RCM for Gastroenterology: 5 Top Challenges and Their Solutions

Even though gastroenterology is one of the highest-paid specialities, groups and MSOs remain frustrated. A study in The American Journal of Gastroenterology reports that between 2007 and 2022, average reimbursement for GI procedures declined 7% in nominal dollars and a steeper 33% after adjusting for inflation. Payments for colonoscopies and related biopsies fell even further, sliding 38% over the same period.

With reimbursement eroding by more than one-third in real terms, every denied claim, coding error, or day of delayed payment now hits margins harder than it did a decade ago. Tech-enabled revenue cycle management like underpayment and denial recovery, automated prior-auth, contract modeling, and proactive patient collections let GI groups claw back dollars that fee-schedule cuts have stripped away.

 For multisite MSOs, centralized analytics and standardized revenue cycle management processes also unlock the efficiencies that private-equity investors expect. About 10% of today’s gastroenterologists are employed by private equity-backed firms. 

Gastroenterology’s procedure-heavy coding, stringent screening-versus-diagnostic rules, and above-average denial rates send many revenue cycle managers to RCM software for support.  

Here, you can review what manual and automated revenue cycle management processes can deliver for gastroenterology’s unique revenue cycle challenges. 

What is Revenue Cycle Management (RCM) for gastroenterology?

Revenue cycle management for gastroenterology is the end-to-end financial workflow that GI organizations rely on to track, manage, and maximize payment for every scope, consult, and procedure. It starts the moment a patient books a visit and runs through registration, insurance verification, charge capture, specialty-specific medical coding, claims submission, denial follow-up, and, ultimately, collection of balances from both payers and patients.

With reimbursement growth stalling and operating costs still climbing, gastroenterology groups and MSOs can protect margin only by squeezing more dollars out of every claim they file. Assertive revenue-cycle management gets that done. 

Tight, tech-enabled and manual RCM keeps net collections high while containing the labor costs required to get paid. Gastroenterology’s procedure-heavy, denial-prone environment makes revenue-cycle excellence even more critical to staying viable and growing.

Proactive RCM for gastroenterology brings robust benefits 

Effective RCM at your gastroenterology group or MSO delivers these advantages:

• Revenue protection and optimization: Screening-versus-diagnostic missteps can block GI payments, some of which enter the five- and six-figures range. Prioritizing accurate coding is a key feature of robust revenue cycle management. Specialty-tuned coding engines cut the screening/diagnostic confusion, modifier omissions, and site-of-service errors that drive GI denials.
• Limitation of denials: Effective RCM at your gastroenterology group or MSO limits denials by proactively verifying patient eligibility, securing prior authorizations, and ensuring precise coding and detailed documentation before claims are submitted.
• Improved cash flow: Streamlined pre-auth, charge capture, and claim scrubbing accelerate reimbursements and shrink days in A/R, strengthening the practice’s day-to-day liquidity.
  
• Actionable financial insights: Optimized revenue cycle workflows and RCM platforms surface real-time analytics on procedure mix, payer yield, and site-of-service margins—crucial when endoscopy towers, scopes, and biopsy equipment require ongoing seven-figure investments.
• Sustainability and growth: By capturing every eligible dollar and easing administrative load, optimized RCM frees gastroenterologists to focus on high-quality care and fuels expansion across new ASCs or satellite clinics.
  
• Regulatory compliance: Automated rule updates keep the practice aligned with shifting CMS guidelines and payer policies—vital in a specialty where colonoscopy billing draws frequent audit attention and Stark or Anti-Kickback missteps can trigger multimillion-dollar penalties.
  
• Enhanced patient experience: Transparent patient payment estimates and streamlined statements are central features of optimized RCM. These build trust, helping patients proceed with recommended scopes or biologic infusions without hesitation—improving outcomes and loyalty.
  

