Laboratory Billing Systems

Laboratory Billing System

Billing methods for labs is part of the same overall coding and billing system in use in the various medical fields throughout the US, but billing services for laboratories are unique in several different ways. One of the key differences between labs and other types of medical offices is the number of claims processed. Labs typically service many more patients every day, which results in a high number of claims being submitted.

Another difference and one which makes billing for such healthcare organizations particularly challenging are that lab claims are for relatively small amounts. This makes it difficult to devote time to handling each denial or rejection because labor costs can quickly outweigh the value of the claim. The problem with giving up on denials is that the accumulated amount of unpaid claims can rapidly rise to an unsustainable amount, putting the lab at risk of failing as a business entity.

The Best Services Have a Reliable System

For laboratory services to be sustainable, it needs to be based on a system that encompasses all aspects of the lab as a business and includes the details of billing for each patient from contact through payment. Having a system in place establishes a repeated process so time isn’t invested in figuring out how to do things that have already been done, and routine problems with claims don’t result in lost revenue.

The system should include training of all employees on the parts they are involved with, from the front office that takes the appointment to the billing staff who send statements to patients when they have a balance due after testing. The system also needs to include a procedure for generating reports so that the revenue cycle management (RCM) practices are analyzed and principals are aware of how successful that aspect of the lab is.

Tips for Successful billing

  • Make sure to use billing software that is constantly being updated. Codes are updated annually, but insurers and government payers make changes at different times.
  • Verify eligibility and determine that you have the proper authorizations when an appointment is scheduled or a patient arrives as a drop-in.
  • Collect the patient’s part of the charges when they check-in. It’s much easier to collect upfront than to get payments for a bill in the future.
  • Code claims continually. Allowing work to accumulate before it is billed lets more get overlooked and confusions are more difficult to sort out after more time has passed.
  • Scrub claims daily. An experienced medical biller should check each claim for errors before it is submitted. These services are much more efficient when they include a procedure for scrubbing that is repeated for each claim.
  • Track claims until they are paid. Rejections and denials often get put aside and not reworked, so they never get paid, but this results in up to 25% of revenue being lost, which is more than medical labs can afford to lose. The system should include a way to track claims and a process for following up on unpaid claims.
  • Review reports, analyze problems and communicate results with staff. It is important to verify that the amount you are paid is increasing as a percentage of the amount you are billing, and the time it takes to get paid is decreasing (or at the minimum reasonable time). Rejections and denials should be assessed to determine if there are particular payers that are problems, so the associated issues can be found and eliminated. When problems are found, it is important to come up with a solution and make sure all staff involved are informed so no one makes the same mistakes in the future.

Medcare MSO is an established medical billing company specializing in lab billing services. It takes an experienced staff of medical billers to be able to track and process the volume of claims that a lab submits in an efficient enough manner to increase revenue, but we have done it time and again. Give us a call at 800-640-6409 today to discuss your particular challenges and see how we can help, or click here to get a free demo.