AI revenue integrity for gastroenterology practices

Screening vs. diagnostic logic errors cost GI practices millions annually.

The distinction between a screening and diagnostic colonoscopy determines reimbursement, and payers exploit every documentation gap. Add anesthesia bundling disputes and infusion auth failures, and gastroenterology practices are leaving substantial recoverable revenue on the table.

Book a GI demoSee the denial patterns
57%denial rate reduction
100%encounters reviewed
3 daysto first results

Trusted by specialty groups and health systems

Ozark OrthopaedicsFinancial District Foot & Ankle CenterPeninsula Gastroenterology Medical GroupMVPQuantum RadiologyMoami Hand Center

Where GI revenue leaks

The denial patterns Ember was built for

GI practices face a set of recurring, high-value denial types that manual billing teams cannot systematically prevent or recover. Ember closes each gap.

01 · Screening vs. diagnostic

Colonoscopy downcoding when polyps are found during a screening exam.

When a polyp is found and removed during a scheduled screening colonoscopy, payers frequently downcode or deny the screening benefit, shifting cost-sharing to the patient and triggering reimbursement disputes. Ember validates the screening vs. diagnostic distinction before submission and appeals every incorrect downcode.

45378 · 45380 · 45385 · G0121

02 · Anesthesia bundling

Improper bundling of anesthesia with endoscopy procedure codes.

Moderate sedation and monitored anesthesia care (MAC) billing rules differ by payer, and incorrect bundling generates systematic underpayments across high-volume endoscopy practices. Ember validates anesthesia billing against each payer's specific bundling rules and identifies underpayments at the line level.

00810 · 99151 · 99152 · 99153

03 · Infusion therapy auth

Prior auth failures on biologics and infusion therapy for IBD.

Biologics for Crohn's disease and ulcerative colitis require auth tied to specific clinical criteria, and each infusion cycle may require renewed authorization. Ember tracks every active auth, monitors payer policy changes in real time, and flags documentation gaps before the infusion is administered.

J0515 · J0135 · J3490 · 96413

Three engines.
One source of truth.

Ember connects clinical documentation, payer policy, and contract terms into a single intelligence layer. Built for the procedure volume and coding complexity gastroenterology billing requires.

01 · Foundation

Data Engine

Bridges the clinical and the financial. Unifies documentation, coding decisions, payer policy, and contracts across every encounter and provider.

J. Whitfield

Encounter #G-71840

Unified
Documentation
Screening colonoscopy + polypectomy
Coding
45385Z12.11K63.5PT
Payer policy
Aetna · Screening
Contract
Rate §5.4

02 · Audit

Coding Engine

Reviews 100% of encounters against national standards, payer-specific policies, your internal guidelines, and your payer contracts. Every flag carries a rule citation.

Audit#G-71840
45385Polypectomy, snare
Pass
45385Missing modifier PT
Flag

Append modifier PT — screening converted to diagnostic

CMS NCD 210.3 · confidence 0.97

03 · Recovery

Appeal Engine

Reads CARC and RARC codes, identifies the applicable LCD/NCD policy and contract terms, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.

Re: Claim #G-71840 · Denial CO-97

The screening colonoscopy retains its preventive benefit under CMS NCD 210.3 despite polypectomy, per contract §5.4…

Denial received
Appeal drafted
Submitted · in review
Adjudication pending

Audit upstream.
Appeal downstream.

Two workflows do most of the work for GI practices. The first prevents denials before they happen. The second recovers the ones that slip through.

Pre-bill audit

Catch the screening vs. diagnostic issue before the claim leaves.

Ember reviews every encounter against coding standards, payer endoscopy policy, and your contracts. Screening/diagnostic distinctions, anesthesia bundling, and infusion auth gaps are flagged before submission.

  • 1

    Ingest the encounter

    Pulls clinical notes, procedure codes, and modifiers from your EHR and practice management system.

  • 2

    Validate against rules

    Checks screening vs. diagnostic classification, anesthesia billing rules, infusion auth status, and modifier application against each payer's specific policies.

  • 3

    Recommend with citation

    Returns the suggested correction tied to the exact payer policy, LCD/NCD reference, or contract term, not a generic flag.

  • 4

    Educate the provider

    Coding patterns drive provider-level coaching, so documentation accuracy for screening intent and infusion indication improves over time.

