Gastroenterology billing services are essentially the financial backbone of a gastroenterology practice. They handle the intricate task of translating medical services provided by gastroenterologists (doctors specializing in the digestive system) into a language understood by insurance companies. This ensures the practice gets properly reimbursed for the care they deliver. Gastroenterologists perform a wide range of procedures, from endoscopies to colonoscopies. Each procedure has a specific code, and gastroenterology billing services ensure these codes are assigned accurately. Billing Care Solution handle submitting these codes, along with other necessary information, to insurance companies so the practice receives payment.

Services offered by Billing Care Solutions:

Medical Billing & Coding: This is likely their core service. Billing Care Solutions accurately code procedures specific to gastroenterology, considering the complexities of the specialty. Billing Care Solutions highlight having a team with in-depth knowledge of complex gastroenterology coding to minimize errors and maximize reimbursement.

Revenue Cycle Management (RCM): This involves managing the entire revenue cycle, from scheduling appointments to collecting payments. Billing Care Solutions offer features like automated claim scrubbing to minimize errors before submission.

Account Receivable Management: Billing Care Solutions efficiently track and collect outstanding payments from both patients and insurance companies. Billing Care Solutions look for features like automated reminders and self-service patient portals for faster collections.

Provider Enrollment & Credentialing: Billing Care Solutions handle the process of getting gastroenterologists enrolled with insurance companies, potentially offering a faster and more streamlined approach.

Eligibility & Benefit Verification: This involves verifying patient insurance coverage and benefits before appointments. Billing Care Solutions utilize real-time verification tools to ensure accuracy and avoid denied claims. Up-to-date verification ensures appointments are scheduled with accurate information, minimizing claim denials. Billing Care Solutions streamlines the process of obtaining authorizations, potentially reducing delays in billing services patient care.

Authorization and Referral Services: Billing Care Solutions streamline the process of obtaining authorizations and referrals from insurance companies for procedures, potentially using electronic tools for faster approvals.

Business Intelligence Reporting Services: Billing Care Solutions offer customized reports that provide insights into practice performance. Billing Care Solutions billing features ensure in-depth analysis of specific metrics relevant to gastroenterology practices can be a valuable tool.

Patient Support: Billing Care Solutions involve offering dedicated support staff to answer patient billing questions and resolve any issues. A secure online portal allows patients to easily access billing information, make payments, and communicate with the practice.

Types of codes used

Current Procedural Terminology (CPT® codes): These codes define specific medical services and procedures performed by a healthcare professional. They are used for reporting purposes to insurance companies to ensure proper reimbursement. Here are some examples of CPT® codes commonly used in gastroenterology:

  • 43235: Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimens(s) by brushing or washing, when performed (separate procedure). (Upper endoscopy)
  • 91110: Gastrointestinal tract imaging, capsule endoscopy. (Capsule endoscopy for examining the small intestine)
  • 91034: Tests for gastroesophageal reflux. (Tests for acid reflux)
  • 91200: Liver elastography. (Non-invasive test to assess liver fibrosis)

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes: These codes represent diagnoses or medical conditions a patient has. They are used alongside CPT® codes to provide a complete picture of the service rendered and the reason for it. Here are some examples of ICD-10-CM codes commonly used in gastroenterology:

  • K21.0: Gastroesophageal reflux disease with esophagitis. (GERD with inflammation of the esophagus)
  • K57.30: Diverticulosis of large intestine without perforation or abscess. (Presence of pouches in the colon without complications)
  • K85.9: Acute pancreatitis. (Inflammation of the pancreas)
  • K92.1: Melena. (Black stools due to bleeding in the digestive system)

Modifiers used

Modifier 51: This indicates multiple procedures performed during the same session by the same physician. For instance, a colonoscopy with a biopsy removal would use modifier 51 alongside the colonoscopy code.

Modifier 59: This signifies a separate, unrelated procedure performed on the same day as the primary service. An example an upper endoscopy (EGD) with a liver biopsy, where the EGD is the primary procedure and the biopsy is denoted by 59.

Modifier 25: This modifier is used when a significant, separately identifiable service is performed on the same day by the same physician on a different lesion or location of the same organ system. For instance, a colonoscopy with a polyp removal in the ascending colon and another polyp removal in the descending colon might use modifier 25.

Modifier 52: This indicates a reduced service due to unforeseen circumstances. It is used for colonoscopy is planned to be diagnostic but polyps are found and removed, making it a therapeutic procedure with a reduced level of service compared to a planned polyp removal.

Modifier 53: This modifier signifies a discontinued procedure due to medical necessity. For example, an endoscopy might be started but discontinued due to bleeding, requiring modifier 53.

Modifier 76: This indicates a repeat procedure performed on the same day by the same physician due to an unforeseen complication during the original procedure.

In conclusion, Billing Care Solutions is a good fit for your gastroenterology practice. It demonstrate a strong understanding of the complexities of dermatology billing and how they can address the specific challenges faced by gastroenterology practices.

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