2027 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2026-From Patient to Payment- The GI Revenue Cycle

Pdf Summary

The presentation explains the gastrointestinal (GI) revenue cycle from a patient’s first contact through final payment, emphasizing that effective accounts receivable (AR) management requires coordinated front-end, claim-submission, and back-end processes. Unresolved claims must be followed through to payment, adjustment, appeal, or another documented resolution; delays increase the risk of write-offs and lost revenue.<br /><br />Front-end practices include confirming patient demographics, insurance eligibility, deductibles, copayments, referrals, and prior-authorization requirements. Staff should collect copayments at registration, clearly explain financial responsibilities, and provide financial counseling or payment plans when needed. Accurate medical-record documentation is essential for obtaining authorization, particularly for procedures, diagnostic tests, and infusion services.<br /><br />Before submitting claims, staff should verify diagnoses and their priority, orders, documentation, codes, modifiers, authorization numbers, and other required claim details. A claim-scrubbing system can identify common errors, including eligibility, coding, demographic, provider, and missing-information issues.<br /><br />Back-end responsibilities include accurate payment posting, identifying underpayments, checking secondary-payer crossover, and assigning denials for timely follow-up. Practices should track denial patterns, investigate rather than automatically write off denied claims, and submit supported appeals within payer deadlines. AR workflows should prioritize older and higher-value claims while monitoring timely-filing limits and aging balances. Patient balances should be addressed consistently under documented practice policies.<br /><br />The presentation also stresses staff training, accessible and current procedures, payer-policy awareness, and regular communication among providers, front-desk staff, coders, and billers. Recommended performance measures include AR days, denial rates and trends, clean-claim and first-pass resolution rates, and insurance and patient collection rates. Standardized workflows, appropriate technology, and cross-team collaboration can reduce errors, improve collections, and strengthen practice finances.

Asset Subtitle

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

Meta Tag

Concept Accounts Receivable

Concept Revenue Cycle

Concept Claim Submission

Concept Claim Denial

Concept Claim Rejection

Keywords

gastrointestinal revenue cycle

accounts receivable management

claim submission

insurance eligibility

prior authorization

copayment collection

claim denial appeals

payment posting

denial management

clean claim rate

Accounts Receivable

Revenue Cycle

Claim Submission

Claim Denial

Claim Rejection