As with all businesses, molecular, medical, and anatomic Pathology Billing Services make their living by being paid for the services that they provide. Labs and other healthcare providers are unique in that their billings must pass inspection by insurance companies and other payers. Payers have a variety of reasons for denial of payment, much to the dismay of lab managers.
Since the outbreak of the pandemic, medical denials in healthcare have increased. According to the industry publication Medical Laboratory Observer (MLO), medical laboratories have been particularly hard hit, with an average denial rate of 15% for in-network claims and 30% for out-of-network. Today’s labs are facing significant fluctuations in patient volumes and unimaginable staffing shortages, not to mention reduced reimbursement rates and ever-changing payer rules. This is making it hard for some labs to succeed.
Pathology Billing Services
Labor Billing Denials can be costly.
While some denials can be considered business costs, others can be avoided. (Laboratory Billings RCM Billing Manager) says that most denials are caused by human error. He said that claim denial is often caused by poor coding or other errors. Automation can fix this problem. We have helped labs increase their revenue by automating billing and coding.
However, many lab managers remain hesitant to make changes in their operations. Many lab managers are reluctant to invest in improving their revenue cycle management (RCM). Those who aren’t willing to invest in new solutions face greater risks.
Lab Billing stated that expenses are rising and reimbursements are falling, so it is unacceptable to leave hard-earned cash on the table. RCM solutions that allow automatic billing and coding can be a boon for labs looking to grow and sustain their businesses.
How denials can be triggered
Clear claims depend on precise coding and a good understanding of the billing process and payer policies. For smaller labs that may not have a billing specialist, this can pose a challenge. Lab managers will have to either train their staff or take training.
Lab Billing stated that even if a lab insists upon manual billing and coding, they will still have to spend money on training and staff. “Coverage policies change constantly and every payer has their own way of doing things.” Even coders can have trouble understanding all the details. Timing is another aspect of billing That could be problematic. Late claim submissions can lead to denials that cannot be challenged. The consequences of submitting claims late could be very severe.
Lab Billing said that claims have a limit on how long they can be submitted. “Lab personnel are often in a hurry to get claims out, even when they are wrongly coded.” This approach can lead to thousands of dollars in losses and hundreds of hours wasted on appeals.
A new trend is creating a more difficult billing process for labs. Some payers and clients with high volumes now require volume discounts and credits embedded in their new contracts. This has become more common with COVID-19 testing.
Imagine how difficult it is for labs to compute and operationalize a tiered system using manual processes. Some payers also require labs to adjust for alternative payment methods. The lab has rolling totals and discounts, as well as a range of payment options to manage.
Labs of all sizes can benefit from technology that simplifies billing and codes. Platforms such as the Laboratory Billings LIS and RCM Laboratory Operating Platform can help labs save time, increase collectibles, and add automation that is easy to deploy.
Suren Avunjian, Laboratory Billings CEO, stated that there is a lot at stake in billing. “Laboratories need to implement systems that increase productivity and protect them against errors and losses.” Laboratory Billings’ RCM solution has a rule engine and automation that are customizable and easy to update. The labs and their employees can view all processing in real-time. Any adjustments can be made by simply pressing a button. This means that a process that used to take weeks can now be done in minutes. And, most importantly, it is error-free.
Automate and harness the power of rules.
Laboratory Billings’s billing/coding automation is powered by a powerful proprietary rule engine. This rule engine was developed from decades of billing experience and terabytes of data analysis. The technology, although complex, is simple to implement and does not require any specialized service knowledge. It can be programmed to run automatically and can be customized and monitored as required. It is easy to use and intuitive.
Laboratory Billing stated that Laboratory Billing’s automated system can assign ICD-10 or CPT codes accurately based on the NCD, LCD, or payor-specific coverage policy. It also learns from past rejections and alerts if there is a possibility of denial before submitting a claim. “
Laboratory Billings also uses NCCI edits to notify users of code conflicts, and issues with units, or modifiers. Lab Billing states that labs often make the same mistake in all cases. This will eventually lead to mass denials and, in some cases, a push by payers to recoup past payments. Laboratory Billings helps labs avoid this by alerting them to possible denials.
Automation is the key to quality and scalability.
Coders can easily code approximately 250 claims per day with very few errors. Automation is required if a lab’s RCM workload exceeds the capacity of manual processes. Avian stated that there is an increasing reliance on diagnostic testing in the medical community. “Lab services are in high demand due to the wider adoption of evidence-based medicine, as well as the COVID-19 demands, and they will continue to be so for the foreseeable future.”
Laboratory Billings
Laboratory Billings, a leading provider of innovative healthcare services for pathology labs, has been awarded numerous times. They currently service 150+ facilities across the country. The Laboratory Billings LIS & CRM Laboratory Operating Platform(tm), a complete enterprise-grade solution, includes modules for anatomic, clinical, and molecular pathology. It also supports revenue cycle management and direct-to-consumers. Laboratory Billings allows laboratories to better serve their patients, differentiate themselves in the market, scale up their operations, and become more compliant and profitable. Contact us today @ (505) 521-2145 or https://laboratorybillings.com/pathology-lab-billing-services/
