rcm solutions Urology facilities

Medical Billing And Revenue Cycle Management Solutions For Urology Facilities

In urology facilities, specialists focus on the genitourinary system, diagnosing and treating issues related to the kidneys, bladder, prostate, and male reproductive organs. At StafGo Health, we specialize in providing end-to-end medical billing and revenue cycle management (RCM) services designed specifically for urology practices. The urology billing process consists of various steps, like coding, prior authorizations, and high-volume claim management, and also problems or challenges that can strain internal resources and delay revenue if not handled correctly and carefully.

Advanced CPT & Modifier Expertise For Your Urology Practice With Stafgo Health

Urology practices rely heavily on the accurate application of CPT codes to ensure timely reimbursement for multiple diagnostic and surgical services. Our certified coders are well-versed with the use of key CPT codes for urology, some of which are 52000 (cystourethroscopy), 52235 (cystourethroscopy with fulguration), and 51798 (measurement of post-void residual urine), which are frequently used for evaluating bladder and urinary tract conditions. Surgical procedures such as 52601 (transurethral resection of the prostate - TURP), 50590 (extracorporeal shock wave lithotripsy - ESWL), and 52356 (ureteroscopy with laser lithotripsy) require meticulous documentation and often pre-authorization to avoid denials. Accurate use of evaluation and management codes like 99214 (office/outpatient visit) and 99285 (emergency department visit) is also essential.

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

Urology practices have to deal with a huge number of patients on a daily basis, perform complex coding, and deal with follow-up payer-specific billing rules that can create a burden on in-house teams. At StafGo Health, our experienced team brings comprehensive knowledge of urology billing, including expertise in handling various procedures like cystoscopies, TURPs, lithotripsy, and urodynamic testing. By outsourcing to StafGo Health, your practice will have the benefits of faster claims processing, accurate document submission, and robust denial management to enhance your financial health and operational efficiency

Common RCM Challenges Faced by Urology Practices

Intricate Coding and Modifier Usage - Urology procedures like cystoscopies, lithotripsy, or prostate biopsies usually require the use of several specific CPT codes and modifiers. Errors in the use of correct coding and the use of wrong modifiers can lead to denied claims or a reduction in reimbursements.
High Volume of Diagnostic and Procedural Claims - A high level of accuracy and speed is required in handling claims for lab tests, imaging, and in-office procedures. When you have to deal with a large number of claims, the chances of mistakes in data entry become high, or charges are delayed.
Frequent Prior Authorization Requirements - Some complex procedures like BPH treatment (e.g., UroLift) or incontinence surgeries are likely to require prior authorization. If authorizations are delayed or missed, it will result in claim rejection and dissatisfied patients.
Managing Global Periods and Post-Op Billing - Urology involves various complex procedures, like surgeries, like vasectomies or TURPs, which need billing in a defined global period. Billing for post-op visits inaccurately or the use of the wrong modifiers can cause compliance problems and denied claims.
Insurance Verification & Coverage Variability - For some urological services, insurance coverage is specific to different plans or specific network providers. If there is a failure in the verification of patient eligibility or benefits, it can cause unexpected out-of-pocket costs and claims rejections.
Inconsistent Documentation from Providers - If the documents are incomplete or unclear, it will lead to coding delays, underbilling, or compliance-related problems.

Solving Your Urology Practice’s Challenges with StafGo Health

Accurate Urology Coding & Documentation - Our team of coders is expert in accurate coding for unique procedures of urology like cystoscopy (52000), prostate biopsy (55700), etc. To avoid unnecessary costly denials, our team assures the use of correct modifiers and documentation
Efficient Prior Authorization Management - Our team smoothly handles the pre-authorizations very efficiently for high-cost services, like BPH treatments, Botox, etc. It will help you to keep away from treatment delays.
Denial Prevention & Quick Resolution - With the help of a proactive denial tracking system and advanced expert appeals, we not only fix the denials but also tend to prevent them. Our team makes sure of the reduction of claim rejections, underpayments, and coding errors with ensuring your cash flow remains stable.
Comprehensive Global Period Tracking - We keenly track and monitor the global surgical periods and ensure the use of appropriate modifiers for post-op visits. Our team ensures that you remain compliant and compensated.
Performance Reporting & RCM Transparency - With the help of concise, clear, and customized reports and dashboards, our team will provide you with real-time visibility into collections, outstanding A/R, and claim status so that you can make smarter and more informed financial decisions.
Dedicated Account Management & Support - Each and every StafGo client gets a personalized account manager and a specialized billing team who keenly understand your urology-specific needs and work accordingly. We provide proactive communication, monthly performance reviews, and fast answers to help you out with all aspects of billing.