Who We Serve/Gastroenterology

Find where gastroenterology revenue is leaking.Know what to do next.

Gastroenterology practices lose revenue through preventable denials, underpayments, and cancellation-driven procedural capacity loss. The challenge is knowing where the issue is concentrated, why it appears to be happening, and which revenue integrity actions should be considered first.

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Built from real work with GI data.

A PE-backed management services organization had acquired multiple gastroenterology practices across different markets. Each practice brought its own systems, payer mix, operational history, and reporting structure.

Leadership needed recurring visibility across the organization, including AR aging, monthly billing performance, payer mix, and reporting that could support operating decisions across acquired practices.

The work created a unified reporting layer across acquired practices and supported recurring monthly reporting without manual assembly. It also supported annual MIPS submission across the organization.

Recurring monthly reports delivered

Multi

Acquired GI practices unified under one reporting layer

Annual

MIPS submission supported across the organization

Why this matters for GI

GI revenue leakage often sits across procedure scheduling, payer requirements, claims, payments, and multi-site reporting gaps. Leadership needs these signals connected clearly enough to know what deserves attention first.

What gastroenterology practices need to see clearly.

The goal is not more reporting. The goal is a clearer answer across denials, underpayments, cancellations, and the operating patterns that affect revenue integrity.

Preventable denial leakage

Denial Prevention

GI practices often face denial patterns tied to payer requirements, prior authorization, eligibility, documentation, coding, and procedural claim complexity. The value is knowing which denial patterns are recurring, preventable, and worth addressing first.

Authorization and medical necessity risk

Denial Prevention

Authorization and medical necessity issues can affect both reimbursement and procedural volume. Leadership needs to see where these breakdowns appear to be creating denial risk, cancellation risk, or both.

Underpayment exposure

Revenue Integrity

A paid claim does not always mean the payment was right. GI practices need visibility into where earned revenue may not have been fully collected across payers, CPT codes, providers, procedures, and locations.

Payer and procedure reimbursement variance

Revenue Integrity

High-volume endoscopy and procedural claims can hide reimbursement variation that is difficult to see one claim at a time. The goal is to surface where payer behavior and procedure-level payment patterns deserve deeper review.

Cancellation-driven revenue loss

Cancellation Impact

Cancellation rates are easy to report. The harder question is where cancellations are concentrated, what procedural capacity is being affected, and which scheduling issues may be affecting revenue integrity.

Multi-practice visibility

Practice Visibility

GI groups, especially PE-backed or multi-site organizations, often operate across different systems, markets, payer contracts, and reporting structures. Leadership needs a connected view across claims, payments, scheduling, and operational activity.

The questions leadership should be able to answer.

GI practices usually have the data. The gap is turning the data into clear answers leadership can act on.

Denials

Which denial categories are recurring and preventable?
Which payers, providers, locations, procedures, or workflows appear to be driving denial leakage?
Which denial issues should leadership address first?

Underpayments

Where did the practice earn revenue but collect less than expected?
Which payers, CPT codes, procedures, or locations show reimbursement variance?
Which payment gaps deserve finance or revenue cycle review?

Cancellations

Where are cancellations creating unused procedural capacity?
Which appointment types, providers, locations, procedures, or payer groups are most exposed?
Which scheduling issues may be affecting revenue integrity?

The work starts with the data already available.

GI practices should not need to adopt another software system just to understand where revenue integrity is breaking down. The starting point is the data already produced by the practice.

Prexisio uses the practice’s claims, payment, scheduling, and supporting operational files to identify where leakage appears concentrated and what leadership should examine first.

Scheduling Data

Procedure schedules, cancellations, reschedules, provider capacity, location activity, and appointment movement

Claims Data

Submitted claims, CPT codes, payer activity, service locations, providers, denial patterns, and procedure mix

Payment Data

Allowed amounts, paid amounts, remittance activity, payer variance, and reimbursement patterns

Operational Files

Supporting context such as authorization status, procedure type, location mapping, and internal reporting files when available

Free CMS Benchmark Reports