How Inefficient Billing and Coding Hurt Gastroenterology Centers

In the healthcare sector, every detail matters, and this is especially true in the context of gastroenterology billing services. These seemingly minor administrative tasks play a crucial role in a healthcare facility’s financial health.

In GI departments at hospitals, where medical procedures are often complex and varied, errors in billing and coding can lead to substantial revenue loss.

This blog will explore the detrimental impact of inefficient billing and coding processes and the possible solutions that following effective gastroenterology billing guidelines can provide.

The connection between billing, coding, and revenue in relation to gastroenterology practices

In a healthcare setting, ‘billing’ and ‘coding’ refer to the process of translating healthcare services into billable charges and submitting these to private insurers like Humana or government health plans like Medicare, for reimbursement.

Every GI procedure has multiple unique CPT codes. For example, procedures like colonoscopy, endoscopy, and laparoscopy have more than 25 unique CPT codes whose usage varies depending on the specifications of the procedure. Thus, in order to ensure optimum GI reimbursement, coding must be accurate.

In GI departments at hospitals, where procedures are often intricate and involve complexities, the chances of errors in billing are high. Such inaccuracies can lead to serious financial implications.

The Side-Effects of Inefficient Gastroenterology Billing and Coding

When GI billing and coding SOPs are not followed efficiently, hospitals and health systems face several adverse consequences:

  • Lost Revenue: Incorrect use of gastroenterology billing codes can lead to under-coding or over-coding, both of which can result in revenue loss. Under-coding means the center doesn’t get paid for all the services it provided, while over-coding can lead to penalties and fines.
  • Lower Reimbursements: GI billing errors can lead to reduced reimbursements from insurers. If a claim is inaccurately coded or lacks essential information, the insurer might reimburse less than the clinic’s expectation.
  • Increased Denials: Billing and coding errors of GI procedures are a common cause of claim denials, requiring additional time and resources to rectify and resubmit, further impacting the department’s bottom line.
  • Weaker Bottom Line: Ultimately, all these factors contribute to a weaker financial outlook for the center, affecting its ability to invest in advanced GI billing software, hire certified professional coders, and provide high-quality patient care.

Gastroenterology billing and coding guidelines to improve efficiency

Given the significant financial implications, GI departments must take steps to improve their billing and coding efficiency:

  • Invest in training: Regularly training your admin staff in the latest billing practices and coding updates can significantly reduce errors.
  • Utilize technology: EHRs and advanced gastroenterology billing software can automate and streamline the billing process, enhancing accuracy and efficiency.
  • Audit regularly: Regular billing audits can help identify recurring issues and provide an opportunity to rectify these before they impact revenue significantly.
  • Gastroenterology billing services outsourcing: Partnering with a specialized gastroenterology billing company can be an effective solution as these professionals are experts in their field, stay up-to-date with regular coding changes.

By recognizing the importance of these processes and taking proactive steps to enhance efficiency, hospitals can significantly reduce revenue loss, maximize reimbursements, and strengthen their bottom line.

For more information, please contact Sunknowledge Services Inc., a trusted RCM company handling GI billing and revenue cycle processes for hospitals and health systems for nearly two decades now.