The recipe for better revenue in laboratory medical billing and coding services

If you are into healthcare billing, you must be aware of the fact that medical billing and coding systems across the US are all the same. However, when it comes to laboratory medical billing and coding, the process narrates a whole new story. One of the biggest differentiators between labs and other medical practices is the number of claims processed. Medical laboratories tend to file more claims as they witness a greater number of patients as compared to other practices.

Laboratory medical billing and coding can be challenging and intricate. Reason? Claims containing relatively smaller bills! Laboratory owners can lose on their time, which can be otherwise devoted to handling denials and claim rejections. Labor costs this way can quickly outweigh the value of the claim leading to loss of valuable time and revenue. Now, why don’t they just leave the claims with smaller bill amounts? The problem with giving up on such denial cases is the overall collective amount that can contribute to a greater revenue loss, altogether.

Then, what can be a possible way to counter such denial cases? We at Bikham Healthcare help you understand the same.

Building an efficient and reliable RCM system

If you want your lab practice to sustain market conditions, you need to build an effective revenue cycle management system. Effective RCM system may include filling out claims, submitting them and dealing with any subsequent denials or rejections, however, there is a lot than what meets the eye. A successful RCM system should encompass all aspects of the laboratory as a business. Having such a system in place ensures that no time is wasted on figuring out ways to do things that have already been done and efforts can be channeled in the direction of collecting more revenue.

You can begin by training your employees on the daily processes they deal with. From the front office desk staff to the billing executives who send statements over to patients, you can include everyone. Also, make sure you have a provision of generating reports so the entire process can be analyzed and you are aware of just how effective different aspects of your lab are.

Below are some tips on how you can make your laboratory medical billing and coding practices are successful.

Medical Billing Software
Make use of medical billing software that is updated regularly. There may be changes to entity codes, testing procedures, modifiers, and other requirements that you may want to keep a track of.
 
Insurance Eligibility Verification
Make sure to get the insurance eligibility verified in the first place. It is important to determine whether a patient has the proper authorizations for appointment scheduling and no-shows can be avoided.
 
Patient Payment
If there are deductibles that are due on the patient’s part, make sure you collect them when they check-in. It will be much convenient for you to collect them upfront than waiting to receive payments and also wasting time on adjudicating denials.
 
Coding
Assign codes as procedures take place. This will ensure you do not have a lot to handle at the time of submission, and confusions are handled in advance.
 
Claim Scrubbing
Make sure to conduct a thorough quality check before making the final submission. Additional quality checks can save your time and money in the long run and help you receive payments seamlessly.
 
Claims Tracking
Make it a provision to track claims till the time they get paid. Putting aside rejections and not working on them may result in an almost 25% of revenue loss, more than what you can afford. Make sure to include a way that claims can be tracked and followed upon for payments.
 
Reporting and Analysis
Once you receive the payment, make a report and review the same. Analyze problems and discuss the results with the staff. An analysis is important to determine issues and eliminate them successfully. When issues are discovered, it is important to come up with feasible solutions to address them. The staff must be aware of the same so future complications may be avoided.

Tackling issues that hinder the growth

It becomes of utmost importance that your laboratory staff is aware of the issues that may arise during the claims filing process. Non-compliance to guidelines or using old test codes may only attract reasons for unnecessary denials that hinder the flow of revenue into your business.

Improper Payments

Improper payments may occur as a result of billing services without adequate documentation to support their medical necessity. It is important to submit all required documents that have a written record of the services rendered to the patient.

Medical Necessity/ Insufficient Documents

Claim denials due to medical necessity are common when you are billing for lab practices. Make sure you include adequate documentation and medical records that support the lab test, before submitting the claim for processing with the health insurance.

Orders and Intent

Claims are denied or often rejected if the services are found billed in an unidentified order other than the one mentioned in the patient charts. One more problem is unsigned prescriptions. Even when all other records are signed and there is one document left without them, denials are sure to arrive. Ensure all the documents and medical records contain your signature as well as from the ordering physician.

Related Services

In cases when the insurance denies a claim for medical necessity, the surgeon’s Part B services are also denied. Services that are non-covered by the primary insurance, are also not covered by Medicare. Make sure your staff knows the guidelines well.

Seeking help from Bikham Healthcare

Laboratory medical billing and coding is very different from general billing practices and demands a whole different skill set. Also, Laboratory billing is afflicted with a host of problems that can be difficult for a busy lab to handle.

According to a study, almost 70-72% of patients get confused by the medical bills and EOBs sent over to them by providers and insurance companies. What’s more? Only 9% of patients can defer common terms like premium, Co-insurance, co-pays, out-of-network expenses, and deductibles. Taking care of everything may get so much overwhelming at times that it begins interfering with growth practices.

