Gastroenterology Medical Billing Services

Our certified professional coders (CPC) and certified professional billers (CPB) have extensive experience ensuring accurate claims submissions for diverse gastroenterology services. We cover billing and coding for various services, including simple to complex procedures like endoscopy, colonoscopy, diagnostic testing (X-rays, ultrasounds, blood tests, etc.), transjugular intrahepatic portosystemic shunt (TIPS), endoscopic retrograde cholangiopancreatography (ERCP), etc. Combining human expertise and technology empowers us to simplify and expedite gastroenterology billing and coding services. Here is how we do it for you:

• Integrate gastroenterology-specific billing software with digital systems like electronic data interchange (EDI), EMR, EHR, and others to facilitate the electronic processing of claims.
• Ensure precise collection of patient details (demographics, medical history), physician referral data, and insurance payer particulars (provider details, coverage type, prior authorization, claims address, effective date, expiration date) to facilitate error-free claims submission.
• Get approval for certain medical procedures through preauthorization to ensure reimbursement in full without any claims denials. 
• Expertise in several billing types, including value-based billing, fee-for-service (FFS), global billing, episode-of-care, and more.
• Adhere to AAPC-mandated code specificity (ICD-10-CM codes for gastroenterology diagnoses and examinations, 91010- 91322 CPT code range, HCPCS codes, relevant modifiers, place of service (POS), and anesthesia modifiers) to ensure billing accuracy.
• Assign specific codes for claims submission for diverse gastroenterology procedures such as endoscopy (colonoscopy, EGD, ERCP, EUS), pathology and biopsy, therapeutic procedures (polypectomy, EMR, ESD), capsule endoscopy, motility testing, hepatitis, Gallstones, Gastritis, Gastroesophageal Reflux Disease (GERD), Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), etc.
• Submit claims electronically in compliance with the diverse fee schedules and payment guidelines of Medicare, Medicare Advantage Part C, Medicaid, and private insurance payers, including Blue Cross Blue Shield Association and Humana, Tricare, Veterans Affairs, employer-sponsored health plans, and COBRA.
• Help clients receive electronic payments and ensure they are posted in the financial system accurately.
• Assign a specialized claims status specialist to handle patient inquiries and communicate with payers, guaranteeing prompt claims adjudication.
• Verify EOB to effectively track claims for disputes, resolve them, and initiate an appealing process to get maximum reimbursements.
• Oversee clear and comprehensive reports delineating charges, authorized amounts, deductibles, copayments, and coinsurance for each patient to prevent unpaid bills.
• Regularly review billing metrics, such as clean claims rate, claims rejection rates, and collection rates, in order to identify gaps and areas of improvement.