Gastroenterology Billing Services waqas khan October 25, 2024

Trusted Gastroenterology Billing Experts Backed by Real Results

Maximize Gastroenterology Revenue with 98.9% First Pass Claim Success

We help gastroenterology providers boost collections, reduce denials, and clean up aged AR without requiring any changes to your EHR or workflow.

Efficient Gastroenterology

Rapid Revenue Recovery

0 Days

Revenue Increase

0 %

Denial & Rejection

5 % - 10 %

Short Turnaround Time

Hours

Electronic Claim

0 Days

Electronic Payment

0 %

Client Retention

5 %

First-Pass Resolution

%
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    Why Leading Gastroenterology Practices Trust Us to Handle Their Billing

    We don’t just submit claims. We optimize your revenue engine. From clean claim submission to aged AR recovery, every part of our process is designed to grow your bottom line.
    Specialty-Focused Billers & Coders

    GI-trained professionals who know exactly how to handle procedures like colonoscopies, biopsies, and endoscopies using the correct CPTs and modifiers.

    EHR + PM Integration

    We plug into your existing systems like eClinicalWorks, Kareo, or DrChrono so there’s no disruption to your front office.

    Real-Time Denial Prevention

    Proprietary checks and expert reviews catch errors before payers do, reducing rework and delays.

    Aggressive A/R Recovery

    We follow up on unpaid claims over 120 days with dedicated escalation, helping you unlock stuck revenue.

    EHR+PM

    What You Can Expect When We Handle Your GI Billing

    From onboarding to monthly reporting, every step of our partnership is designed to keep you in control while we handle the heavy lifting.
    Our Gastroenterology Billing experts, with their unwavering dedication, help you achieve your financial goals.

    As a prominent Gastroenterology Billing Service provider, our primary mission is to offer comprehensive gastroenterology billing services to healthcare practices across the Nevada. Our approach is specialized in improving the revenue cycle and addressing the common billing challenges that gastroenterology physicians often face. Our Las Vegas GI Billing Services ensure a potential increase in your revenues.

    We review your workflows, EHR setup, and payer mix to create a seamless transition with no disruption to your daily operations.
    You get access to billers, coders, and AR specialists trained in gastroenterology services, fully white-labeled to represent your practice or brand.
    Weekly and monthly performance dashboards show exactly where your revenue is coming from and how we’re improving it.
    Our team proactively identifies patterns in denials, delays, or underpayments and refines your billing strategy for better long-term gains.

    Proven Results for Gastroenterology Practices Across U.S

    We’ve helped gastroenterology practices across the country streamline their billing, increase collections, and reduce denials without disrupting their daily operations. Our performance is backed by real data and measurable outcomes.

    GI Practices Served

    48%

    48+

    First Pass Resolution Rate

    99%

    99%

    Average Revenue Increase

    20%

    20%

    Reduction in Denials

    5%

    5% - 10%

    How We Keep Revenue Flows Smooth

    Statistics That Define Our Company

    48

    Serving States

    35 +

    Specialties

    1,200 +

    Healthcare Providers

    97 %

    Claim Acceptance rate

    100 %

    Compliance

    Frequently Asked Questions

    We’ve have compiled a list of commonly asked questions to provide you with quick and informative answers.

    Gastroenterology involves a broad spectrum of procedures. Each procedure has a specific CPT code assigned to it. Mentioned below are some gastroenterology procedures with their CPT codes

    • Colonoscopy 45378, 45380, 45385, 45388, 45384.
    • Esophagogastroduodenoscopy (EGD) 43235, 43239, 43250.
    • Endoscopic Retrograde Cholangiopancreatography (ERCP) 43260, 43261, 43265.
    • Endoscopic Ultrasound (EUS) 43231, 43237.
    • Capsule Endoscopy 91110.
    • Sigmoidoscopy and Proctosigmoidoscopy 45330, 45331, 45333.

    It is important to realize that every procedure has a unique CPT code. These codes vary based on complexity of the procedure, techniques
    used, and the extent of examination required to perform the procedure. It is recommended to refer to the most current CPT code references
    and guidelines to obtain the latest information on coding gastroenterology procedures.

    The Modifier is additional information regarding the specific aspect of a medical procedure or service. It is a two-character code added to Current Procedural Terminology (CPT) or Health Common Procedure Coding System (HCPCS) to reflect the specific circumstance of the procedure performed. Incorrect use of modifiers may lead to claim denials and lower reimbursement rates. Some of the key modifiers used in gastroenterology billing are mentioned below.

    • Modifier-22 for Increased Procedural Services.
    • Modifier-51 for Multiple Procedures.
    • Modifier-52 for Reduced Services.
    • Modifier-53 for Discontinued Procedure.
    • Modifier-59 for Distinct Procedural Service.
    • Modifier-99 for Multiple Modifiers.

    ICD-10 codes describe patients’ diagnosis whereas CPT codes are the prescribed procedures or services performed to treat the condition. Both types of codes are essential in accurate billing and documentation in gastroenterology and other medical specialties.

    • ICD-10 codes inform about diagnostic information, while CPT codes convey procedural or service-related information.
    • ICD-10 codes are alphanumeric (e.g., G11.0), whereas CPT codes are numeric (e.g., 45378).
    • ICD-10 codes are on the patient’s condition, disease, or diagnosis, while CPT codes focus on the services provided by the healthcare provider.
    • ICD-10 codes support medical necessity and justify the need for specific procedures. CPT codes are used to identify the specific procedures or services performed.
    • ICD-10 codes are linked to CPT codes in medical billing to show the relationship between the patient’s diagnosis and the procedures or services rendered.