Encounter review#G-71840
45385Polypectomy, snare
Pass
00810Anesthesia, lower endoscopy
Pass
45385Missing modifier PT
Flag

Append modifier PT — screening converted to diagnostic

CMS NCD 210.3 · confidence 0.97

+23%

Clean-claim rate

100%

Encounters reviewed

+5%

Net collection rate

Automated appeals

Pull. Review. Push.

When a denial occurs, Ember identifies the root cause, retrieves colonoscopy, sedation, and infusion records, references payer policy and contract terms, drafts the appeal, and tracks it through adjudication.

Pull12
CO-97

Screening downcode

CO-16

Missing modifier

Review7
CO-236

Anesthesia bundled

Push9
CO-197

Infusion auth

Learn—
PAID

Screening appeal

-57%

Denial rate

-45%

Cost to collect

+9.3%

Net revenue per appt

The full revenue cycle

From eligibility to adjudication. Covered.

Audit and appeals are the workhorses, but Ember protects GI revenue at every stage of the cycle.

Eligibility Verification

Confirms active coverage and screening benefit status before the procedure, and flags coverage gaps before they become billing problems.

Prior Authorization

Checks auth requirements in real time for infusion therapy and advanced endoscopy, generates clinical documentation, and submits to payer portals automatically.

AI Medical Coding

Reviews 100% of encounters, endoscopy codes, infusion charges, and anesthesia billing, against national standards and payer rules before claims submit.

Pre-bill Audit

Predicts and prevents denials before claims go out, catching screening vs. diagnostic classification errors, anesthesia bundling issues, and infusion auth gaps before write-offs.

Denial Management

Full appeal lifecycle for every GI denial type, screening downcode, anesthesia bundling, auth failure, and medical necessity, tracked to adjudication.

Underpayment Recovery

Parses contracts to model what each endoscopy and infusion claim should pay, then surfaces line-item underpayments at scale.

High-volume GI revenue, recovered

-57%

denial rate

-45%

cost to collect

100%

encounters audited

3 days

to first results

Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.

Frequently asked questions

Everything you need to know about how Ember fits into your revenue cycle.

Yes. Ember AI connects seamlessly with all major EHRs and PMS platforms, including Epic, Oracle Cerner, athenahealth, and eClinicalWorks, as well as payer portals. Our standards-based integrations automate prior authorization, eligibility verification, and claims submission, allowing you to preserve existing infrastructure while modernizing the revenue cycle.
Ember AI deployments are measured in weeks, not months. Most organizations complete pilot launch in under 30 days and scale enterprise-wide within a quarter. We provide a structured onboarding playbook, technical support, and change-management guidance so your teams achieve measurable ROI rapidly with minimal IT lift.
Yes. Ember AI is fully HIPAA and SOC 2 Type II compliant and signs Business Associate Agreements (BAAs) with all covered entities. Protected Health Information (PHI) is encrypted in transit and at rest, supported by role-based access controls, detailed audit logging, and continuous monitoring. Your organization retains complete ownership and control of its data.
Health systems, MSOs, and health plans using Ember AI typically achieve:

- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials

We provide ROI benchmarks and dashboards so you can track outcomes from day one.
Yes. Ember's coding and scrubbing logic is specialty-aware, it understands endoscopy and colonoscopy procedures, polypectomy techniques, multiple-endoscopy rules, and modifier requirements, and validates documentation against payer medical-necessity criteria before submission.
Ember reads the indication and findings to determine whether a colonoscopy bills as screening or diagnostic, applies modifier 33 or PT correctly, and protects both payer coverage and the patient's cost-share, preventing the denials and surprise patient bills this distinction commonly causes.
Yes. Ember checks eligibility, identifies which biologics, capsule studies, and procedures require pre-auth, gathers the needed documentation from your EHR, and submits through payer portals, reducing the delays and missing-auth denials that hit high-cost IBD therapy and procedures.
Yes. When monitored anesthesia care is denied for endoscopy, Ember pulls the clinical justification from the record, cross-references payer policy, and drafts audit-ready appeal letters for review, so medically necessary sedation gets paid.
Ember connects to your existing EHR/PMS and payer systems with standards-based integrations, no rip-and-replace. Most teams pilot in days and see measurable ROI before scaling across service lines.

See what your GI practice is leaving on the table

Bring us 30 days of denial data. We'll show you where the revenue is and exactly how Ember would recover it.

Book a GI demoBack to Ember