It is no secret that the world of healthcare is complex and constantly evolving. With the new growth in technology and science, the landscape of gastroenterology billing is also undergoing significant shifts. In fact, it is not only gastroenterology but also in terms of infusion, DME, and fertility. All specialties that are undergoing seismic modification. A recent study published in The American Journal of Gastroenterology reveals a concern that many GI providers are currently worried about - Medicare reimbursements for gastrointestinal procedures. It has only seen a decline of 18% between 2018 and 2022. Alongside this, procedure volumes dropped by 11%, and not to forget, the number of practicing gastroenterologists performing these services also fell by 7%, making gastroenterologists quite worried and concerned. In the report, the numbers shown aren't just statistics—they represent a deeper, growing challenge in the world of medical billing and of course for revenue cycle management (RCM) as well. And it's high time that GI providers like you need to look out for their gastroenterology billing.

What the Decline in Medicare Reimbursement Means for Your Gastroenterology Practice

For any medical practice, reimbursement is the lifeline. Be it for sustaining operations, payroll, and investments in patient care, reimbursement plays a vital role. In gastroenterology, where procedures like colonoscopies, EGDs, and biopsies form the backbone of revenue, an 18% drop in Medicare payments, in fact, can create a ripple effect as:

• Less revenue per CPT code—even for high-volume procedures.

• Increased reliance on private payers or high-deductible plans.

• Strained practice budgets and tighter margins.

• Shift toward selective procedure offerings, limiting patient access.

What do you, as a gastroenterologist, need to keep in mind during gastroenterology billing?

The billing implications of this reimbursement crisis are broad and significant that it is seen. In fact, one managing the billing and coding affair of the gastroenterology billing needs to keep in mind about like-

1. Shrinking Claims Volume - As procedure volumes decline, this means that the billing teams are handling fewer claims. While this might sound like a reduced workload, it is not so. It rather actually intensifies the pressure to ensure each claim is optimized for full reimbursement. Every dollar counts more than ever.

2. Coding and Documentation Complexity - Lower reimbursements can tempt providers to upcode or maximize services rendered—which, without proper documentation, increases audit risks for your practice. Thus, the billing teams must walk a fine line between compliant coding and optimized revenue capture. This will not only ensure a seamless billing transaction but also an improved ROI.

3. Increased Denials and Delays – With this, the Medicare and private payers undoubtedly are tightening their audit mechanisms. From pre-authorization hold-ups to medical necessity disputes, denials are actually rising. This leads to longer A/R cycles, rework of all your PA, claims, and of course not to forget mounting administrative overhead.

4. Workforce and Credentialing Gaps - A drop in the number of gastroenterologists performing procedures means billing teams are frequently seen revisiting credentialing data. Updating payer enrollments and dealing with shifting provider rosters. While adding operational friction more than ever.

Understanding the Bigger Picture: Strained Access to Care for GI practices

This crisis in reimbursement and billing isn't just an operational or financial issue anymore. It now affects patient care as well. Fewer procedures are performed, longer wait times, and stressed providers are seen more. And all these will eventually result in diminished access to critical GI diagnostics and preventive care, such as colon cancer screenings etc.

How SunKnowledge Can Help Turn the Tide and Ensure Better ROI:

At SunKnowledge Inc., we understand that gastroenterology billing today demands more than just claim submission. It is more of a strategic solution with constant attention and precision in managing both pre and post-billing operations. While billing experts need to adapt to policy shifts and payer behavior for seamless gastroenterology billing, one need to be more careful than ever.

Starting from all the coders need to be AAPC-certified and experienced in high-complexity GI procedures. While ensuring accurate, compliant coding captures maximum revenue, it is essential when you bill for gastroenterology; you work for a first-pass resolution rate. In fact, with a record of a 97 % first-pass collection rate, our expert today aggressively manages denials and ensures all claims meet payer-specific criteria upfront. By reducing front-end rejections and delays in reimbursement rates within the first month itself, SunKnowledge experts provide deep insights into payer trends, helping practices rebalance their payer mix and renegotiate contracts for better margins. With 80 % cost savings compared to in-house operations, partnering with a gastroenterology billing leader like SunKnowledge means a pathway toward long-term success. If you are looking for a change in your billing operation, get in touch with the expert to improve your gastroenterology revenue cycle today.