Healthcare denials for medical reasons have increased since the start of the pandemic. According to the industry publication, electronic claim submission, medical laboratories have been hit the most by the virus, with a rate of denials of fifteen percent in the case of claims in-network while 30 percent are for claims that are out of network. But, in addition to lower reimbursement rates, constantly changing regulations for payers, and an increasing number of underinsured and uninsured patients, Laboratory Billing And Coding today are experiencing significant variations in the number of patients they see and a flurry of staffing shortages. This can make it difficult for some labs to thrive.

Laboratory Billing And Coding

Laboratory Billing Denials

Although some denials are an expense for business, many could easily be prevented. According to Laboratory Billings ‘ RCM Director of Billing, Farzad Abdi, a majority of denials result from human mistakes.

“Improper coding and other mistakes play a major role in claim denials,” the expert explained. “But this can be easily corrected by implementing automated processes. Through the simple process of automating the billing and coding process, we’ve assisted some labs in boosting their revenue by up to 30%. “

However, many managers of labs are reluctant to alter the way they work. They aren’t ready to invest money in improving their efficiency in revenue cycle management (RCM). But, the stakes are increasing for those who aren’t willing to invest in innovative solutions.

“Expenses are going up and reimbursements are going down, so leaving hard-earned money on the table isn’t acceptable,” Abdi added. Abdi. “Labs that want to grow and sustain their business have no choice but to innovate, and RCM solutions that offer automatic billing and coding are a step in the right direction.”

How Denials are Triggered

Clean claims depend on accurate coding and understanding of the payer’s policies and billing procedures. This is a huge issue for smaller labs that may lack a billing expert in-house. Lab managers will be required to train their personnel or go through training for themselves.

“If a lab insists on manual billing and coding, they’re still going to have to spend money on training and staff,” Abdi added. Abdi. “Coverage policies are always changing and every payer has their own specific way of operating.” Even coders who are certified struggle to understand the complexities. “

One aspect of billing which could cause problems is the timing. In most cases, denials that result from claims submitted late are not contested, and the consequences of making claims submitted late could be serious.

“There is a shelf life on when claims can be submitted,” Abdi said. Abdi. Because of that, laboratory staff tends to be in a hurry to submit claims even if they’re incorrectly coded. COVID-19 testing has increased the frequency of this.

“Imagine how difficult it is for labs to calculate and operationalize a tiered structure utilizing manual processes,” Abdi added. Abdi. In the meantime, some players would like labs to be able to accommodate different payment methods. Platforms such as the highly acclaimed Laboratory Billings LIS & RCM Laboratory Operating Platform help labs save time and improve collections by making it easy to deploy automated.

That’s why Laboratory Billings’ RCM solution comes with a rules engine and automation that can be tailored and easily modified. 

Alongside automated ICD-10 and CPT coding and billing for clients, Laboratory Billings’ other unique features include:

• The demographics are up front and the insurance verification is done
• Insurance discovery services
• White-page address lookups
• Automatically validated claims and correction of errors
• Workflow queues for data processing that is real-time to provide greater visibility
• The detailed statistical reports can assist labs to monitor the trends and KPIs
• Improved Automation Increases Workflow Productivity

Encrypt Important and Private Data

Every piece of data input into devices or computers must be protected by encryption. 

Educate Your Lab Staff.

Another approach to ensure an appropriate amount of security for your patients’ data is to provide your staff with the correct protocol and laboratory equipment. Give them the equipment and information that they need to effectively manage patient information. Without this information, many errors can be made, and those mistakes could cost you a lot of money when it comes to the handling of patient information. Organize regular HIPAA training sessions and inform your staff members of any technology or device updates when they happen.

In-progress regulatory changes as well as the continuous requirement for the updating of Revenue Cycle Management (RCM) systems mean:

• Workflows should be automated and also able to add clinical documentation or handle denials of high balances.
• The need for investment is in the latest technology in analytics as well as artificial intelligence, which can identify denials before submission in relation to payers and take remedies.

About Laboratory Billings

Laboratory Billings is an award-winning company that provides innovative, end-to-end health software for laboratories in pathology with 150+ facilities across the country. It is a complete enterprise-grade solution. 

Harnessing the Power of Rules and Automation

It is able to be programmed to run on autopilot and be monitored and modified according to its needs. Its functions are simple and simple.

“One of the mistakes labs make is overusing the same modifier for all cases,” Abdi said. Abdi. “This could result in a mass denial and, in some instances, it is a strategy by the payers to recover past claims.” “Laboratory Billings protects labs from this by informing them of the possibility of denials. “

The secret behind the way that Automation of Laboratory Billings works is to analyze a lab’s billing patterns. From lab to lab, most of the tasks they perform are redundant, which means that the system is able to quickly detect the patterns of a lab’s billing and follow these without making mistakes or second-guessing. In the remaining 5 percent of the cases, all the billing administrator needs to click is “create billing pattern,” and the pattern will then be saved to the system for later use. To get a sense of context and stimulate discussions among your team prior to launching the new system, try out our demo of Our Laboratory Billing Solution today.