Gastroenterology Billing
Accurate, AI-Backed Revenue Protection for GI Practices
Gastroenterology claims come with complexity: scopes, colonoscopies, biopsies, infusions, telehealth, and evolving payer rules. We bring together AI-driven workflows + human oversight to catch leaks before claims leave, accelerate authorizations, manage denials, and ensure your GI practice receives what it earns on time.
Our Comprehensive Gastroenterology Billing Services
Our end-to-end solutions intended to boost collections and lower bureaucratic workload include:
1. Accurate Coding & Documentation
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Expertise in HCPCS, CPT, and ICD-10 codes for digestive operations.
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Correct use of modifiers can help to avoid denials.
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Complete clinical documentation enhancement (CDI).
2. Claims Submission & Management
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AI-powered claims scrubbing for clear submissions.
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Verification of eligibility and insurance in real time.
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Faster reimbursements via electronic claim submission.
3. Denial Management & Appeals
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Root cause analysis of denials.
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For rejected gastroenterology claims, there is a strong appeal procedure.
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Proactive preventive approach.
4. Patient Billing & Support
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Clear patient declarations.
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Several payment options are available to ensure patient comfort.
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Fewer patient complaints via open communication.
5. Improvement of the Revenue Cycle
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Reporting and analysis are done automatically.
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Forecasting and monitoring of cash flow.
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Following payer-specific, CMS, and HIPAA rules.
Benefits of Partnering with Sirius Solutions Global
When you choose us for your gastroenterology billing needs, you gain:
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Higher reimbursements with accurate coding.
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Reduced denials through AI-powered claim scrubbing.
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Faster payments with optimized billing cycles.
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Full compliance with payer and government regulations.
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Dedicated account managers with gastroenterology billing expertise.
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24/7 reporting access to monitor performance.
Why Gastroenterology Billing is Complex
Gastroenterological billing, demands accuracy and extensive knowledge because of:
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Sometimes many processes are carried out during one session.
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Sophisticated coding for diagnostic versus therapeutic techniques.
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Use modifiers often to prevent denials.
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High risk of payer audits if documentation is not complete.
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Frequent revisions in HCPCS, ICD-10, and CPT codes linked to gastrointestinal treatments.
Our staff guarantees correct compliance and maximum income cycle management customized for gastroenterology offices.
Why GI Billing Needs a Specialty Mind
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Policy shifts and payment pressures in 2025-2026: CMS is proposing payment cuts for facility-based GI procedures (HOPD/ASC) and E/M under an “efficiency adjustment,” while increasing payments for office-based office GI services. GI practices must adapt.
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Gastroenterology MIPS Value Pathway (GI MVP): Starting in CY 2025, GI providers engaging in MIPS could employ a specialty-focused GI MVP with particular quality indicators connected to colorectal screening, hepatitis, and IBD. Payment fines may result from non-compliance or misunderstanding of these.
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Expanded ASC roles & service shifts: More ASC-covered procedures are being added, including newer ones like POEM (CPT 43497). Site of service, payment rates, and pre-op preparation are all impacted by these changes.
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Denials & audits focusing on documentation, modifiers, and medical necessity: High rates of denials in GI practices result from inaccurate modifiers (-25, -59), unclear diagnosis codes, and failure to satisfy medical necessity for expensive procedures like biopsies or biological infusions.
Common Gastroenterology Billing Challenges & How We Solve Them
Incorrect or Vague Diagnosis / Medical Necessity Gaps
Every colonoscopy, ERCP, upper GI scope, or biopsy needs clear diagnosis that supports the procedure. We enforce documentation templates that capture symptoms, prior treatments, reason for scope or biopsy, findings, and decision points.
Modifier & Bundling Errors
Modifers like -25 (same-day E/M), -59 (distinct procedural service), laterality modifiers, and bundled procedure rules often trip up claims. Sirius AI flags potential misuse and suggests the correct modifier based on procedure details.
Prior Authorizations & Referral Requirements
Many high-cost GI diagnostics, biologic infusions, and imaging require prior auth. We start authorization early, track payer documentation needs, and maintain payer-specific templates to meet requirements.
Colonoscopy Screening vs Diagnostic Confusion
Colonoscopies performed for screening vs diagnostic reasons are reimbursed differently and may carry cost-sharing implications. Patients and payers need correct coding, including follow-up after a positive stool test, to avoid surprise denials.
Endoscopy & Biopsy Coding Detail Emphasis
Procedures like upper GI endoscopies, colonoscopies with or without biopsy/removal need documentation of the extent, method, device used, and path report attachments. Missed biopsy code (e.g., 88305) or incomplete pathology documentation often results in denials.
Denial Monitoring, Appeals & Analytics
We implement root-cause denial tracking; categorize denials by payer, CPT code, clinician; generate appeals with full supporting documentation; and feed insights back into provider workflows.
AI-Powered Gastroenterology Billing
Sirius Solutions Global includes automation tools and artificial intelligence (AI) in billing procedures:
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Predictive analysis for denial prevention.
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Intelligent claim scrubbing before submission.
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Automatic reminders for unpaid or delayed claims
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Data-driven insights to raise practice income.
Combining artificial intelligence and human knowledge guarantees precision, efficiency, and financial expansion for gastrointestinal clinics..
The Sirius GI Billing Playbook What We Add That Others Often Miss
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Pre-procedure insurance & site-of-service checks confirms the procedure is covered, then ascertains if billing is under ASC, hospital, or office and uses appropriate place-of-service codes.
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Template-driven procedural notes capturing procedural specifics, problems, devices, pathology, and sedation for endoscopy, colonoscopy, ERCP, and infusion.
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Modifier rule engine + AI validation recommends right modifiers, and flags whenever several procedures are done on the same day.
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Cost estimate & patient patient consent workflows particularly for follow-ups after colonoscopy, biological treatments, and infusion procedures.
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Post-procedure follow-ups check that pathology report receipts are enclosed, dosage and infusion coding are accurate, and reconciliation of gadgets/supplies is done.
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Voice AI for patient reminders & outreach appointment preparation, pre-op fasting, drug instructions, follow-ups for preparation (e.g., bowel preparation for colonoscopy), and balance reminders.
How Sirius Voice AI & AI Billing Transform GI Practices
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Patients receive text or voice reminders for pre-visit and for procedural preparation bowel preparation, fasting, and medication instructions so that they arrive prepared and avoid last-minute cancellations.
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To ensure claims, automation gathers device charges, biopsy results, and pathology reports.
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Before submission, a manual investigation of modifiers and code-flag alerts is done since medical records are written.
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Artificial intelligence flags payers, perhaps to deny, and then automatically writes appeal drafts for staff consideration: Denial Detection and Escalation.
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Patient financial discussion: Clear estimates, sympathetic scripts for unexpected costs, and payment plan possibilities preserving trust and lowering write-offs.
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