For gastroenterologists, handling billing and collections can be a difficult and laborious responsibility. There are numerous aspects to consider, such as coding, submitting claims, and collecting payments from patients, which even seasoned practice managers can struggle with. Gastroenterologists must keep themselves up to date on various coding guidelines and payer-specific regulations to run a compliant and financially successful practice.
Operational costs at many gastroenterology ASCs are rising faster than the proposed payment rates for GI procedures in 2023. The American Gastroenterological Association states that increasing the proposed conversion factor slightly could boost it by 2.7% to $51.31 for ASCs that meet quality reporting standards. In contrast, a 2.7% increase for hospitals would result in a conversion factor of $86.78. As a result, healthcare clinics may face overhead costs for gastroenterology surgeries that are comparable to those of hospitals for the same procedures, but hospital reimbursements may more accurately reflect actual expenses. To mitigate the financial impact of this discrepancy, one solution is to implement centralized software that simplifies operations and records, reduces costly manual labor, and scales consistently across multiple surgery centers.
In this blog, we’ll explore some common billing challenges facing gastroenterology practices and offer tips on how to overcome them.
- Keeping Up with Changing Regulations
One of the biggest challenges facing gastroenterology practices is keeping up with constantly changing billing regulations. From updates to ICD-10 codes to changes in payer policies, there are always new rules to learn and follow. Failure to keep up with these changes can lead to claim denials and delays, which can impact your practice’s cash flow.
To overcome this challenge, make sure your billing staff is trained and up to date on the latest regulations. Consider investing in continuing education and resources like coding books or online training courses to help them stay current. Additionally, consider partnering with a billing vendor (like iTech Workshop) that specializes in gastroenterology billing to help ensure that your claims are always submitted accurately and on time.
- Ensuring Accurate Coding
Accurate coding is essential to getting paid quickly and avoiding claim denials. However, coding for gastroenterology procedures can be complex and time-consuming, particularly for procedures like colonoscopies or endoscopies. Failure to use the correct codes can lead to claim denials and delays, which can negatively impact your practice’s revenue.
To overcome this challenge, ensure that your billing staff has the proper training and resources to accurately code procedures. Consider investing in coding software or outsourcing your coding to a third-party RCM vendor to help ensure accuracy and efficiency.
- Managing Denials and Appeals
Claim denials are a fact of life in the healthcare industry, and gastroenterology practices are no exception. However, managing denials and appeals can be a time-consuming and frustrating process, particularly if you don’t have the resources to do it effectively.
To overcome this challenge, consider implementing a denial management process that includes identifying the root cause of denials, tracking and analyzing denials data, and taking action to prevent future denials. This process can help you identify patterns and address denial-related issues before they become bigger problems.
- Collecting Patient Payments
Collecting patient payments can be one of the most challenging aspects of running a gastroenterology practice. Patients may not understand their financial responsibilities, or they may be reluctant to pay due to high deductibles or copays. Failure to collect patient payments can lead to a significant loss of revenue for your practice.
To overcome this challenge, implement a clear and transparent patient financial policy that outlines patient responsibilities and payment options. Consider offering payment plans or discounts for patients who pay in full upfront.
At iTech, we do offer a Patient Payment Agreement (PPA) product feature and a Patient Responsibility Agreement (PRA) RCM service that outlines the financial responsibilities of patients receiving medical services. PPA is a document that outlines the payment terms, tenure, and conditions for a patient’s medical treatment. PRA, on the other hand, is similar to a PPA, but it specifically outlines the patient’s responsibilities for payment. This agreement may include information about the patient’s insurance coverage, deductibles, co-pays, and any out-of-pocket expenses.
Additionally, consider using automated patient payment solutions to make it easier for patients to pay their bills and for your practice to collect payments.
- Streamlining Billing and Collections
Finally, one of the biggest challenges facing gastroenterology practices is the time-consuming nature of billing and collections. Managing these processes manually can be a significant drain on your staff’s time and resources.
To overcome this challenge, consider implementing an integrated practice management and billing system (like expEDIum) that streamlines billing and collections processes. This can help reduce the amount of time your staff spends on administrative tasks and allow them to focus on patient care and other value-added activities.
In summary, there are several solutions available to address the challenges of medical billing, and these include:
- Utilizing precise and up-to-date medical billing software, which can aid internal billing departments in identifying appropriate codes for every patient encounter.
- Smaller teams can leverage outsourced medical billing services to access the required expertise without incurring the expenses associated with hiring, staff costs, and training.
- A practice management system (PMS) can facilitate copay and revenue collection efforts by sending advance appointment reminders, allowing online copayments, and sending email and text notifications for unpaid bills.
Discover how iTech Workshop and our partner EllipseIntel Solutions® can assist in improving the billing process of your gastroenterology practice, ultimately leading to increased success.