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

1. 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.

2. 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.

3. Authorization Delays

   Manual and unstructured prior authorization processes resulted in treatment delays and revenue bottlenecks.

4. Unstandardized Clinical Documentation

   Providers used different templates and formats, leading to missing elements required for successful claims submission and compliance.

5. 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.

Results After 6 Months

• Revenue grew by 45%

• Claim denial rate dropped from 22% to 8%

• Reimbursements processed 35% faster

• Staff workload reduced by 40%

• Patient billing complaints decreased

By optimizing the full gastroenterology revenue cycle, the practice saw measurable improvement in financial performance and day-to-day operations.

Conclusion

Billing for gastroenterology is complex—and errors in endoscopy billing, colonoscopy coding, or prior authorizations can have a major impact on cash flow. But with the right expertise, these challenges are completely fixable.

MBW RCM specializes in gastroenterology billing services. Our deep understanding of procedure coding, payer rules, and workflow automation helped this New York practice maximize reimbursements and minimize stress.

Struggling With Gastroenterology Billing?

Don’t leave revenue on the table. Let our experts audit your billing process and show you where improvements can be made.

👉 Request your Gastroenterology Billing Audit.