April 11, 2016
As it is hospitals and other service providers are finding it extremely difficult when it comes to collections, especially so when the amounts due from patients are pretty large. There may be patients with high deductible health plans (HDHP), and ever since Affordable Care Act came into being, collections have been dwindling. However, that's not the only reason for poor collections in pathology billing.
Time is of essence
One way to ensure that collections in pathology billing remain at acceptable levels is to ensure that documentation coding and billing is done on a timely basis. Efficient management of processes will certainly help with your Accounts Receivables (AR). Try setting expectations and ensure that your medical billing and coding company is done with the documentation within 24 hours, or at least 48 hours, utmost. Any follow-ups that may be required for rejections should also be managed within this time frame.
Pay attention to denials
As in other medical specialties, denial management in pathology billing too plays a crucial role in realizing collections on time. Have a set system in place for tracking all denials and see that they are accepted. Staff need to be educated on the importance of time management, and trained to maintain a healthy turnaround time for all ARs. They need to be done with every single denial within 2 business days or receipt, which can be eventually reduced to one business day, which is quite a reasonable expectation.
Be thorough with policy requirements
Staff need to be trained on Local Coverage Determination (LCD) and National Coverage Determination (NCD) for Medicare. They also need to be thorough with other medical policy guidelines of other payors in order to ensure healthy collections in pathology billing. Information is available on the Internet, and staff should be prevailed upon to participate in webinars that are frequently held by specialists from Medicare and other payors.
Issues related to being out-of-network
There may be instances where the hospital may be in-network and the pathologist is out-of-network, thought the insurer is the same for both. A patient may be treated at an in-network provider and receive care from an out-of-network pathologist who may not be in the same plan network. This was usually handled by pathology labs used to bill as out of network providers and would be paid accordingly. However, of late health plans deny such payments. There are several pathology labs that have to contend with out-of-network charges while the patients are blissfully unaware. They realize the gravity of the situation only when the pathologists demand the payment from them as the payment was denied by the insurer. Insurance companies may also refuse payment for some specific services like a specific blood transfusion product with the pathologist being expected to discount such services.
The challenges lying ahead
The other challenges that one may encounter include being updated with the ever changing medical requirements. There may also be changes and updates in the reimbursement policies of Medicare and other payors that can affect pathology billing. One needs to also proactively plan for the proposed ICD-10 transition, which will certainly increase the number of people coming under insurance.
Best Billing and Coding Practices