6 Essential Laboratory Billing Practices for Growing Clinical Labs

Staying ahead in the growing clinical labs industry

Staying updated on the latest technological advancements, regulatory changes, and industry best practices can help ensure your laboratory remains competitive and provides high-quality services. Here are a few industry best practices and key areas that your clinic can focus on:

1. Pay attention to discrepancies in patient information

A simple mistake can greatly impact your practice’s finances because incorrect information can disrupt billing transactions. This is why it’s important to keep track and strive for the accuracy of patient records to enable the laboratory to prepare and submit billing claims accurately.

A good medical record should include the following:

• Patient Identification: This includes the patient’s name, birth date, and social security number or government ID.
• Insurance Information: This includes the patient’s insurance ID and coverage plan and information on whether a third-party payer covers reimbursements for patient care services.
• Medical History: This summarizes past diagnoses, treatments, medical care, and a list of allergies.
• Medication History: This serves as a guide to current medications, their effectiveness, and any potential for allergic reactions.

2. Understand the importance of medical coding

Medical coding is the backbone of healthcare organizations. It involves converting medical information, such as patient information, diagnoses, and treatments, into a special code. This coded information is then sent to insurance companies and others. The goal is to ensure healthcare providers get paid correctly by giving insurance companies the right details.

However, it’s estimated that up to 80 percent of all medical bills contain errors, meaning four out of five claims risk being rejected. These errors can lead to revenue loss, government penalties, and loss of clients. Here are the common coding mistakes to watch out for:

• Incorrect modifiers. This refers to misusing or applying incorrect modifiers to procedure codes
• Billing the wrong payer. This happens when claims are forwarded to the incorrect insurance company or payer
• Omitting details on claims. This happens when there’s a failure to include essential information on claim forms, like patient demographics or service dates
• Lack of prior authorizations. This occurs when one neglects to obtain the required authorization for certain medical services
• Unbundling. This refers to billing individual components of a bundled service separately instead of as one comprehensive service
• Upcoding. This refers to billing for a higher-level service than provided or documented in the medical record

3. Streamline your practice’s claims processing

Laboratories typically experience prompt payment for established laboratory diagnostics like clinical blood tests, urinalysis, and preventive screenings. However, obtaining claims for advanced testing, such as molecular techniques, genetic analysis, or infectious disease testing, presents bigger challenges. To solve this, you need to set clear steps for how things should be done. Here are two ways you can do to mitigate this risk:

• Prepare a standardized process to follow. Consistently improve your employee training to include finding filing requirements, accessing patient files, and educating them about the new trends in laboratory services. This helps carriers process claims faster when you submit them.
• Invest in the right software. Utilizing up-to-date and right software ensures that your staff has access to the complete claims management landscape, resulting in a more streamlined workflow.

4. Coordinate patient financial responsibility

Clear communication of patient financial responsibility is vital to avoid billing disputes and ensure prompt payments. Transparent discussions about costs and payment options upfront can prevent misunderstandings and promote smoother financial interactions.

Additionally, ensuring the patient is well informed can help them manage their expectations. This is significant as it builds patient trust and loyalty, which can impact your clinic’s revenue.

5. Comply with regulatory changes

In the next few years, labs could see big changes in how they get paid and their role in healthcare. Keeping up with healthcare rules is crucial to avoid problems. Medical billing rules follow different regulations, such as:

• Federal regulations, such as the Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act (ACA)
• State laws
• Guidelines from Medicare and Medicaid
• Health insurance policies

6. Find a tried and tested laboratory billing expert

As the clinical lab service industry grows, automation has become essential to simplifying the laboratory billing process. This can also lessen the burden on your staff so they can focus more on patient care.

To achieve this, partnering with a lab billing expert with years of experience like Synapse can be advantageous, helping you stay ahead of many other industrialized countries in terms of efficiency and effectiveness.

With over 25 years of experience, Synapse Lab Billing offers comprehensive laboratory billing solutions tailored to address critical challenges, including:

• Reduction in billing errors: Synapse ensures accuracy in billing processes, reducing errors that can affect revenue.
• Faster insurance and claims payment: By streamlining processes, Synapse expedites insurance and claims payments, improving cash flow.
• Control over billing processes: Synapse controls and oversees billing procedures, enhancing operational efficiency.
• Enhanced transparency: With Synapse, transparency is ensured throughout the billing process, promoting trust and accountability.
• Ensured compliance: Synapse helps clinics stay compliant with healthcare regulations, mitigating the risk of penalties and legal issues.

Let us help you grow your practice. Learn more at synhs.com, or contact our sales department at medicalsales@synhs.com or (844) 384-7532.

Sources:

Clinical Laboratory Services Market Projected to Reach $286.77 Billion by 2030, Driven by Advances in Disease Diagnosis and Increasing Geriatric Population; Lifted from https://finance.yahoo.com/news/clinical-laboratory-services-market-projected-171100345.html

US Clinical Laboratory Services Market; Lifted from https://www.fortunebusinessinsights.com/u-s-clinical-laboratory-services-market-107909