In short, robust revenue-cycle management ensures GI groups and MSOs can survive reimbursement pressure, fund capital-intensive endoscopy services, and sustain growth.

Take a quick, self-guided tour through a powerful RCM tool that optimizes contract performance, denial management, and payer reimbursements for cardiology practices, groups, and MSOs. 

5 common gastroenterology RCM challenges and their solutions

Gastroenterology’s high-ticket procedures, shrinking margins, and rising write-offs put revenue at risk. Optimized revenue cycle management helps organizations overcome the following challenges.

RCM for gastroenterology challenge #1: Shrinking reimbursement

As mentioned above, Medicare and commercial reimbursement for common GI procedures have fallen. Commercial payers often mirror CMS cuts, leaving little margin to absorb workflow leakage.

With payers cutting fees for upper endoscopy, colonoscopy, and ERCP and commercial payers quickly mirroring those reductions, every percentage point lost to contract loopholes or silent underpayments now hurts. Contract management platforms give gastroenterology groups the data, alerts, and leverage needed to stop that bleed.

Contract management software 

1. Identify hidden underpayments 

RCM software for gastroenterology ingests each payer contract, converting it into machine-readable fee schedules down to the CPT level. It scores every incoming payment against that schedule. Organizations can detect underpayments from payers and follow Healthcare underpayments and appeal before timely-filing windows close.

GI practices can recover net revenue that would have been written off as “contractual,” especially on high-RVU scopes with pathology or anesthesia add-ons.

2. Model the revenue impact of proposed cuts to strengthen negotiation stance

Contract management software’s modeling engines let administrators simulate payer  updates or payer proposals across their CPTs—e.g., a 4% cut to 45385 (colonoscopy with polypectomy)—and instantly see the dollar loss to ASC, office, and hospital sites of service. 

Armed with hard numbers, practices enter renewal talks knowing the exact increase required elsewhere to stay whole. With this information, provider organizations can back up their objections to fee changes with concrete data, strengthening not only their confidence but their negotiation position.

3. Catch auto-renewals and “quiet” amendments

Dashboards surface renewal dates 6–12 months out and flag unilateral amendments slipped into portals, preventing contracts from rolling over at outdated rates. Built-in alerts for silent clauses help groups renegotiate or opt out before third parties start applying unvetted discounts.

4. Strengthen negotiating position with market benchmarks and competitive performance

Many contract management tools benchmark each payer’s rates against a national dataset of GI contracts, showing where procedures like your 45378 screening colonoscopy fees ranks percentile-wise. That evidence translates directly into data-driven counteroffers during negotiations. Practices leverage reports to justify shifting volume or tier status if payers refuse to close egregious rate gaps.

Manual tactics to counter shrinking reimbursement

Contract-management software automates much of the reimbursement optimization heavy lifting, but small gastroenterology groups can still defend margins with disciplined, low-tech processes that mirror technology features. Staff can take these steps to help optimize revenue: 

1. Identify hidden under-payments manually

• Build a spreadsheet fee schedule for each payer by translating contract language into concrete dollar amounts.
  
  
• Every week, sample remittances for those codes. If the paid amount is lower than the spreadsheet, drop the claim into an “appeal” folder and start the under-payment dispute before timely-filing limits expire.
  
  
• Track appeal outcomes so recurring variances surface quickly.
  
  

2. Model the impact of proposed cuts

Before CMS or a commercial payer releases new rates, copy last year’s volume for your highest-volume CPTs into a worksheet, reduce each by the announced percentage cut, and total the projected annual loss. Use that figure as the baseline ask during contract renewals (“We need a 3% bump on all pathology codes to offset a $180,000 loss on colonoscopies next year.”).

3. Monitor Auto-Renewals and Quiet Amendments

Enter every contract’s effective and notice dates into a shared calendar with reminder alerts 180, 120, and 60 days out. Assign one staff member to review payer bulletin boards and portal messages weekly for unilateral amendments; flag any rate or language change for legal/leadership review immediately.

