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presentation

Reimbursement Challenges in Pathology Billing

May 20, 2016



Reimbursement Challenges in Pathology Billing

With an end goal to cut national health care costs, various changes have been set up that will adversely influence lab reimbursement and as a result, the laboratory center benefits. Three noteworthy changes that will challenge the repayment of pathology billing happening are the termination of the TC Grandfather Clause, changes in Molecular Pathology CPT Codes from the Clinical Laboratory Fee Schedule to the Physician Fee Schedule, and a general decrease in clinical research facility payments.

With these repayment cuts, it is key factor for clinical and anatomic pathology labs to obtain arrangements that take into consideration fast access to the quality, operational, clinical, and budgetary information they have to settle on winning choices. A proactive way to deal with lab administration is fundamental to guarantee the future success of your research facility.


Multiplying Down On Business Intelligence

Confronted with critical descending weight on repayment, laboratories are progressively taking a look at approaches to cut expenses and enhance lab proficiency. One technique that can majorly affect a lab's productivity is the reaction of a business insight (BI) arrangement. Clinical research centers and pathology groups are under weight to enhance quality and convey a more higher amount of services, all while pressing out each pointless expense. By using a lab specific business intelligence platform, for example, Viewics Health Insighter, research facilities can drive key clinical, money related, and operational pathology coding and billing opportunities.


Clinical Lab Payment Rates

These real changes correspond with a general change in clinical laboratory installment rates. Compelling from January 1, 2013, there was a 2.95% rate cut in clinical research center payments. It is expected to spare Medicare $2.7 billion over a 10 years period. This cut was a part of the Affordable Care Act (ACA). There is likewise the possibility of another 2% cut as a major aspect of government spending plan adjusting. Together, these can possibly add up to a 23% decline in lab facility charge cuts over 10 years.


Molecular Pathology CPT Code Changes

The Center for Medicare and Medicaid Services (CMS) has additionally proposed changes to the Physician Fee Schedule (PFS) for CY 2013, specifically to payment for molecular pathology administrations or services. For the last couple of decades, CMS has repaid clinical labs for sub-molecular pathology tests under the Clinical Laboratory Fee Schedule (CLFS). CMS is proposing adding new codes to portray sub-molecular pathology tests and moving some of those tests to the PFS. Molecular pathology tests regularly require a level of interpretation, which is ordinarily performed by a Ph.D. geneticist – not a doctor. Sometimes (around 20%), a pathologist may include elucidation. If the sub-molecular pathology test CPT is moved to the PFS from the CLFS, a specific measure of reimbursement is moved from the lab to the physician, regardless of the fact that the doctors are not included in interpreting the test (just requesting it). The American Clinical Laboratory Association (ACLA) led a review and found that roughly 80% of services did not require a doctor interpretation.


TC Grandfather Clause Expiration

On June 30, 2012, the TC Grandfather Clause lapsed. This Clause influences hospitals that outsource the specialized segment of some pathology services to a third party laboratory. The outsourced lab, will directly prepare the pathology billing and coding work under the Medicare specifically for the pathology administrations performed. Since the TC Grandfather Clause terminated, hospitals must bill Medicare directly, bringing about the labs charging the hospitals. Also, the Technical Component of code 88305, the most usually requested surgical pathology code, has encountered a 52% decrease. The primary concern is that labs or pathology practices that give TC Services to hospitals patients now need to arrange with hospitals for reimbursement levels for their TC Services. This could possibly bring about lower reimbursement rates for pathology research centers, contingent upon the concerns of transactions with their hospital’s clients.

 

Category : Revenue Cycle Management