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