4. Leverage Informal Market Benchmarks

Swap de-identified rate sheets with trusted peer practices or state GI societies to see how your 45378 and 45385 rates stack up. If you discover a 10% gap, prepare a simple one-page comparison chart for negotiations to justify rate adjustments or tier upgrades.

5. Tie contracts to denial and prior auth workflows

Add payer-specific coding notes (bundling rules, place-of-service edits, pre-auth triggers) to the front page of your internal coding manual so claims leave the office compliant.

When denials arise, reconcile the expected contractual reimbursement against the actual payment; if the variance exceeds a preset dollar threshold, escalate as a bulk dispute instead of one-off appeals.

Overall, implementing these people-driven checkpoints won’t replace a full PCM platform, but they capture under-payments, inform stronger negotiations, and prevent avoidable denials—critical defenses when per-unit reimbursement keeps sliding. 

RCM for gastroenterology challenge #2:  High denial rates

Gastroenterology groups battle a 16% denial rate, according to MedScape’s survey of 17,461 U.S. clinicians, reported in Beckers’ ASC Review. Modern denial management software paired with specialized services attacks the specialty’s four denial vulnerabilities which are: 

1. Missing prior authorization

Automated eligibility modules surface payer-specific authorization rules at scheduling, blocking procedures that lack approval codes. Reimbursement specialists chase retro-auths and overdue determinations, preventing CO-197 “no auth” denials from ever hitting A/R.

2. Medical-necessity edits for biologics

Built-in LCD/NCD libraries validate drug J-codes (infliximab, ustekinumab, etc.) against indication, dosage, and step-therapy history before the claim leaves the system. When payers still deny, experts assemble evidence-based appeals with progress notes, failed-therapy histories, and literature citations to overturn high-dollar rejections quickly.

3. Incorrect Place-of-Service (POS) Coding

Claim-simulation engines mirror payer adjudication logic, flagging mismatches such as ASC work billed with office POS 11. Dashboards trend POS denials by facility and CPT, enabling managers to retrain staff or add EHR hard stops where patterns emerge.

4. Screening-vs-diagnostic colonoscopy mismatches

Coding scrubs verify that preventive colonoscopies carry modifier -33 and conversions to diagnostic include modifier -PT plus correct biopsy/polypectomy add-on codes.
Analytics drill down to provider/CPT pairs, spotlighting physicians who repeatedly omit the right modifier so targeted education eliminates repeat errors.

Denial recovery services combine the data and insights listed above with seasoned GI denial experts to create an end-to-end denial management platform. This comprehensive program improves appeal outcomes and increases reimbursement yields. It neutralizes the specialty’s most stubborn rejection triggers, converting a 16% denial headache into faster cash flow and lower cost-to-collect.

Manual RCM tactics to reduce denials

Even without advanced denial management software and recovery services, GI organizations can significantly cut denial rates by tightening hands-on processes at every step of the revenue cycle. Here are core manual strategies proven to work:

1. Proactive eligibility & authorization checks

Verify each patient’s insurance coverage, benefits, co-pays, deductibles, and prior-authorization requirements before service. Maintain a payer-matrix cheat sheet at every workstation and train staff to confirm real-time eligibility and authorization status during scheduling, not after the visit.

2. Accurate, up-to-date coding and documentation

Ensure coders stay current with frequent CPT/ICD/HCPCS changes for GI procedures. Organize regular training sessions and circulate periodic coding updates. Implement a dual-coder review process for high-risk encounters and require a documentation checklist to verify that physician notes support medical necessity for every billed procedure.

3. Root cause tracking and denial analysis

Log all denials in a shared spreadsheet, noting root causes (e.g., CO-197 for missing auth, CO-50 for medical necessity, CO-234 for modifier mismatch). Review denial trends weekly to pinpoint problem payers, providers, or procedures, and publish a rolling “top five” list of error sources so staff can focus improvement efforts where they’ll have the biggest impact.

