Today, there’s increased reliance on lab testing before establishing a diagnosis. It’s a great time to start or develop your lab business. We help lab owners establish their business, work towards getting participatory status with various insurance companies and develop an ongoing operational process with referring providers.
“I would like to express my sincerest gratitude to you and your staff in helping us to correct the past and move forward on the right foot.”
- PATHOLOGY LAB, FLORIDA
Getting the lab participated with insurance carriers is essential to ensure a smooth flow of reimbursements. Labs are mostly non-par, many claims get paid to patients and this affects overall reimbursements. Majority of insurance companies have their credentialing panels closed and continuous follow ups are required to check if panels are open and whether a new lab can be credentialed with insurances. We understand federal and commercial state specific credentialing guidelines. We also understand the specificity of getting credentialed for billing under technical or professional components. We can co-ordinate with insurances to help you get credentialed.
Whether it’s differentiating between professional and technical components, billing as independent or reference labs, or for reagents used and tests performed, determining diagnosis codes, coding is critical while billing for labs. Our approach is definitive to the point of getting it right the first time. Our process is flexible depending on the need of the hour. This allows us to be big and small at the same time – to be able to undertake voluminous lab work and at the same time provide personal attention.
Due to the competitive nature of the industry, we have observed that, many independent labs partner with practices for services. As a result, the lab becomes a preferred vendor for specimen analysis and reports. After specimen examination, the lab directly raises a service invoice to practices and the practices submit the charges to commercial insurances. We can help you manage this process. We create customized invoices for your lab, which you can simply forward to practices daily. We also keep a close eye on the payments for these invoices and regularly provide you detailed reports on outstanding payments making it easier for following up and getting paid.
Our lab clients have seen 90% increase in payments upon negotiations with TPAs and significant increase in reimbursements from commercial insurances. Our team will coordinate with carriers to help your lab get highest possible payable rates. We refer to lab specific coding and billing guidelines to ensure clean claims submission and this helps us achieve stellar results and growth for our clients.
CLAIMS SUBMISSIONS AND PAYMENTS
We benchmark ourselves at submitting claims within 48 hours from the date of service. This accounts for a consistent revenue cycle and a regular cash flow. Whether it's extracting charges from your LIS or establishing electronic gateways with insurance carriers, our team will closely work with your lab to ensure regular submission of claims and seamless flow of cash. Using electronic payment gateways for labs, we reconcile received payments on the same day. For insurances that do not allow electronic gateways, payments are manually entered and accounts reconciled as and when received in batches.
We take a coordinated approach towards insurance and patient receivables. With every additional day from the date of service, it becomes more difficult to get reimbursed. We know the average typical days insurances takes to process the claim. Based on the type of insurance follow ups on claims begin as early as the 15th day from the date of submission. This enables us to get accurate status on claims and gives us a head-start on denied claims and better predict the revenues for the lab. On instances of insufficient information on claims, we co-ordinate with PCPs to gather correct information and timely resubmit the claims. Aspects of patient receivables include, running outstanding balance reports, daily statement release, paid to patient collections, regular follow ups and collection coordination.
DAILY DENIAL MANAGEMENT
We follow daily denial management process to ensure claims reconciliation as quickly as possible. Our teams are cohesively tied together. Whenever a denial is encountered, it is flagged and instantly sent to the accounts receivables team for resolution. Both the teams are in constant coordination with each other until proper denial resolution is achieved. This avoids accumulation of accounts receivable, reduces AR days and increases collections.
Labs Case Studies
‣ Approx. $1M recovered within 4 months
‣ Total AR reduced from $9.4M to $5M in 6 months
‣ Mass resolutions with insurance carriers