It is no doubt that gastroenterology billing is a challenging domain particularly because of the intricacy of procedures and the necessity for accurate coding. Mainly because procedures like colonoscopies and endoscopies have specific codes such as CPT 45378 (diagnostic colonoscopy) and CPT 43235 (upper GI endoscopy), which need to be used appropriately to prevent denials and delays in reimbursement. Furthermore with the constantly changing nature of coding regulations, staying current and being accurate is the best way to avoid errors that may result in claim denials.
Recent gastroenterology practice reports show that an estimated 10-15 % of gastroenterology claims receive denials, causing huge cash losses in reimbursement. Hence, lowering these denials is not only critical in terms of strengthening cash flow but vital to the enhancement of gastroenterology billing and achieving high reimbursements ahead of the final quarter of the year. So the question is how do you fix it? The answer is quite straightforward as explained below.
How can your gastroenterology business minimize claim denials and save your bottom line?
5 tried-and-tested methodologies to enhance gastroenterology reimbursement and minimize denials
1. Maximize Coding Accuracy – It is no doubt that accurate and proper coding is the foundation of reducing claim denials. Thus making sure your billing staff and certified coders are up to date on the most recent coding revisions and reviews the codes applied to routine gastroenterology procedures on a regular basis is necessary and vital. Claim-scrubbing software can also be used to catch potential coding mistakes prior to submission, enhancing claim acceptance rates and lowering rejections.
2. Improve Documentation Practices - Inadequate or incorrect documentation is among the most common reasons for denials in gastroenterology billing and often many gastroenterologists fall prey on it. Thus one needs to make sure that all details in the patient's medical record completely justify the procedure being billed, particularly for complicated procedures like therapeutic endoscopies.
To improve documentation you can further:
Utilize standardized templates to guarantee consistency.
Perform frequent audits of documentation processes to catch and fix gaps. In doing so, each claim will be supported by the appropriate documentation, and approval will be more likely.
3. Track Revenue Cycle Management (RCM) KPIs - Monitoring and reporting Key Performance Indicators (KPIs) is important for optimizing your practice's revenue cycle. So it is always important to your KPIs in track included:
Claim Denial Rate: The ratio of claims denied to the total number submitted. Formula: (Total Denied Claims / Total Submitted Claims) x 100
Days in Accounts Receivable (A/R): Indicates the length of time to receive payments. Formula: (Total Accounts Receivable / Average Daily Charges)
First Pass Resolution Rate: The rate of claims resolved on first submission. Formula: (Claims Paid on First Submission / Total Claims Submitted) x 100
By monitoring these metrics, you can easily identify areas for improvement, optimize your processes, and lower denials. Monitoring these KPIs closely will maximize your revenue cycle management and enhance cash flow.
4. Aggressive Follow-Up on Aged Accounts Receivables (AR) - Old AR is one of the largest perpetrators of slowing your practice's cash flow. AR over 90 days can make a big difference in your bottom line. Having a solid follow-up process in place for old AR is necessary to avoid losing revenue. Frequent follow-ups, re-submission of denied claims, and calling insurance companies regarding unpaid claims can increase your collections and decrease revenue gaps, particularly at year-end.
5. Use RCM Services to Minimize Denials - Outsourcing your gastroenterology billing to a professional RCM service provider can significantly enhance your billing operations, minimize claim denials, and optimize your reimbursements.
So in short, by adopting these strategies, your practice can minimize claim denials and optimize the overall effectiveness of your gastroenterology billing process. Whether through improved coding procedures, improved documentation, or outsourcing to experienced RCM vendors is a way forward to better financial health is clear.
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