4. Appeal and resubmission discipline

Act quickly on all denials: Assign a designated denial “first responder” to address new denials daily. Use standardized appeal letter templates tailored for frequent issues (authorization, medical necessity, modifier errors), attach relevant documentation proactively (e.g., op notes, failed-therapy history), and resubmit within payer deadlines to maximize chances of overturn.

5. Continuous Staff Education and Feedback Loops

Conduct short weekly or monthly huddles to review denial patterns, share payer updates, and celebrate fast-resolved cases or reversals. Update coding and documentation protocols based on failed or successful appeals, building a “living playbook” for the team. 

6. Pre-submission audits and double-checks

Audit draft claims for common GI denial triggers before submission, such as missing prior authorizations, incomplete documentation for biologics, or incorrect POS codes. A second set of eyes on tricky cases can prevent errors from ever reaching the payer.

By enforcing these staff-driven denial management measures, GI groups typically see substantial reductions in denial rates, improved reimbursement, and faster cash flow—even without automation or software.

RCM for gastroenterology challenge #3: Coding inaccuracies

Colonoscopies and endoscopies dominate GI billing, yet reimbursement changes dramatically when a “screening” exam converts to a “diagnostic” or “therapeutic” one mid-procedure. Modifier choice (-33, -PT, -59) and pathology add-on codes are common error points, driving an estimated 30% of GI claim denials.

Automation & AI

Automated revenue-cycle management platforms tackle the modifier problem at three points:

1. Prevention at the front end

• Pre-submission edit rules flag mismatched CPT-modifier pairs (e.g., screening colonoscopy that should carry -33) and missing add-on biopsy codes before the claim ever leaves the practice management system.
  
  
• Automated eligibility/prior-auth tools pull payer-specific modifier rules in real time, alerting staff if a screening is converted to diagnostic needs modifier -PT added.
  
  
• Routine coder education—a key RCM feature—keeps humans current on National Correct Coding Initiative edits and payer quirks, reducing manual slip-ups
  
  

2. Early detection & triage

• AI denial-prediction engines scan draft claims and predict the likelihood of a modifier-related rejection, routing high-risk encounters to senior coders for secondary review before submission.
  
  
• For claims that are denied, bots instantly read the Electronic Remittance Advice (ERA), classify the denial reason (e.g., CO-4 “modifier needed”), and kick off a workqueue so nothing is missed.
  
  

3. Rapid recovery & root-cause fixes

• Robotic process automation (RPA) alone can auto-fill and assemble a templated appeal package when the denial reason is straightforward and all required data already sit in structured fields. When the appeal gets complicated, however, it can take AI-driven tools to create an accurate appeal letter. Both can also attach op notes or pathology reports to justify the correct modifier, and then submit the packet.
  
  
• Analytics drill down to the CPT-level to expose patterns such as a specific endoscopist forgetting modifier -59 on EMR-captured polyps; managers can retrain or create a template fix.
  
  
• Continuous feedback loops update the claim-scrubber rules so the same modifier error can’t recur, steadily driving the denial rate down over time.
  
  

Practices typically see a drop in modifier-related denials after deploying real-time claim edits and coder alerts. This results in a reduction in accounts receivable as automated appeals are sent out within hours instead of weeks. A cleaner first-pass yield frees staff to focus on high-value tasks, trimming the cost-to-collect even while volumes grow.

