Challenges in Laboratory Revenue Cycle Management
Different types of laboratories face different kinds of revenue challenges. Cutting-edge molecular and genetic tests must fulfill payer’s medical necessity requirements.
Capturing out-of-network payments requires expertise. Routine laboratory tests usually have lower fee margins that are quickly eroded by billing errors.
In any case, accuracy is paramount and details matter a lot. At Bikham Healthcare, we work to understand the unique reimbursement challenges faced by several laboratories.
From eligibility verification to benefit investigation and prior authorization to appeals and claims advocacy, our expert Laboratory Revenue management Management solutions are devised to deliver maximum revenue.
The expert laboratory billing service are executed with much care and accuracy.
Declining Medicare Reimbursement Rates
Laboratories continue to feel the pressure from declining Medicare reimbursement. Furthermore, there had been a significant impact on labs with the recent implementation of PAMA (Protecting Access to Medicare Act).
With effect from January 2018, CMS reduced the fee for various lab tests. It utilized the fee schedule of private market lab tests for lab services to establish a whole new Part-B laboratory fee schedule.
Reimbursements got reduced for the high-volume tests including metabolic panels, complete blood count tests and prostate-specific antigen blood tests. The impact on lab operating margins proved to be substantial.
Lack of effective work management Systems
A major contributing factor to improved financial performance and business productivity is automated workflow. A workflow that helps in tracking the claim closely throughout the laboratory revenue cycle management life cycle, and reduces errors to improve efficiency.
An automated workflow needs to be designed to encircle problem areas and perform edits so that missing information can be filled and incorrect data can be corrected as quickly as possible before submitting the claim.
With continuously evolving billing standards and payer rules, Laboratory Revenue Cycle management systems are required to be agile. System information needs to be updated real time to ensure compliance and avoid claim denials due to missing or wrong patient or payer information.
Ineffective tracking of Health related Data
Another challenge for laboratories is the inability to track billed amount and forecast reimbursement during the claims adjudication process. Apt billing information is important to determine the remaining balance collectible (AR or accounts receivables) from the patient.
However, the irony is, most RCM software fail to track this level of detail.
The lack of visibility and inadequate tools for segregation results in inaccurate follow up on balance and causes the clerical staff to accept partial payments as full, directly inflating the contractual obligations and adjustments or write-offs.
All this makes huge impact on revenue levels, and mischievously grants laboratories the belief that it collected all the money they deserve, when actually there may be more dollars to collect.
Laboratory Revenue Cycle Management with Bikham
Bikham Healthcare has the required manpower to deal with these numerous challenges and the required expertise to resolve any issues arising out of them. With complete HIPAA compliance and information security protocols, lab owners need not to worry about the confidentiality of the sensitive health information.
Visit www.bikham.com to learn more about their Laboratory billing Solutions.