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.
Trusted by specialty groups and health systems
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 · G012102 · 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 · 9915303 · 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 · 96413Three 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
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.
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…
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.
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.
Screening downcode
Missing modifier
Anesthesia bundled
Infusion auth
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
7 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.
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.