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Gastroenterology

A patient with coverage from Aetna visited with you last week complaining of severe abdominal pain. You performed an endoscopy this morning and during the procedure, you removed two polyps and sent a sample for biopsy. Which modifiers will you add? Will Aetna deny suggesting bundling? What are the associated diagnoses that are commonly suggested by Centers for Medicare and Medicaid Services for the procedures you performed? What if the patient was pregnant? What if she had co-morbidities such as hypertension? How would those factors change how you get reimbursed? When you are not convinced why the patient had two polyps and decided to examine further through a video capsule endoscopy - will you get paid at all? When Aetna asks to review your medical chart, what exactly are they looking for? Does it matter whether you saw this patient in the hospital or at your surgery center?

These are precisely the questions we ask when we review and submit claims for gastroenterologists. The best chance for a claim to get paid is before submission and not after. We therefore pause billing a claim to get complete information rather than mindlessly submitting it. If after all precautions, an insurance company still denies or holds a claim, our insurance negotiators are trained to talk “GI” knowledgeably. It helps in getting our clients paid quickly.

Therefore, when you are considering performing an unfamiliar procedure (be it removing a bigger polyp or stenting inside the intestines), be assured that the NextServices team stands by waiting to get you paid correctly.