Case Study: How We Recovered 45% Revenue for a Gastroenterology Practice
A high-volume gastroenterology practice in New York was facing revenue challenges due to common but costly billing issues. Errors in colonoscopy billing, delays in prior authorizations, and inconsistent documentation were resulting in claim denials, underpayments, and reimbursement delays.
After partnering with MBW RCM, the practice saw a 45% revenue increase within six months—alongside faster collections, fewer errors, and better financial performance.
Client Profile
Location: New York, USA
Specialty: Gastroenterology
Monthly Patient Volume: ~1,200
Monthly Billing Volume: $500,000
Collections Before RCM Optimization: $300,000/month
Despite a steady patient load, the practice was struggling to collect on time due to inefficient revenue cycle management (RCM) and lack of specialty-focused billing support.
Challenges in Behavioral & Mental Health Billing
High Claim Denial Rates
Frequent rejections due to coding errors, missing documentation, and incorrect modifiers—especially for endoscopy and ERCP billing—led to delayed payments.
Complex Gastroenterology Coding
Procedures like colonoscopy with biopsy, upper GI endoscopy, and ERCP require precise CPT and ICD-10 coding. Incorrect or inconsistent use caused claims to be rejected or underpaid.
Authorization Delays
Manual and unstructured prior authorization processes resulted in treatment delays and revenue bottlenecks.
Unstandardized Clinical Documentation
Providers used different templates and formats, leading to missing elements required for successful claims submission and compliance.
Insurance Eligibility Issues
Lack of real-time insurance verification meant services were often rendered before confirming coverage, increasing denial risk.
Our Gastroenterology Billing Strategy
We conducted a complete audit of the practice’s billing workflow, with a focus on gastroenterology-specific pain points. Then we implemented targeted, scalable improvements:
| Billing Problem | Solution by MBW RCM |
|---|---|
| Claim Denials | Introduced automated denial tracking, pre-submission audits, and better claim scrubbing. Denial rate dropped by 64%. |
| Procedure Coding Errors | Standardized gastroenterology coding (CPT/ICD-10) and trained coders on payer-specific rules. |
| Slow Authorizations | Deployed real-time prior authorization software with alerts to reduce delays and missed approvals. |
| Inconsistent Notes | Created unified gastroenterology documentation templates and performed routine chart audits. |