Cash flow is critical for GI practices, but rising denial rates, payer complexity and Medicare cuts have made billing navigation difficult, according to a recent blog post from RCM company Sun Knowledge.
Here are eight tips to know about GI billing, according to the post:
1. GI procedures require precise CPT codes. In 2025, CMS introduced 270 new codes, including updates for colonoscopies. Ongoing staff training and regular audits are key to maintaining accuracy and reimbursement, according to the post.
2. Adopting EHR systems and GI-specific billing software can improve claim submission accuracy and speed. CMS data shows EHR adoption leads to 20% faster claim approvals.
3. Identify and analyze recurring denial causes — coding errors, missing prior authorizations, etc. CMS reports that 80% of denied claims can be recovered with timely appeals. Outsourcing denial management can also lift administrative burden.
4. Real-time eligibility checks ensure patients are covered and aware of costs. GI procedures like advanced endoscopies often need pre-approval. Confirming this up front reduces billing delays and boosts patient satisfaction.
5. Payers like Medicare, Blue Cross Blue Shield and Cigna have distinct rules, according to the post. Equipping one’s front office and billing teams with knowledge on each insurer’s protocols can help avoid costly errors and slow payments, according to the post.
6. High deductibles and out-of-pocket expenses, averaging $1,400 in 2024, can delay payments. Proactive patient communication about financial responsibilities improves collections and trust.
7. CMS expanded telehealth billing in 2025. GI practices can now be reimbursed for virtual consultations, offering flexible care options while stabilizing cash flow.
8. Staying current with CMS, HIPAA and payer regulations is beneficial. Medicare GI reimbursements dropped by 2.83% in 2025. Remaining compliant protects revenue and reduces audit risks, the post said.
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