Challenges for Pathology Labs

Unique billing requirements create challenges for pathology groups and labs. In order to successfully submit and collect on claims, billers and coders need to have in-depth knowledge of the sub-specialties in pathology, and they must have a current working knowledge of billing guidelines and updates to CPT codes. With increasing scrutiny and tightening restrictions on laboratory billing practices, it is imperative that pathology labs implement stringent compliance procedures in accordance with changing laws and regulations.

Perhaps an even greater challenge than federal and commercial guidelines, however, is the Merit-Based Incentive Payment System (MIPS), which determines Medicare payments according to scores in four performance categories: Quality, Cost, Improvement Activities (IA), and Promoting Interoperability (PI). To prevent payment cuts in 2020, and to earn the maximum incentive, pathology labs must report on six Quality measures and up to two IA measures.

it is critical to manage
Documentation and reporting

When the future revenue of your lab depends on documenting and reporting the quality of care you provide, it is critical to adjust front-office and back-office procedures to ensure maximum reimbursement from all payers. Many insurance companies have narrowed their provider networks, and pathology labs are increasingly deemed out-of-network providers. Adding to the challenge is the fact that health insurers are placing greater limitations on benefits. It’s becoming more and more difficult to collect payments from insurers and patients alike. You may not be able to do anything about coverage, but you can avoid these types of denied claims and collection accounts by verifying eligibility before providing services.

As if all of these challenges aren’t enough, timely sample processing and reporting are integral to filing successful claims and increasing reimbursement rates. Altogether, the regulations and reporting requirements placed on are confusing and time-consuming, resulting in delayed or lost payments. For many pathology labs, these challenges can make or break your business, but with assistance from a dedicated team of laboratory billing experts and analysts, you can take control back.

Medcare MSO provides comprehensive pathology billing solutions that identify and address potential compliance, regulatory, and reporting issues before they occur to keep your lab profitable and operational. We aggressively and effectively collect on old A/R accounts to recover lost revenue, and we submit accurate, timely claims for consistent revenue streams. Our certified medical billing professionals have specialized expertise in pathology billing which results in a shortened reimbursement cycle and maximized profitability.