Gastroenterology has a billing problem that almost no other specialty shares. The same procedure can be preventive, diagnostic, or therapeutic depending on what the scope finds, and the coding, the modifier, and the patient’s financial responsibility all change mid procedure.

Get that wrong and you either write off money you earned or bill a patient for a screening that should have cost them nothing. Both are expensive, and the second one generates complaints.

A patient presents for a screening colonoscopy. A polyp is found and removed. The procedure is now therapeutic, but it started as preventive, and how that gets coded determines whether the patient owes a deductible they were told they would not owe. Modifier 33 and modifier PT exist for this, and they get missed constantly.

Snare, cold biopsy forceps, hot biopsy, EMR. These are different codes with different reimbursement, and the operative note frequently does not specify which technique was used on which lesion.

When different removal methods are used in the same session, each is separately reportable with the right modifier. Practices routinely bill one and lose the rest.

ASC, hospital outpatient, and office based procedures bill differently. Groups with ownership in an ASC need both sides handled correctly or the same case gets underbilled twice.

• Charge entry and coding review against your documentation
• Claim submission and clearinghouse rejection management
• Denial classification by reason, source, and cause with actionable feedback to your team
• Accounts receivable follow up and payer escalation
• Payment posting and reconciliation
• Patient billing inquiries through our dedicated toll free line
• Monthly financial reporting so you can see what is actually happening

You keep your EHR and your workflow. We integrate with PrognoCIS, athenahealth, AdvancedMD, gGastro, Sevocity, eClinicalWorks, and Open Practice, among others.

Gregory Corbett, CEO of Digestive Health Partners, came to us after thirty five years leading hospitals and reorganizing revenue cycle departments. He was against outsourcing RCM.

His words: our team’s expertise, transparency, and accessibility took their revenue cycle to an unparalleled level of excellence.

We also integrate directly with gGastro, so GI practices do not have to change systems to work with us.

Cyndi Walker founded Medicus after decades inside medical billing, and holds Certified Medical Coder and Certified Healthcare Business Consultant credentials. Medicus carries corporate accreditation from HBMA and the National Society of Certified Healthcare Business Consultants.

We are not a call center and we do not route your account offshore. You get people who know your specialty and answer the phone.

If it began as a screening, modifier 33 or PT should be applied so the preventive benefit still governs cost sharing. Applied correctly, in most commercial and Medicare situations the patient owes nothing or substantially less than a straight diagnostic claim would produce. Applied incorrectly, they get a bill they were told they would not get.

Yes. We integrate with gGastro along with PrognoCIS, athenahealth, AdvancedMD, Sevocity, eClinicalWorks, and Open Practice. You do not change systems to work with us.

Yes, and that is where a lot of GI groups lose money. The facility claim and the professional claim have to reconcile, and when they are handled by different parties without coordination, cases get underbilled on one side or both.

• Revenue Cycle Management
• Denial Management Services
• Chart Review and Clinical Audit Services
• Coding Education and Training
• Areas We Serve

Schedule a billing review and we will tell you where the revenue is going.