Having Difficulties with Clinical Billing?

As a clinical laboratory, you probably feel like you’ve been under siege lately. Increased oversight and audits, rising operating costs, and falling reimbursement rates have created an uphill financial battle for clinical labs. And many are struggling to survive, especially in a highly competitive market with a lot of client turnover. Now, more than ever, it’s critical to tighten up the documentation and billing processes in your lab to ensure you are recovering costs.

Many labs felt an initial shock wave in 2014 when the Protecting Access to Medicare Act (PAMA) was signed into law, and again in 2018 when new payment rates became effective. But with additional restrictions and reporting requirements, as well as deeper PAMA payment cuts on the horizon, clinical labs are bracing for the full impact. For many small and medium labs, it will prove difficult to make a profit, and some may struggle to break even. This is especially true when you consider the existing challenge of obtaining insurance contracts and receiving appropriate reimbursement. Narrowing insurance payments and issues collecting patient payments only make matters worse.

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Certified Billing Experts

Medcare MSO offers tailored billing solutions for clinical labs. Our certified medical billing specialists stay up to date on regulatory and code changes, and our specialized knowledge of clinical billing ensures increased revenue stream and maximize profitability. With accurate coding, timely submission of completed claims, and aggressive follow up on denials, we help you shape a long-term plan to succeed amidst all of the changes in store for clinical laboratories.

However, for the majority of clinical laboratories the outlook doesn’t have to be so dismal. Making efficient and timely adjustments to both back-office and front-office procedures can make all the difference. Submitting complete and accurate claims has never been more important to the success of your lab. Not only is it imperative that CPT and IDC-10 codes be correct, but claims must also be coded to the highest level of specificity to prove medical necessity. And time is of the essence – the limited window for reporting clinical diagnoses and submitting claims means you may have to adjust the pace of your administrative and billing processes. This can especially be challenging when the ordering provider sends a requisition with missing, incomplete, or incorrect information.