Analyze your Current Pathology Billing Process



Providers in various specialties have to face increasing hardships given the healthcare reforms and CMS rules & regulations. The pathology practitioners are today challenged by declining payments, changing payment models and competitive pressures.

Pathology practices need to make medical billing and coding more efficient and effective in order to maximize revenues and provide for an effective Revenue Cycle management (RCM) process. This includes proper diagnostic coding, fee schedule analysis, and practice management. To reduce rate of payment refusals by third party payers, accurate diagnostic coding is essential to decrease the rate of appeals claims. To help set competitive fees for services reflecting both market trends and client / payor expectations, fee schedule analysis is a must for pathology practices and laboratories. And, finally to optimize use of resources effectively, enhanced practice management aimed at improving the administrative and business aspects is vital to provide high quality services to patients.

So just how can you go about analyzing your pathology billing process to increase revenues?

  1. Automating: By introducing automation into your billing process you can immediately track and reconcile accessions against reports received for billing.
  2. Credentialing: Updation of credentialing/provider enrollment is very critical. When accurate bills are sent to each payer, then your pathology practice will immediately see daily financial and operational success. Analyzing outstanding balances with payers and patients on a daily basis assigned to an Accounts Receivable (A/R) expert should be integrated with your billing process system.
  3. Auditing: Auditing helps to check if collections are up, A/R outstanding days have been brought down, denials are reduced and net collections achieved. A regular auditing thus can aid in detecting loopholes.
  4. Performance & Productivity: Electronically processing claims employing the most advanced tools should reduce billing intervals from weeks to days & hours and thus lower  overhead costs in the long run which reflect increased productivity among teams and total focus on core business.
  5. Reduction in Compliance Risk: Processes and workflows should be streamlined such as automation of routine tasks, which lead to efficient claims processing.
  6. Reporting: Besides the CMS regulation for the most current version of eCQMs for electronically reporting to Quality Reporting Programs or demonstration of meaningful use, analysis of daily reports helps improve pathology billing and coding cycles.

The below steps can help analyze your Pathology Billing:


Once you have analyzed if the above is running well and you think you still need experts, if time management is the problem, then outsourcing the above to a third party medical billing and coding vendor, is your best bet to enhancing your core pathology practice and leaving the operational and administrative practices to those who know best and meet the healthcare industry compliance.

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