 Manual coding interventions

Manually curbing modifier-related denials still follows the same three challenges but depends on disciplined human workflows rather than bots. If you want your team to catch each of these tricky modifiers, follow these steps:  

• Front-end coders must cross-check every colonoscopy encounter against payer policies and NCCI edits before claim release, confirming that preventive cases carry -33, diagnostic conversions carry -PT, and biopsy add-on codes are present. 
• Billing staff must keep laminated cheat sheets of each payer’s modifier quirks at their desks and verify eligibility or prior-auth notes in the practice management system to ensure those rules are met.
•  Senior billers must run daily “pending/hold” reports, combing for high-risk claims. Once ERAs arrive, they must read remittance codes, categorize denials such as CO-4, and log them into a shared spreadsheet that feeds individual coder scorecards.
• Appeals specialists must copy-paste patient, CPT, op note, and pathology details into Word templates, draft custom narratives when medical necessity is questioned, attach supporting records, and upload the packet through payer portals; meanwhile, an analyst aggregates denial data monthly, identifies root-cause patterns (e.g., one endoscopist’s frequent -59 omission).
• Appeals specialists must circulate refresher training or update the internal coding checklist so the same error is blocked at submission next time.

Small GI practices with few payers can often handle tasks given sufficient and experienced staff. 

Whether through disciplined manual workflows or AI-enabled automation, locking modifier accuracy into the front end of the revenue cycle—and wiring fast, data-driven fixes when denials do occur—is the fastest route to reclaiming the GI revenue now lost to preventable coding errors.

RCM for gastroenterology challenge #4: prior-authorization burden

Biologic therapies for Crohn’s, ulcerative colitis and advanced reflux routinely require multi-step prior authorizations. Fifty percent of GI clinicians report at least one patient harmed by authorization-related delays. Authorizations also extend to anesthesia and pathology services tied to endoscopy, further slowing cash collection.

Automation & AI Solutions

Modern GI-tuned revenue-cycle platforms combine automation, real-time data, AI, and to move those approvals from weeks to hours—protecting patients from treatment delays and practices from denials. Here’s how:

1. Real-time payer rules at the point of order

• An embedded PA knowledge base pulls the latest requirements for every payer–drug–CPT combination (e.g., infliximab J1745 + Crohn’s ICD-10 K50.90) as soon as the order drops, so staff know exactly which forms, labs or step-therapy attestations are needed before submission.
  
  
• Smart checklists surface anesthesia and pathology add-ons tied to endoscopy, preventing “services not authorized” denials after the fact.

2. One-click electronic submission & status monitoring

• API connections feed completed requests—clinical notes, endoscopy reports, pathology requisitions—directly into payer portals; no faxing, no duplicate data entry.
  
  
• A central dashboard refreshes payer responses every few minutes, color-coding cases (green = approved, yellow = pending, red = additional info) so staff chase only the files that need follow-up.
  
  

3. AI-Assisted clinical documentation

• Natural-language tools scan op notes or colon pathology reports, extract medically necessary findings (e.g., multiple failed TNF-α inhibitors), and auto-populate payer-specific medical-necessity fields, trimming clinician paperwork time.
  
  
• Machine-learning models flag likely prior-auth denials before submission, prompting coders to attach extra evidence that bumps first-pass approval rates from the mid-60% range to more than 90%.
  

4. Automated escalation & retro-auth safety nets

• If a payer clock hits 48 hours with no response, bots trigger escalation emails or portal messages and calendar follow-up calls, stopping aged requests from stalling infusion chairs.
  
  
• For unplanned, urgent procedures, the system launches retro-auth workflows the same day of service, bundling clinical notes and time-stamps to preserve reimbursement when real-time approval wasn’t feasible.

5. Analytics & continuous improvement

• Dashboards slice approval turnaround by payer, drug and facility, spotlighting bottlenecks such as an insurer averaging nine-day reviews on Vedolizumab requests.
  
  
• Monthly KPI reviews feed updates back into the PA rule engine—adding new payer forms or modifying clinical triggers—so the platform gets smarter with every cycle.
  
  

Purpose-built GI RCM software turns prior authorization from a manual, error-prone grind into a streamlined, data-driven process. By marrying real-time payer intelligence, AI-enhanced documentation and automated follow-up, specialty practices secure faster approvals, protect patient care timelines and keep high-value claims out of denial purgatory.

