Indication and coverage
Review the documented reason for the service and payer requirements. Do not assume every colonoscopy follows the same coverage pathway.
Gastroenterology BILLING SUPPORT
Keep the indication, procedure and billing setting aligned.
GI billing moves between office care, endoscopy, pathology and facility workflows. We clarify which services the practice bills and what documentation supports the claim.
WHERE THE WORK GETS STUCK
The claim starts before submission.
A screening indication, a diagnostic procedure and a therapeutic intervention can lead to different coding and patient responsibility questions. Billing needs the completed procedure record.
SPECIFIC OPERATIONAL CHECKS
What we connect in the workflow.
Completed procedure details
Reconcile the report, findings and performed interventions with charges. Clarify pathology and facility responsibilities.
Setting and payer edits
Check place of service, provider details and applicable edits. Track record requests and denials with the relevant procedure documentation.
ILLUSTRATIVE CODE REFERENCES
Small details.
Different claim questions.
Examples for understanding the workflow.
Code selection follows the actual service.
| Code | Example service | Operational check |
|---|---|---|
| 43239 | Upper GI endoscopy with biopsy example | Use the completed procedure record and applicable policy. |
| 45378 | Diagnostic colonoscopy example | The actual intervention and indication determine coding. |
Illustrative CPT, HCPCS or other billing references, not coding instructions or coverage promises. Current code sets, documentation, payer policy and date of service control the correct claim. Review the relevant billing reference
WHAT YOUR PRACTICE RECEIVES
Clear exceptions.
A visible next action.
A procedure-report reconciliation queue, component handoff and payer follow up priorities.
- A named owner and agreed communication plan
- Enrollment and payment setup gaps included in the review
- Written scope before access or service begins
CLAIM VOLUME AND SCOPE
Use your workload, not an industry guess.
Office visits, procedures, locations and associated services determine scope. We distinguish encounter volume from procedure claim lines.
Billing is quoted as a percentage of monthly collections. Provider count, workflows and historical outstanding work help define the responsibilities included in your agreement.
See Billing & RCMBEFORE WE BEGIN
Agree on the details that affect delivery.
We map your payer mix, systems and the three workflow checks above, then agree on the records and scope needed. No practice information is required before the mutual agreement is signed.
No. We identify gaps and possible next actions. Coverage, records, filing windows and payer decisions determine whether a claim can be corrected or paid.
After the agreement and a BAA, we arrange a secure handover with approved access. Please do not send patient information through public website forms or regular email.
CONNECT THE DETAILS
Start with your practice, not a generic proposal.
A Free Practice Review connects billing, credentialing, enrollment and payment setup. We agree on scope first, with a signed agreement and BAA before practice data moves.