CLINICAL LAB BILLING
Clinical Lab Billing?
Clinical laboratories are facing significant challenges in today’s landscape, characterized by heightened oversight, increasing operating costs, and declining reimbursement rates. The competitive market, coupled with frequent client turnover, intensifies the struggle for survival among many labs. In such a scenario, tightening documentation and clinical lab billing processes becomes paramount to ensure cost recovery.
The impact of the Protecting Access to Medicare Act (PAMA) has been keenly felt since its enactment in 2014, further compounded by new payment rate adjustments in 2018. With additional regulatory restrictions and reporting obligations, alongside anticipated deeper PAMA payment cuts, clinical labs are preparing for the full extent of the repercussions. Small and medium-sized labs, in particular, face profitability challenges, with some struggling to break even. This predicament is exacerbated by difficulties in securing insurance contracts and obtaining appropriate reimbursement. Constricted insurance payments and challenges in collecting patient payments further exacerbate the situation.
Clinical Laboratories Billing Experts
Remote Expert Solution provides customized billing solutions specifically designed for clinical labs. Our certified medical billing specialists remain current on regulatory requirements and medical lab billing standards, ensuring optimal revenue generation and profitability for our clients. Through precise coding, prompt submission of finalized claims, and proactive pursuit of denials, our clinical lab billing specialists assist you in crafting a strategic roadmap for long-term success amidst the evolving landscape of laboratory operations.
However, for most clinical laboratories, the future doesn’t have to appear bleak. Implementing efficient and timely adjustments to both back-office and front-office procedures can significantly alter the outlook. The importance of submitting complete and accurate claims has never been greater for lab success. It’s not only crucial that CPT and ICD-10 codes are correct but also that claims are coded with the utmost specificity to demonstrate medical necessity. Time sensitivity is paramount—the narrow timeframe for reporting clinical diagnoses and submitting claims may necessitate adjusting the pace of administrative and clinical lab billing processes. This can pose a challenge, particularly when the ordering provider submits a requisition with missing, incomplete, or erroneous information.