Gastroenterology (GI) A/R recovery
Gastroenterology A/R ages around a handful of recurring problems: colonoscopies billed as screening but adjudicated as diagnostic (or the reverse), payer application of multiple-endoscopy payment rules, anesthesia and pathology claims that depend on the primary procedure's outcome, and infusion or biologic therapy that needs a prior authorization for the drug and for the administration. MARR Partners works these 90+ day claims for GI practices on a contingency fee.
Why gastroenterology A/R ages
GI billing depends on coding decisions made after the procedure. A screening colonoscopy that finds and removes a polyp becomes a diagnostic procedure for payment purposes, and the modifier used (33, PT for Medicare) determines whether the patient owes cost sharing and whether the claim pays at all. Multiple endoscopies in the same session are paid under family-specific rules that payers apply inconsistently. Infusion suites add buy-and-bill drug claims where the drug is authorized but the administration is not, or the NDC and units do not match. Each of these produces a denial that is correct to appeal and time-consuming to appeal.
Common gastroenterology denials and the recovery path for each
| Denial | Typical cause | Recovery path |
|---|---|---|
| Screening vs. diagnostic colonoscopy | Modifier 33 or PT missing; diagnosis order wrong; payer applied cost sharing to a preventive service | Corrected claim with the correct modifier and diagnosis sequence; appeal citing the preventive-benefit rules |
| Multiple endoscopy rules | Payer reduced or denied a second scope in the same family without applying the base-procedure rule correctly | Underpayment dispute citing the endoscopy family rules in the fee schedule |
| Anesthesia for endoscopy | Medical-necessity policy for monitored anesthesia care not met on the claim; missing anesthesia time units | Appeal with the sedation risk documentation; corrected claim with time units |
| Pathology | Specimen count or units denied; pathology billed before the procedure claim adjudicated | Corrected claim with units per specimen; resubmit after primary claim pays |
| Infusion and biologics | Drug authorized but administration code not, or units and NDC mismatch; site-of-care restrictions | Corrected claim with NDC and units; appeal with authorization record |
| Capsule endoscopy and motility studies | Prior authorization missing or medical-necessity criteria not documented | Retro-authorization where allowed; appeal with prior work-up documentation |
What we look for in your aging report
- Colonoscopy claims with a patient-responsibility balance that should have been preventive
- Second and third endoscopy lines paid at zero in the same session
- Anesthesia claims denied for medical necessity with a documented risk factor
- Infusion claims where the drug paid and the administration did not, or the reverse
- Pathology claims denied for units
Who it is for
Single-specialty GI groups with 4–30 physicians, practices with an endoscopy center, and groups running an infusion suite for inflammatory bowel disease.
Fee: 12–18% of recovered revenue by claim age, invoiced after the payer pays the practice. No setup fee, no minimum, no long-term contract. Start with the MARR 90+ Day Recovery Audit.
How it works
Send aging report
Your 90+ day aging report through a secure link under a BAA.
MARR analyzes recoverability
Every claim is checked against deadlines, payer rules, and the denial reason.
We work approved claims
Corrections, documentation, appeals, and disputes, claim by claim.
You pay on recovered revenue
Payers remit to you. Our fee is invoiced on remittances actually received.
Related articles
Sources
- CMS, Medicare Physician Fee Schedule (global surgery periods, multiple-procedure rules, modifiers)
- CMS, National Correct Coding Initiative (NCCI) edits and policy manual
- CMS, Medicare timely filing requirements
- CMS, Original Medicare appeals process and deadlines
- HHS Office of Inspector General, OEI-09-18-00260 (2022): Medicare Advantage denials that met Medicare coverage rules
Figures attributed to a source are that source's; commonly used benchmarks are labeled as such. Verify deadlines against your own payer contracts.