Medical billing services is a very complex task and there is no doubt about that.
Pathology medical billing is no different. It might look like a very small domain of medical billing, but it includes a lot of medical tests like hematology, urinalysis, drug tests, blood tests, etc.
If you ignore it purposely or accidentally a huge amount of revenue can be lost for the organization. There are various rules set by insurance companies that add to the complexity of Pathology Medical Billing Services.
That is why it requires maximum attention while procuring accurate data to maximize the organization's revenue.
Pathology Medical Billing
Pathology medical billing includes anatomical, clinical, general pathology and various other fields along with other sub-specialties.
These sub-specialties include molecular pathology, hematopathology, surgical pathology, cytopathology, forensic pathology, etc.
Pathology comprises of two types of tests which include Qualitative & Quantitative tests.
Qualitative tests are done to understand the presence of substance and quantitative tests document the amount of substance in your body.
Pathology medical billing services has its own set of needs and might get complicated for hospital-based service. It happens a lot that the regulations and payer requirements are not updated, making denial obvious.
Tests Included in Pathology Billing
Drug testing: It determines if a drug is present (Qualitative) and then the amount (Quantitative) of the drug present.
Each drug has a specific code that needs to be carefully documented during the billing process.
Numerous pathological tests include:
- Molecular pathology procedures which determine antigens, genes, and a few biological functions which tests and confirms diagnosis
- Anatomic pathology billing comprises of codes for autopsies
- In the Chemistry subsection, tests for any specific chemical compounds are done. It is very similar to immunology section
- The Microbiological tests determines if organisms like giardia, HIV, hepatitis, or Rubeola are present. Each of these has a specific code.
- Surgical Pathology comprises the study of human tissue. The codes of surgical pathology billing are characterized by levels and each of them covers a wide array of things
The codes for Pathology Billing are not measured based on the test results but are measured by the number of tests performed. For instance, if some is being tested for alcohol and phenobarbital, the medical billing expert will have to consider it as two different procedures.
Mistakes Common in Pathology Medical Billing
Just like any other billing procedure, pathology medical billing services also require a fast process where mistakes can happen quite often.
A lot of times the staff is so busy providing quality care to patients that errors become unavoidable. Failing to comply with pathology medical billing guidelines will certainly lead to denial which will have a significant negative impact on your revenue.
So, let's go through some of the very common mistakes and errors in pathology medical billing:
Simple Errors
Pathology Medical Billing requires huge attention to detail, ignoring which will lead to clerical errors with patient data, insurance information, duplicate billing, mismatched codes, and provider details.
Improper Documentation
The cause of improper documentation can be anything from lack of time, misinformation, or even unawareness of patients.
Sometimes healthcare providers fail to provide enough data about a procedure or leave out any other information. This results in incorrect submission of claim, obviously leading to denial.
Under/ Upcoding
Under coding is the circumstance when provider documents a less expensive procedure than what was performed.
Upcoding means receiving higher reimbursements by using the codes that are adjacent to more expensive procedures or document more severe illness than what existed.
Unbundling
This happens when pathology medical billing designed for a group of procedures performed together, are billed under separate codes.
Denied Claim & Rejected Claim Confusion
When an insurance company finds a claim to be unpayable it falls under the category of denied claim. This happens quite often because of omitted information, billing errors, or patient coverage.
Under some instances denied claims are subjected to reprocessing and appeal.
However, the staff needs to put in extra efforts to determine why the claim was denied earlier, fix the errors, ensure no mistakes are left and push it forward for reconsideration.
A claim that has incorrect patient or insurance information will be rejected by the insurance company, and this will be considered as a rejected claim.
These claims never make it to the payer's computer system. After the errors are fixed, the claims will have to be resubmitted.
Why Should You Outsource Your Pathology Medical Billing?
Many healthcare organizations do not consider how much burden can be decreased on their shoulders by outsourcing their pathology billing service to any medical billing company.
It might feel like you will lose your independence but if you think closely, as a doctor you are the healthcare specialist, and the medical billing companies are the experts of medical billing and coding.
A medical billing company identifies billing trends which help to decrease future denials, hence increasing the revenue of your healthcare organization. It results in:
- Increased Revenue
- Decreased Days in AR
- Reduced Denials
- Accelerated Cash Flow
- Improved Understanding of RCM process and Outcomes
Simplify Your Pathology Medical Billing with Unify Healthcare
Unify Healthcare Services is a well-established medical billing company in USA.
We have trained medical billing experts who will take care of all the documentation and billing requirements. Our ultimate objective is to increase the revenue of your clinic so that you can be free of the hectic billing process and focus more on patient care.
Once you try our pathology medical billing services, you will gain peace of mind because we ensure that all your claims get reimbursed to you quickly and accurately.
Partnering with us will give you certain perks such as:
Increased Revenue: Our team focuses solely on the billing procedures, hence maximizing claim reimbursement.
Revenue Cycle Management: Combining medical billing in all the aspects of revenue cycle management ensures that you will have a complete take of what billing means in your laboratory.
Dedicated Claims Follow-up: We use the most advanced systems, processes, and training which ensures follow-up on every claim timely and efficiently
AR Management: We work on claims while improving processes so less work hits the AR that requires follow-up. This ensures that you are getting paid faster so you can solely focus on providing better patient care.
Unify Healthcare Services envisions making billing easy and secure for every practitioner as well as health organization. We believe that healthcare practitioners can take care of patients only when they are unchained from the hassle of managing their finances.
Ultimately our vision is to provide the best billing services to healthcare providers, so that they can provide the best treatment to their patients.
