An extremely critical role is played by healthcare laboratories within the healthcare landscape. This is because they ensure a foundation for all the essential procedures in the medical world. There was a study conducted, according to which labs play a vital role in 70% to 80% of critical decisions.
All these decisions take place within a healthcare facility. But the sad part is that labs are only able to collect 30% to 40% of their revenue compared to that collected by other healthcare providers.
Therefore, it is of utmost importance for the laboratories to maintain an error-free healthcare revenue cycle management system. This will save your laboratory from the struggle of increasing claim denials and reduced reimbursements.
The complexity of laboratory billing, ever-increasing regulatory demands, inadequate applications and difficulties getting information can deeply affect the success of your healthcare business. You need an expert laboratory medical billing services provider, like Unify Healthcare Services, who understands the unique requirements of your laboratory practice.
What is Laboratory Billing
Laboratory medical billing is the process in which invoicing and collecting payments from various insurance providers take place. This payment is for various laboratory services delivered. In easy words, different tests are done withing labs which are later translated into standard codes.
After that, the whole test is submitted to insurance companies to get reimbursed. These medical codes are commonly categorized as the Current Procedural Terminology (CPT) codes. Your services delivered are recognized by insurance providers and other healthcare payers based on these CPT codes.
The laboratory medical billing service includes various tasks that must be performed with precision. When you get a reliable laboratory medical billing service provider, such as Unify Healthcare Services, to help with your administrative tasks, it results in easy reimbursements for the hard-earned services. Depending on the situation, it might take days and even several weeks to complete this procedure and receive reimbursements if there are errors or mistakes.
Essential Steps in Laboratory Medical Billing Services
The complications and the strict regulations are constantly increasing within the healthcare industry in the USA and all over the world. The demand for skilled professionals is more than ever. Today, you’ll get thousands of companies for Laboratory Medical Billing Services offering medical billing services. However, to make the most out of their services and solutions, you must choose your billing partner wisely.
Whether you select the outsourcing option or not, it is important for labs to be aware of how the entire medical billing process works.
Let’s Understand the Steps in Laboratory Medical Billing
Collecting Patient Registration Information
What happens usually is that people assume that the lab billing process begins with preparation of medical claims and applying medical codes. However, laboratory revenue cycle management begins as soon as the patient walks into your healthcare facility.
The front desk staff must collect the patient’s basic demographic information. It includes their name, birth date, insurance ID, employment information, email ID, etc.
All the information must be recorded in the patient’s EHR. It will certainly help healthcare labs to keep track of the overall medical history. Also, make sure to verify that the patient has provided accurate and updated information.
The phrase “Prevention is better than cure” is not just true for patients but also for recording patient registration information.
Acknowledge Financial Responsibility
Once the patient registration information is collected properly, the next step is to take care of who will be financially responsible for the services delivered. One simple but crucial step is to ensure proper verification of the patient’s insurance ID and coverage plan.
Take care if there is a third-party payer covering the payments for the services delivered. Apart from that, it must be ensured that the coverage plan also supports the procedure offered to the patient when they are in your office.
There might be a case where insurance company doesn’t cover some procedures or services. In such a scenario, the registration staff should tell the patient that they will have to pay their dues. And it should be done before getting any services from your healthcare lab.
One idea for better to improve your financial outcome and patient experience is that you can offer multiple and easy payment options to your patients.
Encounter of Patient-Provider
As soon as the document procedure is completed on patient’s end, there is a meeting with healthcare provider to get the services. This meeting is referred to as a patient-physician encounter.
This encounter can take place in various ways. It might be in-person, over a phone call or via the internet as video chat. It is the administration staff at the provider’s end who fill in an encounter form and create a record of all the details about the meeting.
The form of encounter is considered as a key document. It contains the patient’s name, date, place of service, the amount paid/due, diagnostic codes for the patient’s condition, and prescriptions.
The notes will be taken at the end of the physician for the entire patient visit. It can be done either through voice recording or notes in written form. After that, all these notes will be turned or translated into standard CPT and ICD-10 codes.
Creation of Superbill and Medical Coding
As mentioned earlier, the entire medical transcription is translated into medical codes. These medical codes are used to prepare claims in the entire medical billing process. In medical coding, the healthcare services are translated into standard alpha-numeric codes, acceptable all around the USA.
3 Different Types of Medical Codes Include:
- Current Procedural Terminology (CPT®) Codes
- Internation Classification of Diseases (ICD-10)
- Healthcare Common Procedure Coding System (HCPCS)
Final Submission of Claims
As soon as the superbill is created, lab medical billing specialists jump into the picture. They must enter the medical office charges with every CPT code so that a charge entry sheet is created. This sheet will be submitted to the insurance company.
In case services provided to the insurance company are not covered under the patient’s insurance plan the patient is financially responsible for those services. The charge entry sheet must be carefully reviewed to identify and eliminate coding errors, incorrect information, and irrelevant data. After the sheet is properly inspected, it is ready for scrubbing and transmission.
Detect Claim Adjudication
The entire process of the evaluation of medical claims and determination of the validity of data reported by the claim comes under claim adjudication. To ensure that your medical claim is fully compliant and easily reimbursable, health insurance companies initiate the process of claim adjudication.
When your medical claim is error-free, the insurance company reimburses healthcare providers accordingly.
To keep your medical claims fully compliant and reimbursable, you can get laboratory medical billing services from providers like- Unify Healthcare Services. The professionals here are entirely dedicated to providing you with the best claim denial management strategies.
Follow Up for Payments
The entire medical billing process is carried out to ensure that you are getting reimbursed for the services you provide. To ensure that lab billing professionals must follow up with the patients and insurance companies. It is an important step to remember and take timely follow-up for your payments on a frequent basis.
Reasons to Outsource Laboratory Medical Billing to The Experts of Unify Healthcare Services
There are various reasons why you should consider outsourcing medical billing of your healthcare. Such as:
Ensure Faster Payments
When your billing errors are minimized, reimbursements and payments will be timely received. With Unify Healthcare Services, you can streamline workflows, increase revenue, and improve revenue potential for your laboratory. This makes the way for payments to come through quickly and efficiently.
Experience Cost Reduction
When you maintain an in-house medical billing system, there can be a lot of hidden costs associated with that. Outsourcing medical billing to the professionals of Unify Healthcare Services eliminates various overhead expenses. It includes training costs, benefits, insurance, payroll and hardware/software installation costs.
Better Transparency
Apart from providing various reports on time, medical billing experts of Unify Healthcare Services will help you stay informed about payment delays and other issues better than your in-house staff. You will be able to maintain better control over your revenue cycle management without any micromanagement.
Enhanced Compliance
It can be extremely challenging to keep up with the changing healthcare regulations constantly. Medicare, Medicaid, and third-party payer protocols are constantly updated. It is not easy to predict what changes will take place in the coming days. But a qualified expert like Unify Healthcare Services stays on top with all the latest information about every changing rule and protocol.
Unify Healthcare Services is a comprehensive laboratory medical billing services provider that helps labs meet their financial and billing goals. We handle the entire billing process so that you can focus on other crucial tasks. Improve your bottom line today with laboratory billing solutions from the experts at Unify Healthcare Services.
