2026 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2025-Strengthening Revenue Cycle Management from Start to Finish

Video Transcription

Video Summary

This comprehensive discussion emphasizes the critical, team-based nature of managing the healthcare revenue cycle, from the first patient contact through accounts receivable (AR) management. Front-end responsibilities include accurate insurance verification at every visit, pre-authorization for procedures, thorough patient financial counseling, and effective co-pay collection upfront. Ensuring complete, current demographic and insurance data is vital to prevent claim denials and delays.<br /><br />The transition phase focuses on precise claim submission, requiring correct diagnosis coding, valid orders, appropriate modifiers, and adherence to payer documentation policies. Using claim scrubbing software helps identify errors before claims reach payers, reducing denials.<br /><br />On the back end, effective denial management is crucial. Staff should promptly work denied claims, understand payer policies, and track denial trends to facilitate provider and coder education, minimizing future issues. Payment posting accuracy is essential to detect underpayments and ensure correct patient billing. Establishing standardized workflows, regular training, and cross-department communication enhance efficiency.<br /><br />Key metrics to monitor include AR days, denial rates, clean claim rates, and collection rates to drive continuous improvement. Investing in technology, like claim scrubbers, and maintaining up-to-date coding resources are stressed as best practices. Ultimately, collaboration across front-end, billing, and back-end teams is vital for optimizing revenue collection amid evolving payer requirements and decreasing physician fee schedules.

Asset Subtitle

Kathleen A. Mueller, RN, CPC, QMC, QMGC, CCS-P, ICD-10 Proficient
Kristin Vaughn, CPC, QMC, QMGC, CPMA, ICDCT-CM

Keywords

healthcare revenue cycle

insurance verification

claim submission

denial management

payment posting

claim scrubbing software

revenue cycle metrics