Manual RCM tactics to boost prior-auth success

Even without advanced software, gastroenterology practices can raise first-pass authorization approvals by tightening people-based processes at three choke-points:

1. Capture requirements upfront

• Keep a single-page prior-auth matrix at every workstation that lists the top 20 GI drugs/procedures, each payer’s forms, and required labs or step-therapy documentation.
  
  
• During scheduling, require staff to complete a two-item checklist—“Auth requested?” and “All supporting docs attached?”—before locking in the appointment.
  
  

2. Track and chase aggressively

• Log every submitted request in a shared spreadsheet with columns for date sent, payer SLA, and next follow-up date; color-code rows that reach 48 hours with no response.
  
  
• Assign one “auth champion” per day who spends the first hour calling or portal-messaging payers on any yellow or red rows, documenting outcomes in real time.
  
  

3. Strengthen clinical narratives

• Store templated cover letters for common indications (e.g., refractory Crohn’s, Barrett’s esophagus ablation) that cite guideline excerpts and prior medication failures; clinicians add patient-specific details in under two minutes.
  
  
• Include pathology reports, failed drug histories, and endoscopy images up front instead of waiting for payer additional-info requests.
  
  

4. Build fast retro-auth pathways

• Post a standing rule: any unscheduled urgent scope or infusion triggers an immediate retro-auth form before the patient leaves recovery; nursing staff gather op notes and time-stamps while details are fresh.
  
  
• Review retro-auth cases weekly to spot recurring gaps—then update the front-end matrix or checklist to prevent repeats.
  
  

5. Measure. Share. Improve.

• Track key metrics (first-pass approval rate, average turnaround days, auth-related denials) on a hallway whiteboard so every coder and scheduler sees progress or slippage.
  
  
• Hold a 15-minute huddle each month to celebrate wins, dissect delays, and adjust the matrix, templates, or call cadence accordingly.
  
  

Practices that enforce these manual disciplines routinely lift first-pass PA approvals by 15–25 percent and shave a week or more off therapy start times—without adding a single line of code.

RCM for gastroenterology challenge #5: HDHP plans increasing organization write-off and bad debt

Fifty-plus percent of commercially insured GI patients now carry high-deductible plans, pushing more revenue into front-end collections. or GI practices, that means several hundred dollars—sometimes the entire colonoscopy bill—must be paid by the patient, not the payer. Inadequate estimates and billing transparency prolong days in A/R and elevate bad-debt write-offs.

Automation & AI solutions

With automated patient cost estimate software, gastroenterology practices can provide accurate out-of-pocket quotes at scheduling and offer convenient, digital payment options before patients arrive. The software integrates contract rates, patient accumulators, and benefit data to produce CPT-level out-of-pocket quotes in seconds. This estimate can be embedded inside the scheduling screen so staff can review the patient’s share, such as deductible remaining or coinsurance, while the visit is being booked.

GI practices use patient cost estimation software to convert today’s HDHP exposure into cash-in-hand instead of lingering receivables. Implementing advanced technology to streamline patient financial responsibility can improve a practice's financial health, leading to faster collections and a notable reduction in uncollected patient debt.

Manual tactics to limit bad debt and write-offs 

Shrinking payer reimbursement makes every patient balance urgent. Even without automated cost estimation platforms, gastroenterology groups can lift point-of-service (POS) collections by tightening people-driven routines at three stages of the visit. Use these tactics to reinforce patient payments in the HDHP era. 

1. Set clear financial expectations before arrival

• Email or text a one-page cost explainer—listing typical colonoscopy, EGD and infusion charges, the practice’s payment-at-check-in policy, and acceptable payment methods—immediately after the appointment is scheduled.
  
  
• Verify benefits by phone or through the payer portal within 48 hours of booking; call patients whose deductible or coinsurance exposure exceeds a preset threshold (e.g., $300) to discuss the expected amount and payment options.
  
