing, claims for a few services like dietitian consultations or behavioral therapy are often denied by insurance companies due to insufficient documentation, or specific billing rules are not followed. However, these are crucial for surgical success
Payer-Specific Policy Variations - All insurance companies, like Medicare, Medicaid, and commercial plans, have different sets of rules for what is "medically necessary" for bariatric surgery. Due to the lack of knowledge regarding these rules, practices often face claim rejections.

Solving Your Bariatrics Practices Challenges with StafGo Health

Comprehensive Pre-Authorization & Documentation Support - Our professional team helps you to streamline your pre-authorization process by making sure all medical necessity documentation is aligned with the requirements of payers. All the essential documents are compiled and submitted to minimize the chances of delays and denials.

Expert Global Billing and Modifier Management - Our team precisely traces surgical global periods and uses the correct modifiers to bill for postoperative care. This increases the chance of reimbursement while ensuring full compliance.
Accurate CPT Coding and Payer-Specific Rules - Our team has deep expertise in bariatric-specific CPT codes, which makes sure that your claims reflect the right procedures and modifiers for each and every payer.
Inclusion of Ancillary Services - Our dedicated team supports your staff and makes sure your nutritional counseling and behavioral therapy services are billed with proper codes and documents, which reduces the chances of denials and enhances the chances of reimbursement.
Real-Time Denial Management & Analytics - Our team keeps track of denial trends, payer issues, and claim performance in real time, and promptly rectifies the issues that could affect the cash flow. Our deep insights allow your staff to make informed future decisions.