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Lab billing can often be burdened with complications when confronting various encounter types.
There are numerous CPT codes and conditions to deal with in order to correctly submit your claims. Depending on your practice, you may need to bill for hospital based services as well referred specimens from other hospital or private practices.
Practicing Lab providers perform multiple specimen testing’s on a given patient which will generate an abundance of claims, involve multiple payors and can result in a myriad of claims issues. Having an experienced medical billing team, with visibility into performance, is vital to your practice’s financial health.
Etransmedia’s team of certified coders have the kind of experience necessary to ensure your Lab practice will maintain consistent cash flow while increasing collection rates. All of our coders are certified either through the AAPC or AHIMA and uphold the ethics and standards of the profession. Additionally, our billers and coders work with your staff to learn the nuances of your practice so as to be aware of known issues. They will provide feedback on coding scenarios that need attention and possible correction.
What we know…
Most labs do not get to see the patient directly. All the information is given by the ordering physician. So if this information is vague, incomplete, etc. it makes it that much harder to collect. A specialty group usually doesn’t keep up with lab regulations, LCD’s and other payer policies so there is a gap in communication between all three parties.
Lab billing breaks down into several types of work being performed. Some examples are:
Clinical Lab – Much of Clinical Lab is billed using specified panels. These panels contain groupings of tests. They are not to be broken out separately (unbundled). The panel chosen must represent all of the tests performed so the choice of panels is to be made based using that criteria.
Ordering physician submits request for lab work with routine diagnosis, insurance denies and patient is billed. Patient informs the lab it wasn’t routine, ordering physician’s office is contacted and a diagnosis for the sign or symptom prompting the lab test is given.
Here are some of the complications that are affecting Lab revenue collection procedure:
Omitting modifiers causes denials for “duplicate” tests.
Prior authorization needed for genetic testing – not obtained by ordering physician.
On October 1, 2016 the Centers for Medicare and Medicaid Services (CMS) will no longer accept unspecified codes in most cases.
Starting in October, CMS requires greater specificity for claims filed in ICD-10-CM/PCS. The 12-month grace period originally introduced in 2015 said they would not deny claims for lack of ICD-10 specificity. That all changes on October 1, 2016. Payors will most likely follow suit if they haven't already.
First Pass Clean Claim Rate
Boost in Revenue*
Reduction in Cost*
We’re always on top of all the latest coding and billing updates for Lab practices.
Additionally, to make sure all claims are reimbursed on the first claim submission, our system is able to pre-edit claims prior to the initial submission for possible billing/coding errors. Our detailed end of month reports keep our clients up-to-date of what is happening in their practice so that any issues can be addressed quickly. The outcome of these processes and more is our clients have a streamlined revenue cycle with increased collection rates.
Although the new industry standards can be confusing and difficult to navigate, our dedicated team here at Etransmedia can assist in guiding you and helping to make your practice grow successfully.
*Please Note: Results are not guaranteed, implicitly or explicitly, and will vary based on several factors such as individual practice demographics, specialty, payer mix, operations, and management among others
Service and Technology Packages
Our customizable revenue cycle management service and technology solution packages allow you to outsource based on the specific needs of your practice
Silver RCM Service
This package has the core service and technology needed for revenue management allowing you maintain the responsibility of patient billing.
Gold RCM Service
This package includes the core RCM services with added denials, A/R management services, and full service patient billing
Ancillary RCM Services & Technology
Available to enhance any package