Issues faced while billing for laboratory services

The prime task that laboratories take care of is examining the chemical and other specimens collected from a human body. This examination helps in diagnosis, treatment and the prevention of health conditions. Last tests are usually ordered by physicians for apt determination and better diagnosis. The largest payer in the US that takes care of lab test expenses is Medicare. Claims containing information about the type of tests carried out, details of lab provider, ordering physician, and the beneficiary.

According to a study around 50% of beneficiaries registered under the Medicare program, availed lab services at least one time in a year.

With a large crowd availing lab services every year, it becomes crucial for labs to stay current with the compliance and Laboratory billing guidelines. There have not been many changes in billing rules except for the compliance guidance that was updated back in August 1998. And, to our surprise or we shall it bad luck for lab owners, the section listing risks associated with lab billing remains untouched. It has not been changed since 1998 – another reason to worry for lab owners. It is important to note that any mistakes in billing or non-compliance to guidelines will lead to denials or partial reimbursements. Worst case scenario- it can attract legal proceedings as well.

Some of the very common reasons for issues faced by lab owners while billing can be highlighted as:

• Insufficient documentation and failure to prove medical necessity.

• Lack of physician order for lab tests.

• No reviews before or after claims adjudication.

• Not providing lab test results to patients.

• Improper use of Modifiers.

• Inaccurate billing and coding for drug tests.

• Over-coding or Under-coding.

• Not keeping up with the claim submission deadlines.

• No awareness regarding changes to the fee schedule.

Issues faced while billing

A majority of lab billing issues arise due to non-compliance and committing billing errors. Some of these issues can be explained as:

• Incomplete Payment - When lab owners bill medically unnecessary services or are not able to prove the medical necessity for the billed services, insurance does not pay according to the contract resulting in incomplete payments. Make sure to include proper documentation to support the services billed.

• Missing Documentation - Claims can be denied if the insurance does not receive the RX form or the ordering form signed by the ordering doctor. In this case, the services may also be classified as “Not medically necessary”.  Therefore, it is important to include order and intent form while billing for laboratory services. Other documentation must also be complete and should mention complete details about the tests so as to allow verification.

• Billing Inter-Related Tests - Proper care should be taken while billing for inpatient claims. If you are billing inpatient services along with the surgical ones, make sure to include supporting documentation for inpatient services or, it may cause a dual denial situation. As an inpatient surgical claim denied for medical necessity could result in a denial of Medicare Part-B services.

The solution

Laboratory billing services require a whole different skill set. The best way to alleviate issues associated with lab billing is by outsourcing laboratory billing services to a trusted and experienced partner.

Outsourcing makes handling out of network claims, and managing information much easier. Their knowledge in billing management and the laws applicable in each state, understanding of the complex payer policies and being able to stay current with the constantly changing rules is what really makes a difference.

Outsource Medical billing with Bikham.. Bikham is one stop solution for DME medical billing, Lab medical billing, Laboratory medical billing, Cardiology Medical Billing, Dental Medical Billing, ORTHOPEDIC Medical billing, oncology Medical billing, Physical therapy Medical billing, Chiropractic Medical billing, Radiology Medical Billing, Emergency room billing. for More visit us on https://www.bikham.com 

How Medical Billing Helps You Generate More Revenue

Generating revenue is a basic need for businesses to run smoothly. This stands especially true of running successful healthcare facilities. However, the noble cause of treating patients is put to financial risk by the constantly changing healthcare reforms.

The main source of earning revenue for medical practices in the US is the reimbursement from payers. Medicare and Medicaid plans of the Affordable Care Act (ACA) make up the maximum percentage of insurance coverage followed by private insurances.

Importance of Medical Billing

The Medical billing process is a very crucial procedure for medical practices to get their reimbursement on time. This process involves in-house staff members who have to look after everything from appointment scheduling, transcribing, filling the CMS-1500 claims form, submitting them to respective insurers, working on denials to following up with the payers until the payment is made. It is a long and time taking procedure.

• Erroneous Submissions Lower Revenue

The statistics reveal that the most common reason for delayed payments is erroneous form submission. It constitutes a major 30% of the reason why physicians have to wait for long duration to receive their due.

• Follow up is Part of Billing Process

Many a times the physicians have to completely forego their payment because of lack of following up with the payers. The staff is so burdened with administrative and other tasks like coding and compliance that spending at least 15 minutes for every phone call to the payer is next to impossible. Besides that, if the accounts receivable (AR) falls into the next level of the 30 / 60 / 90 bucket the chances of collection lowers significantly.

• Payment Posting and Reports

An important part of the medical billing process is posting the status of payments, checking whether the practice has been reimbursed as expected and for properly for every respective patient. However, the main aim of this process should be to generate reports after analyzing the trend of reimbursement by per insurance payer. This proves to be helpful in strategizing and planning the submissions for different medical specialties.

Thus, if your medical billing cycle is interconnected in a smooth way and functions without glitches, you can be sure of collecting maximum revenue for your practice. Nevertheless, it is also noted that practices of different sizes fail to streamline their billing cycle due to the many systematic steps involved along with compliance issues due to which many practices are losing more revenue than before. In such situation the only feasible option to save costs and comply with the healthcare changes is outsourcing the billing process to a vendor. Outsource Medical billing with Bikham.. Bikham is one stop solution for DME medical billing, Lab medical billing, Laboratory medical billing, Cardiology Medical Billing, Dental Medical Billing, ORTHOPAEDIC Medical billing, oncology Medical billing, Physical therapy Medical billing, Chiropractic Medical billing, Radiology Medical Billing, Emergency room billing. for More visit us on https://www.bikham.com 

Healthcare Revenue Cycle management Flowchart

Healthcare Revenue FLowCHart

Revenue cycle management refers to the business side of your practice–from verifying patient insurance eligibility to submitting claims to receive health plan payments and billing patients for their share of service costs. Although patient care will always be your top passion and priority, an efficient revenue management system is critical for your practice's financial health and sustainability. Electronic methods can streamline revenue-related processes, such as eligibility checks, claims submissions and payments, all allowing your practice to maximize the amount of time available for patient care.
Outsource Medical billing with Bikham.. Bikham is one stop solution for DME medical billing, Lab medical billing, Laboratory medical billing, Cardiology Medical Billing, Dental Medical Billing, ORTHOPAEDIC Medical billing, oncology Medical billing, Physical therapy Medical billing, Chiropractic Medical billing, Radiology Medical Billing, Emergency room billing. for More visit us on https://www.bikham.com 

Laboratory billing solutions

We understand the significant impact of PAMA pricing on clinical and specialized lab tests, especially because laboratory billing has always presented a challenge. But our certified medical billing specialists have unmatched expertise and experience in CPT updates and revisions, so you can rest assured that we will maximize reimbursement for the services you provide your patients. We provide real-time eligibility to ensure services are covered and claims are paid as they should be.. Increase revenue with Laboratory Medical billing. Bikham best Laboratory Billing Company offer Lab medical Billing and Laboratory revenue cycle management

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