Running a gastroenterology practice isn't just about treating patients. You also need a strong billing process. Many practices lose money without realizing it. These are hidden revenue leaks. They look small at first but can lead to big losses through unpaid claims, denials, and delays, especially when you are operating independently of a professional gastroenterology billing company.
Know about the crucial revenue leakages in gastroenterology billing services and how to solve them efficiently
Incorrect or missing prior authorization process:
There are some specific GI procedures that require you to obtain prior authorization approvals from a patient's insurance company. You will always face claim delays and denials because of missing PA formalities for those procedures. You can also face prior authorization hassles when your team is unable to match the billed CPT codes with the prior authorization. Your front-end team should always use a checklist to keep proper track of all PA requests and match each code before submitting each request.
Inaccurate coding and documentation process:
Gastroenterology coding is a complex process, as it often requires you to deal with a wide variety of codes. One wrong code or missing note can lead to denials or lower payments. Here is an example: if a patient comes for a screening colonoscopy and the doctor removes a polyp, the coder must change the code to a diagnostic one. If not, you get paid less or nothing. To fix this, train coders often use clear templates, ask doctors for detailed notes, and conduct monthly audits to identify and fix mistakes.
Failure to bill bundled services:
Some GI services are bundled by Medicare or other payers and billing them separately can cause your practice to face claim denials. You can still bill some services together by using modifiers like -59 or -XS. Many practices miss this. They either forget to add the modifier or use it too frequently, which can lead to audits. You should always follow NCCI billing guidelines and use an advanced billing method that detects bundling issues. Also, use the right modifiers to stay compliant.
Missing information:
Small mistakes like a wrong patient ID, missing referral, or incorrect insurance can lead to claim denials. These are not medical errors—they happen at the front desk. But they still cost you money. To fix this, train your front-office team to double-check all patient details, use real-time eligibility tools, and have billing staff review some registration forms each week to catch problems early.
Slow denial follow-up process:
Denials are common, but the real loss happens when no one follow-up quickly. Most payers give you only 30 to 90 days to appeal. If you miss that deadline, you lose the money. To fix this, track denials every day, have team members follow up within 7 days, and use analytics to find and fix the common reasons for denials.
Delayed charge entry and claim submission process:
Sometimes providers finish a procedure but take too long to submit the encounter sheet. Coders may also delay processing the code. These delays can cause missed filing deadlines. Some payers only give 30 to 90 days. If you miss that, the claim gets denied and can't be fixed. To avoid this, try to enter charges on the same day, use automated coding templates for common GI procedures, and remind providers to send in their notes right after the procedure.
Underbilling the complex cases:
Some gastroenterologists undercode because they're afraid of audits. This happens with sedation, foreign body removal, or multiple biopsies. But undercoding means you do more work and get paid less. To fix this, use the right CPT codes for every part of the procedure, don't forget to bill for sedation, pathology, or anesthesia if needed, and train coders to include add-on codes, not just the base ones.
Ignoring payer contract changes:
Payers often change their rates, bundling rules, and authorization policies. If you don't keep up, you might bill using old rules and lose money.
You should keep someone on your team to check payer updates every month and negotiate with the payers accordingly. The person should also watch EOBs and ERAs to know about any sudden payment drops.
Poor patient billing and collection:
Patient balances now make up a big part of your revenue, but many practices struggle to collect them. They send bills late, don't offer payment plans, or confuse patients with unclear policies. By the time they follow up, the patient may forget or avoid paying. To fix this, collect co-pays and deductibles upfront, send reminders by text or email, offer online payments and flexible plans, and explain benefits to patients before their procedure.
Gastroenterology billing isn't something every in-house team can handle. It needs the support of a gastroenterology billing company that knows:
Know how a professional gastroenterology billing company helps
A professional gastroenterology billing company has experts who know GI CPT coding, payer rules in different states, prior authorization steps, and how to manage denials and appeals. Many gastroenterology practices now work with specialized gastroenterology billing companies, as these experts handle everything from checking patient eligibility to final collections. If you're facing denials, slow payments, or poor collections, outsourcing your GI billing could be the right solution.
So, what are you waiting for? Hire a perfect gastroenterology company and enjoy your practice growing successfully.
