Laboratory billing is NOT like medical practice billing and the difference can cost you.
Is your billing company up to the task?
Laboratory billing companies often make a key mistake.
They assume that their medical practice billing acumen will seamlessly translate to billing for laboratories. But the skill set is not the same. If your billing company’s core skillset is not billing for labs, you could be leaving money on the table. Here are some pitfalls to watch for:
Bad order information
Labs receive orders from physicians, who often fail to take the necessary care in getting them right. So unlike a medical practice, labs often have to burn hours chasing down missing or incorrect information from doctors who have no financial interest/incentive to correct their errors.
Unlike physicians, labs often do business across state lines, which means a laboratory billing company must have knowledge of billing rules and regulations across the country.
Out of Network Claims
Labs will often have a much higher percentage of claims that are out of network, which comes with many challenges that a typical medical billing company might never encounter. Knowing which payers will pay out of network, which will not, and for which it is possible to contract is critical to success in laboratory billing.
Patient Balance Billing
Many patients have few if any out of network lab benefits, or huge deductibles. You need a laboratory billing company that is knowledgeable in the range of options available to manage patient billing, as well as the balance billing laws applicable to each state. The best laboratory billing services are skilled in patient outreach/collection, and experienced in successfully dealing with patients across a variety of issues.
The Importance of Sales Reps
Salespeople and distributors can be a lifeline to a laboratory. You need to stay in good standing with them, so accurate and prompt reporting, broken out by individual rep, is critical. While transparency is a big part of keeping salespeople and distributors happy, even more important is knowing that the laboratory billing is competent and will get them paid since their compensation is often tied to collections.
Laboratories often perform tests that are unbillable as part of the standard workflow so unlike a medical practice, tracking and differentiating what is and is not billable is critical to maximizing laboratory revenue. Anything that can be done in order to increase the number of billable samples can have a tremendous impact on the bottom line.
Many Payers, Complex Policies
Labs will typically have many more payers than a medical practice (including all the different Medicaids), so a laboratory billing company must have appropriately comprehensive knowledge. And this is more than a coding issue. It’s about knowing and understanding these payers’ complex billing policies and staying on top of their constantly changing rules.
The Cost of Inaction
Labs often feel “forced” to proceed with testing a sample, even if payment is uncertain, in order maintain good standing with a referral source, among other reasons. It is often a prohibitive risk to delay. Checking eligibility & benefits must be optimized for speed, and increasingly obtaining pre-certifications or pre-auths is becoming a critical part of the laboratory billing workflow, especially for genomics (CGx / PGx).
Checks to Patients
Labs are often in a position of having to collect payments from patients who receive checks directly from the payers, especially the Blues (Blue Cross, Blue Shield, BCBS). Most labs collect little if any of these payments, however there are ways to dramatically increase collections from these payers.
Access to Information
Labs receive a high volume of requests for additional documentation and medical necessity, so you need a billing resource with good integration with the lab, LIS/LIMS, and ordering physicians.
Apache Health Understands Your Business
Does your billing company have the depth of knowledge and understanding required to maximize your collections? Apache has been in lab billing for over a decade. We have solutions to all of the above issues because, well, we have to. It’s how we stay in business…and it’s how we help to keep labs in business.
Learn about how you can get paid more, faster and increase your lab’s collections.