rcm solutions Gastroenterology facilities

Medical Billing And Revenue Cycle Management Solutions For Gastroenterology Facilities

At StafGo Health, we have designed medical billing and revenue cycle management (RCM) solutions tailored for gastroenterology practices. In Gastroenterology facilities, the GI procedures are very complex in nature, ranging from diagnostic endoscopies and colonoscopies to advanced therapeutic interventions, which require precise coding and understanding of payer-specific billing rules.

Scalable Cpt Code Management For Gastroenterology Facilities With Stafgo Health

Gastroenterology billing possesses a different set of complex procedures that require accurate coding with commonly used CPT codes like 45378–45385 for diagnostic and therapeutic colonoscopies (e.g., biopsy, polypectomy, or control of bleeding), 43235–43259 for upper GI endoscopies such as esophagogastroduodenoscopy (EGD) with biopsy or dilation, and 91110–91112 for GI motility and capsule endoscopy studies. Our specialized coders are well trained in the accurate application of these codes, in addition to 82270 and 82274, which are frequently used for fecal occult blood tests, while 44799 is often applied for unlisted gastrointestinal procedures. Our team clearly understands the proper modifier usage (e.g., -59, 26) and bundling rules, which are essential to avoid denials.

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

In Gastroenterology, doctors work with patients who have a wide range of healthcare needs, from normal routine visits to procedures that require surgery. Due to this, billing and dealing with issues become more complex. Hence, a knowledgeable billing and RCM partner like StafGo Health can help you support your staff through audit risk assessments and provide better solutions as per your gastroenterology practice.

Common RCM Challenges Faced by Gastroenterology Practices

Gastroenterology practices encounter numerous billing and RCM challenges due to the intricacy of procedures, frequent updates in payer policies, and the specialized nature of gastrointestinal diagnostics and treatments.

Complex Procedure Coding - Gastroenterology consists of several diagnostic and therapeutic procedures in which specific CPT and ICD-10 codes are used. An error in the use of these codes can lead to denials.
High Volume of Procedures - GI practices handle a high volume of patients daily and perform numerous procedures daily, leading to a high risk of errors during data entry, claim creation, and submission, which leads to increased billing complexity.
Bundling and Modifier Confusion - As GI practices handle multiple procedures, understanding and applying correct modifiers (e.g., -59, -51, 26) is essential. Wrong use of modifiers can lead to claim denials.
Payer-Specific Guidelines - In GI, the guidelines are specific to payers, and these payers have different rules for different services like colonoscopy coverage, screening vs. diagnostic coding, and other routine preventive services. If these guidelines are not followed properly, it will cause a delay in reimbursement.
Pre-Authorization Requirements - As GI works with several complex procedures, prior authorization is required for many procedures. Delayed authorizations can result in claim rejections or payment delays.
Outdated Billing Systems - Another growing challenge is outdated billing systems. Practices that use manual or outdated billing tools usually have to face inefficiencies in work and delays in follow-ups, which affect the overall revenue cycle.

Solving Your Gastroenterology Practice’s Challenges with StafGo Health

Accurate Coding by GI Experts - Our certified GI experts have a comprehensive understanding of gastroenterology and stay updated with the latest CPT, ICD-10, and HCPCS code changes. We ensure precise coding for specific procedures, which minimizes the chances of denials.

Advanced Claims Scrubbing and Automation - At StafGo Health, our team utilizes advanced and automatic billing tools to search claims for errors, use correct modifiers, and ensure compliance with payer-specific rules, which improves reimbursement rates.
Seamless Pre-Authorization Support - At StafGo Health, our team is experienced in handling pre-authorizations for diagnostic and therapeutic GI procedures, reducing rejections and speeding up approvals.
Medical Necessity Validation - At StafGo Health, our team proactively reviews supporting documents to make sure they align with payer criteria for medical necessity, preventing delays and reducing the risk of denials related to insufficient justification.
Payer-Specific Knowledge Base - At StafGo Health, our team maintains a database of guidelines for different insurers to help your practice avoid common billing pitfalls.
Real-Time Analytics and Reporting - Our team provides you with customized dashboards and reports that give you real-time insights into KPIs such as denial trends, net collections, and AR days so that you can track your performance.