The team at Bikham Healthcare ensures that the entire claims process, from order making to submission and payment reporting, becomes seamless. This gets done with a customized billing strategy specific to your lab practice.

Selecting an ideal Lab RCM partner: What you should know?

The biggest challenge that laboratories face is unsettled financial transactions due to an unorganized revenue cycle. These factors create a malicious loop that lab service providers find difficult to resolve. To handle a lab’s revenue cycle effectively, you must select a healthcare service provider who understands your needs and can address the challenges appropriately.

Here are some points to consider when selecting the right RCM partner:

·         Will this provider help enhance cash flow?

·         Will the partnership makes the operations seamless and structured?

·         Will it help your practice focus on patient care?

·         Will it help you take care of the training needs?

With the transition of the traditional healthcare model towards value-based care, enhancing the business’s financial workflow has become a necessity. Factors like attrition, unproductive processes and challenges related to Laboratory Medical Billing has made labs outsource their RCM services to secure financial success.

Overheads related to lab testing procedures, variations in reimbursement, regulatory imperatives and administrative workload exert pressure on lab establishments. And revenue loss due to these factors has started to affect most players. Therefore, the decision to outsource and the choice of a profitable Lab RCM partner takes on additional significance.

Why having a Lab RCM partner becomes crucial?

With a quick and efficient Laboratory Medical Billing process in place, labs can avoid the instances of write-offs and enhance their bottom line. It is natural for some laboratories to try and make in-house improvements to tackle issues like an untrained team, communication gap, and an inappropriate workflow. However, this may be a wise decision to hand over the responsibilities related to a Lab Billing process if you get lucky finding a competent partner.
Without a thorough understanding of the Lab Billing process, it is impossible to spot the best billing partner for your lab practice.

Here is a checklist that you can use:

·         Selecting someone who provides the best ROI

Selecting a sensibly-priced vendor for billing services is vital, especially for smaller establishments that have constricted budgets. Investing in a third-party Lab Billing Service is not a wise judgment if you are trying to rationalize the financial workflow. When considering a potential Lab Billing partner, assess the collection costs which regulate your return on that investment.

·         Varied Expertise

When crucial functions like Laboratory Medical Billing Services are outsourced, it is important to find a partner well-versed in handling issues related to billing and compliance. To avoid making errors, the outsourcing Lab RCM partner should have a thorough understanding of the Lab Billing Process.

·         Denial Handling and Effective Claims Processing

A partner who can manage denials effectively can help enhance revenue in a better way. A Laboratory Billing Services partner should be capable of recognizing and overseeing trends in payments, and understanding and eliminating the root causes of denials by comparing the existing data with the previous one. Consider looking out for effective denial management skills to enhance revenue and speed-up payments.

·         Turn-Around Time for the entire RCM process

Ensuring successful payment involves multiple steps. The Lab Billing partner you choose should be able to conclude everything within minimum turnaround time.

·         Reporting Capabilities

Communication is important to stay informed about every aspect of your business. This helps improve financial matters and makes the selected Lab Billing Services partner accountable for the work undertaken.

·         Customer Experience

Make sure to check the credentials of the firm you partner with. Research online and read up testimonials to see the satisfaction levels of their past clientele. Without any evidence of client satisfaction, there’s no point in outsourcing your Laboratory Medical Billing services to them.

·         Technology and Support

Technology is yet another motivating factor when it comes to selecting a partner. The company you are selecting should have systems that are well-placed and solutions that well synchronize with yours.

A partner that has applications supporting billing through the latest ICD-10 transition can be easily integrated into your current billing system, and the transition will be much smoother.

Some questions to ask before partnering with a Lab Billing service provider

To make the decision-forming process easier, you can consider asking the following questions to a Lab Billing services provider.

·         What abilities do you have to interface with your EHR, and lab system?

·         Do you provide training during the on-boarding process?

·         What is your approach to denial management?

·         What percentage of your denied claims are appealed?

·         What is your pricing model?

·         How do you cope with patient calls and respond to questions from clients?

·         Do your RCM solutions offer access to patient portals, appointment reminders, and reports?

·         Do you charge additional fees for tasks such as pre-authorization and e-claims submission?

·         Do you have dedicated account managers who are accessible to resolve issues rapidly?

The Road Forward

Once you get answers to these questions and the potential partners are narrowed down, you can go on to make a decision that’s ideal for your Lab practice. Make sure the agreement you execute with them indicates the services that are going to deliver and the staff who will interact with you.

Also, consider making your expectations apparent. If all goes well, you’ll have a seamless transition from in-house to outsourced Laboratory Medical Billing.