Medical labs generate considerable volumes of tests yearly, so it’s no wonder these same laboratories also encounter some of the highest rejection rates in the healthcare industry.
Years ago, armed with solid budgets and impressive margins, labs often wrote off many of these denials, thinking the exertion to resubmit wasn’t worth the time and resources needed to work the claims. They weren’t worried about leaving funds on the table because they were prosperous.
Unfortunately, those days are over, and every penny counts. Today’s labs face many market pressures and challenges, forcing them to look internally and assess shortcomings while pinpointing areas where advancement needs to be a focus.
Laboratory billing has traditionally been regarded throughout the industry as a backend function instead of one that starts on the front end at order origination. But backend billing designates a missed prospect for labs because the truth is that the billing process begins when the order arrives in the laboratory, not once the report is final. Fortunately, lab operators are starting to realize the need to proactively enhance RCM workflow to defend themselves against persisting trends like payer reimbursement cuts, custom payer conditions, fast-changing regulations, expanded restrictions, and patient payment obligation evolution.
Absent patient demographics account for most lab rejections. Labs that acknowledge this and take the time to execute a strategy that captures the patient’s name, address, and phone number on the front end of the billing process will encounter immediate progress.
Actions To Enhance Your Lab’s First-Pass Resolution Rate:
- Maintain Correct Patient Files – Confirm patient demographics and insurance details with each visit. Insurance companies change often, and so do coverage limitations.
- Insurance Discovery – Contact the client or provider to acquire any absent, incorrect, or insufficient patient data. This will help you locate commercial and government insurance coverage that’s billable.
- Review Eligibility – Visit the patient’s payer portal or contact the payer to guarantee that the insurance you’ve pinpointed is active.
- Whitepages Lookup – Log in to Whitepages.com to review and verify the patient’s name and phone number.
- USPS Address Validation – To verify the patient’s address, log in to USPS.com.
- Don’t Be Delinquent – Designate a strategy that guarantees the claim is filed on time and that the payer accepts the claim.
- Analyze Outcomes – Take the time to discover why a claim was rejected and learn from the outcome to identify patterns and trends.
- Remain Current- Rules and ordinances are in continuous flux. Take the time to familiarize and train staff members to remain current.
- Close The Gaps – Recognizing patterns and trends does a lab no good if the results aren’t communicated effectively to front desk employees, billers, and doctors. Make sure everybody is on the same page and operating from the same playbook.
By assuming the time to move through these steps on the front end, labs will appreciate more clean claims and boost net collections. In addition, this short-term fix helps stabilize struggling labs, permitting them the time to recognize and execute a long-term solution that will expand their capacity to collect on all claims with complete visibility while minimizing labor expenses.
We hope these strategies help you maximize
your laboratory billing capability. Contact us today if you need support in medical transport logistics. We are here to help you remain successful.