Laboratory Billing Companies 2022

A Practical Guide to Laboratory Billing and Reasons to Outsource

Laboratories are a distinct part of the medical formation that come in a variety of sizes and iterations. While a hospital’s lab accounts for only 3 to 5 per cent of total revenue, its findings account for 70 to 80 per cent of a patient’s electronic health record (EHR) and form the most essential aspects of healthcare decisions.

As a result, paying close attention to lab revenue – as well as the working cash flow obtainable to further technology, additional staff, and providing other resources – means paying close attention to improving patient outcomes.

Whereas revenue is a significant priority for the medical laboratory, the lab technicians, who make up the majority of lab staff and have a direct impact on it, are rarely involved in the billing and revenue process. In reality, most labs, regardless of lab type, keep their billng facilities separate from the rest of the facility.

This separation allows primary employees to concentrate on the laboratory information system (LIS), procedural equipment, and – most crucially – an ongoing purpose to give exact, correct results while maintaining contact with physicians and patients.

As a result, laboratory medical billing necessitates a scheme tailored to the differences between the services provided by a medical lab and the procedures required by a physician’s office or hospital visit. Current procedural nomenclature – or CPT – codes are used to bill all labs. All of the preceding aspects necessitate paying attention to a very complex bills cycle.

A Guide: Medical Laboratory Billing

In general, the medical laboratory billing cycle refers to the continual contact between a physician or other entity ordering a test, the lab performing the services as requested, and the insurance company or other payer that reimburses the time, labour, and materials spent.

This billing cycle can last anywhere from a few days to several months, and it usually necessitates different interactions between the involved parties before it is resolved. As previously stated, laboratories often have a distinct coding and bills department that is responsible for navigating the bills cycle.

How Does the Billing Cycle in a Lab Begin?

The bills cycle begins with a code for the specific lab sought from a physician or other entity. Following the completion of the requested analysis of the specimen or sample, labs are issued a diagnosis or procedure code based on one of two coding indices used by the medical and insurance industries. These codes give an insurance company or other payer the information they need to decide whether or not to pay a claim.

Laboratory Billing Codes

For laboratory bills, there are two main sets of codes that are used. The first is the International Statistical Classification of Diseases and Related Health Problems, or ICD, as it is more frequently known. The World Health Organization (WHO) maintains the ICD, which is widely acknowledged as the international diagnostic and epidemiological standard. It provides a framework for diagnosing diseases, symptoms, injuries, and other concerns using diagnostic codes.

The American Medical Association provides the second code set, formally known as the Current Procedural Technology Code Set and popularly known as the CPT, which indicates services are given rather than diagnoses. The CPT catalogues all of the medical, surgical, and diagnostic procedures that are performed in the United States. It is intended to give medical bills professionals, patients, coders, insurance companies, and other payers a set of uniform classifications.

Laboratory Billing Codes

The Billing Cycle Has Come to an End

The laboratory collections and revenue cycle management phase begin when codes are determined. Most of the time, the lab invoices the insurance company or other payer directly or through a clearinghouse, utilizing an ANSI 837 claim file submitted electronically via an electronic data interchange (EDI). Once received, the payer evaluates medical necessity, patient eligibility, and whether the provider has the appropriate credentials to execute the surgery with the help of medical claims adjusters or even medical practitioners’ assistance.

At last, if a claim is approved, the payer reimburses the provider for a percentage of the billed services at a pre-negotiated rate. Denied or failed claims are returned to the provider as an explanation of benefits (EOB), which must then correct the claim and resubmit it. This process is repeated several times until the payer makes the agreed-upon payment or the provider acknowledges a partial payment.

The Benefits of Outsourcing Laboratory Billing

Many labs use a software system to provide an electronic health or laboratory record to accurately glean the above-mentioned information, which is critical to the representation of your laboratory’s daily, weekly, and monthly activities. While these systems can help to improve internal workflow,

improve communications between your laboratory, medical providers, patients, and payers, and simplify your billing process, simply installing a software program isn’t enough. You’ll need to set aside time to properly analyze the data captured by your billing system and to learn how to extract information from it – primarily to identify strengths, zones of need, and growth opportunities.

For many labs, outsourcing laboratory billing can be a cost-effective way to perform the in-depth analysis while freeing up financial, physical, and personnel resources for other critical activities. Collaboration with a laboratory billing firm can provide numerous benefits. It is a much more comprehensive approach to billing than simply adding a software system. Among the advantages are:

  • Reduced operating expenses and increased cash flow Maintaining your laboratory billing department entails software fees, initial and ongoing training costs, and salaried, skilled people. As the overhead costs of the US healthcare system approach USD 190 billion, trying to cut your overhead costs by outsourcing your lab billing is a great way to reduce spending and promote healthy cash flow.
  • Errors in billing and coding are eliminated. According to NerdWallet, nearly half of all Medicare claims contain some type of billing error. Furthermore, cutting-edge billing software reduces your chances of encountering coding or billing errors, which can cause payment delays and increase your workflow and billed hours. Above all, precise billing and coding results in better data for your analysis.
  • Automatic validation. The most common reason for claim denial is incorrect verification and eligibility. If you currently use in-house staff to verify reportage, medical necessity, or other claims info, outsourcing your verification services can improve quality and reduce the number of hours spent on procedures that can be managed much more easily by an automated system. Even better, you won’t have to spend time and effort keeping your team up to date on coding changes.
  • Processing and payment are completed faster. By automating the aforementioned tasks, you will be able to complete your end-of-the-billing-cycle tasks much more quickly. Instead of the months that a typical paper claim can take to process, using an automated software system to file a flawless claim prepared by an expert coder can result in the payment in just a few days.

Laboratory Billing Services Are Probably a Good Step Forward For Your Laboratory

Organized laboratory billing services are a solution for your manning and analysis issues, regardless of which ERM software or services your lab requires. Outsourcing your lab billing can result in a faster billing resolution and better data. Better data, in turn, can help you identify loss leaders, improve efficiency, develop strategies for growth opportunities, and significantly improve cash flow.

Hire a Trustworthy Laboratory Billing Company

Your laboratory deserves to make every effort possible to improve efficiencies, increase revenue, and capitalize on growth opportunities. However, many lab managers simply do not have the time, staff, or resources to devote an adequate amount of attention to the complexities of laboratory billing. Hiring a fully customized lab billing partner to assist you with lab management is a massive opportunity for improved lab performance.

From payer credentialing to old AR collection, TMB’s (The Medical Billing) laboratory billing services include all facets of medical revenue cycle management (RCM). Medical billing services from Laboratories are available as a stand-alone service or as part of a fully customized solution that may include insurance verification, patient billing, and old AR collections, as well as medical coding and billing software, billing specialists, and other services.

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