Growing Reimbursements and Volume

This is a pathologists-owned and operated, diagnostic company located in Flushing, New York. The lab offers a variety of services that include histopathology, immunohistochemical analysis, cytology, urine analysis, and molecular pathology.

CHALLENGES

‣ Establishing an entirely new lab.
‣ Setting up practice management system for billing.
‣ Incorrect patient insurance information leading to high denials.
‣ Data extraction from Lab Information System (LIS).
‣ No access to paper remittances for timely payment reconciliation.

SOLUTION

‣ We established a process for daily patient information extraction and verification.
‣ Setup Direct Deposits and Electronic remittance for major insurances for quick payments.
‣ Negotiated contracts with TPAs and established global agreements for higher reimbursements.
‣ Started sharing billing summary with the business owners on a weekly basis.
‣ We created carrier specific coding and billing guidelines for clean claims submission.
‣ We also assisted the lab in building process for managing patient receivables.

RESULTS

‣ Negotiations with TPAs resulted in agreements for 90% payments.
‣ 15% increase in payments from two major insurances due to clean billing.
‣ Overall collections improved by 31% between 2014-15.
‣ Closed 90+ insurance AR at 9% by the end of 2015 (industry average for 120+ insurance AR is 12%).
‣ 2x increase in the samples screened due to streamlined operations.