    For Medicare beneficiaries and other private payers, screening colonoscopies are generally billed with CPT code 45378. The ICD-10 code that indicates the patient’s intention for a screening exam is Z12.11 (Encounter for screening for malignant neoplasm of the colon).

    The CPT code used for a diagnostic colonoscopy is typically 45380 (Colonoscopy, flexible, with single or multiple). The ICD-10 codes should be selected based on the patient’s symptoms or indications, such as codes related to specific GI conditions or symptoms (e.g., abdominal pain, rectal bleeding).

    Gastroenterology billing services under Medicare and Medicaid have unique rules and variations among states. A successful billing practice needs to stay informed and follow guidelines to accurately maintain documentation.

    Medicare Billing for Gastroenterology Services

    • Ensure that the healthcare practice is enrolled as a Medicare provider and that all gastroenterologists are properly credentialed with Medicare.
    • Verify the patient’s Medicare eligibility and coverage to avoid claim denials.
    • Correct usage of Medicare-specific modifiers when applicable
    • Comply with Medicare billing rules and regulations to avoid audits and penalties.

    Medicaid Billing for Gastroenterology Services

    • Ensure that the healthcare practice is enrolled as a Medicaid provider in the state’s Medicaid program.
    • Determine if prior authorization is required for specific gastroenterology procedures or services and obtain it as necessary.
    • Stay in compliance with Medicaid guidelines of the state for Billing codes, modifiers, and any specific requirements.
    • Ensure claims are submitted within the specified timeframes.
    • Stay updated on Medicaid policies through provider training sessions.

    Evaluation and Management (E/M) service is based on several factors, commonly referred to as “Three Key Components” and “Medical Decision Making. To determine the appropriate E/M level for office visits, the following procedures must be put in place.

    Three Key Components

    Evaluate Patient’s history by documenting chief complaint, history of present illness (HPI), review of systems (ROS), and past medical and social history (PFSH). Perform physical examinations relevant to patients’ complaints. The extent of the examination should be commensurate with the complexity of each case.

    Medical Decision Making (MDM)

    Medical Decision-Making process includes

    • The number and complexity of the patient’s problems addressed during the visit.
    • The amount and complexity of data reviewed (e.g., test results, imaging).
    • The risk of complications, morbidity, or mortality is associated with the patient’s condition.


    Selecting the Appropriate E/M Level

    The E/M levels are typically categorized into five levels, level 1 being the lowest complexity to level 5 being the highest complexity.

    Yes, when billing gastroenterology service, several compliances, and regulations are set in place to ensure proper and ethical billing practices.

    • Avoid any payments or agreements that are prohibited under the AKS.
    • Comply with Stark Law, which prohibits referrals for certain designated health services, including certain gastroenterology procedures.
    • Adhere to CPT and ICD-10 guidelines.
    • Support the codes billed with relevant documents.
    • Follow specific regulations and guidelines when billing for services provided to Medicare and Medicaid beneficiaries.
    • Ensure patient information is protected and that they comply with the Health Insurance Portability and Accountability Act (HIPAA) regulations.
    • Implement NCCI edits to ensure that procedures are correctly bundled or unbundled based on CMS guidelines.
    • Use modifiers to convey information for specific circumstances.

    To avoid claim denials it is essential to ensure complete and accurate patient information, verify insurance coverage and use appropriate codes and modifiers. Prior Authorization (PA) and Verification of Benefit (VOB) help to avoid claim rejections and give a clear image of the financial obligations.

    Our Solutions

    Our advanced Infrastructure and Strategies are designed to determine issues in your Revenue Cycle Management and improve them with precisely streamlined processes. We recognize that healthcare providers face a variety of challenges, including missed charges, under pricing, non-reimbursed errors, coding errors, and more, which can lead to significant revenue loss each year.

    Therefore, we have designed our Medical Billing & Coding Services as well as Physician Credentialing to prevent any discrepancies and provide accurate deliverables, ultimately helping healthcare providers achieve optimal Revenue generation

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    Medical Billing & Coding Services
    Credentialing-Contracting
    Physicians Credentialing Services
    Revenue-Cycle-Management
    Revenue Cycle Management
    Ar-Denial-Management
    AR & Denial Management Services
    Medical-Billing-Coding-Audit
    Medical Billing and Coding Audit
    Verification-Prior-Authorization-Services-1
    Verification & Prior Authorization
    Ambulatory-Surgical-Center-Billing-1
    Ambulatory Surgical Center Billing
    Contact-Center-Patient-Scheduling-Management
    Contact Center & Patient Scheduling
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      Medical Billing Software We Leverage for Revenue Cycle Management

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      Our Esteemed Clients' Testimonials

      What Sets Our Medical Billing and Coding Services Apart
      Quick Turnaround Times
      Monthly Coding Audit
      Timely AR Follow-Up
      Revenue Cycle Optimization
      24/7 Helpdesk Support
      Expert Medical Billers
      Advance Cash Flow
      Reasonable Pricing
      Qualified Coding Auditors
      Real-Time Insurance Verification
      Auditing Complex Denials
      Unlimited Physician Credentialing
      30 Days Free Trial
      Denial Management
      Healthcare Analytics
      Medical Billing Consultation
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      Specialties
      Head Office | Houston

      857 Tristar, Suite A1,
      Webster, TX 77598, US.

      Nevada Office

      2300 W Sahara Avenue, Suite 800,
      Las Vegas, NV 89102, US.

      Colorado Office

      1600 Broadway, Suite 1600,
      Denver, CO 80202, US.

      Las Vegas Office

      732 S 6TH ST, STE R,
      LAS VEGAS NV 89101, US.

      Virginia Office

      5600 General Washington Dr Ste B207,
      Alexandria, VA, 22312, US.

      Thousands of providers growing their practice with PROMBS.

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