April 27, 2016
Today, pathology practices and clinical laboratories trying to maintain a good financial performance is tough in an environment of increased regulations, reduced reimbursements and changing healthcare reforms. Added to this are the newer payment models, like the value-based payment model, which makes more reason to find ways to strengthen and optimize the Revenue Cycle Management(RCM) process. So how can one control costs, optimize revenues, and mitigate regulatory risks in today’s challenging healthcare environment and still differentiate oneself in the market?
Here are 5 essential ways that can help you enhance and make robust your Pathology practice financial health
Certified medical Coders & Billers:
It is of paramount importance that you have certified medical coders and billers. Regular training and testing ensuring that their skills stay updated with the regulatory changes is very essential to your Pathology practice and thereby your reimbursements.
Nuances of Billing:
It is a given fact that many a times due to misunderstanding of the Hospital Medicare part A, payments are not given to pathologists. Here pathologists can miss out on 25 percent to 45 percent of their revenue potential if they do not correctly bill for their professional services. So don’t miss out on these revenues by double checking your claims that will optimize your revenues.
Updated technology & Compliance:
With the growing insistence on Electronic access and use, it is of immense importance that in order to reduce declining reimbursements certain hardware and software inside the pathology practice should be updated. This will also help in keeping with the Meaningful Use (MU) requirements by CMS given that several of the MU criteria relate directly or indirectly to pathology laboratory testing and laboratory information management. The ability to provide electronic ordering and reporting which is interfaced with the practice EMR, can directly impact referral patterns in the market.
Performance of Lab equipment and Personnel:
The liability for any patient problem arising from the performance of lab equipment or from the interaction of personnel rests on the pathologist. Thus, ensure and regularly monitor that equipments function properly and that safety and quality protocols are in place. Also ensure that personnel maintain the highest professional standards. Patient safety, care quality & regulatory compliance go a long way in reducing legal exposure.
Healthcare Provider/Payor contracts:
Ensure that when negotiating contracts, consider all the clauses, as there could be hidden clauses keeping you from revenue that you would ideally deserve and can help boost a lot of local administrative operational systems.
For many of the above essential points cited, in-house workflows and personnel may be difficult to train and build upon given the present resources. Out sourcing to a professional vendor with expertise in the nuances of Pathology billingand compliances and keeping updated with the CMS regulations, is one way of increasing your revenues and also focusing on providing enhanced pathology quality care to your patients.
Best Billing and Coding Practices