  
• Require schedulers to note “financial discussion complete” in the EHR. Front-desk staff should only finalize check-in if that flag is present.
  
  

2. Equip front-desk staff to collect confidently

• Post a quick-reference grid at every check-in station showing the top GI procedures, average patient-due ranges, and common HDHP talking points (“You’ve met $2,000 of your $3,500 deductible; today’s estimate is $225—how would you like to take care of that?”).
  
  
• Role-play payment conversations in weekly 15-minute huddles so staff practice empathetic yet firm scripts and learn to pivot to payment-plan offers when needed.
  
  
• Offer multiple payment options—chip card, HSA debit, Apple Pay, even paperless “card-on-file” authorizations—so no patient can claim, “I forgot my checkbook.”
  
  

3. Create visible, time-bound follow-up for missed collections

• Color-code tomorrow’s schedule: green = estimate paid, yellow = partial, red = no payment yet. Supervisors review the color map each afternoon and assign outreach for red patients.
  
  
• If a balance remains at checkout, print a same-day statement with QR code or payment link and require staff to note a promised-payment date in the A/R tracker.
  
  
• Run a weekly POS gap report: compare expected versus collected dollars by staff member; recognize top collectors publicly and coach the bottom quartile.
   

Practices that enforce these manual checkpoints typically raise upfront collection rates. 

MD Clarity is a GI RCM specialist

GI groups are facing shrinking margins in an environment of rising operational costs.  Investing in GI-specific denials, underpayment, contract management, and patient estimates offers the fastest path to maximizing reimbursements.  

MD Clarity can help. 

MD Clarity’s RevFind contract management software is purpose-built to tackle two of gastroenterology’s biggest challenges: underpayments and poor contract performance. RevFind automatically ingests and analyzes all managed care contracts, continuously comparing each payer’s remittance to its contracted rates. When discrepancies or underpayments occur—whether from payer processing errors, missing escalators, incorrect bundling, or even provider side mistakes—RevFind instantly flags them for staff, bypassing the slow, error-prone manual tracking that can cost GI groups up to 3% of net revenue annually. 

For multisite practices and MSOs, RevFind’s powerful dashboards expose underpayment trends by payer, procedure, and location, giving leaders the insight to recover lost dollars and target operational fixes at the root cause. When it’s time to negotiate contract renewals or accept payer proposals, RevFind models the financial impact of rate changes in real time, benchmarks contract performance against competitors or Medicare, and arms GI groups with concrete data to secure better terms—rather than relying on guesswork. By surfacing previously hidden revenue leakage and supporting data-driven negotiations, RevFind helps GI organizations continuously defend and grow reimbursement in today's challenging landscape.

For GI groups facing patient payment challenges, MD Clarity’s Clarity Flow platform transforms upfront payment collections for GI organizations. As high-deductible health plans increase patient financial responsibility, collecting a larger share of revenue at the point of service is essential to avoid mounting A/R and bad debt. Clarity Flow automates eligibility checks and produces accurate, procedure-specific estimates for every patient, factoring in deductibles, coinsurance, and remaining out-of-pocket exposure. The software delivers these estimates via text or email—complete with a “click to pay” option—allowing GI patients to prepay or set up payment plans before their visit with complete clarity and confidence. By making upfront costs transparent and offering convenient digital payment options, Clarity Flow dramatically increases early collections, reduces confusion, and improves both the patient experience and practice cash flow.

In sum, by leveraging advanced tools like RevFind and Clarity Flow, gastroenterology groups and MSOs can recover more of the dollars they’ve earned—protecting revenue margins, powering smarter contract negotiations, and ensuring the patient portion of each claim is collected quickly and compassionately. This modern, analytics-driven approach turns revenue cycle management from a defensive posture into a proactive engine for financial health and growth.

Get a demo to see how RevFind and Clarity Flow can protect and improve your organization's revenue. 

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