COVID-19 is caused by severe acute respiratory syndrome corona virus-2 (SARS CoV-2), a highly contagious single-stranded RNA virus genetically related to SARS CoV. The lungs are the main organs affected leading to pneumonia and respiratory failure in severe cases that may need mechanical ventilation. Pathologically, the lungs show either mild congestion and alveolar exudation or acute respiratory distress syndrome (ARDS) with hyaline membrane or histopathology of acute fibrinous organizing pneumonia (AFOP) that parallels disease severity. The treatment for COVID-19 was principally symptomatic and prevention by proper use of personal protective equipment and other measures is crucial to limit the spread. Digital pathology was also introduced and the COVID-19 pandemic accelerated its adoption as there is the need to deal with higher (as much as 250 percent increase) case volume. During the COVID-19 pandemic, pathology billing witnessed high denied claims and staggering account receivables (AR). Our AR Cleanup & Insurance Follow-up Specialist Clean up your AR services to reduce medical practice costs & recover overdue payments from insurance carriers.
Even though the need for pathology services has increased exponentially, patient and insurance collection hasn’t increased to that extent. Billing and collecting for pathology and laboratory services is ‘tough’ and things got tougher during a pandemic. During the COVID-19 pandemic, most of the claims were denied by insurance carriers due to the absence of correct procedure codes, non-payable diagnosis codes, and incomplete documentation failing to prove medical necessity. Pathologists struggled to collect insurance reimbursement both as in-network and as out of network for various payers.
Pathology billing offered unique challenges, like double billing; coding compliance; claim denials; and patient collections during pandemics. Patient responsibility is creeping up more and more; it used to be it was just the 20 percent coinsurance fees but now annual deductibles for the commercial payers getting to be so high that so much of that has shifted over to patient responsibility. When looking at the opportunities to collect more, much comes down to doing the basics effectively, organizing workflow efficiently, and reengineering processes all to ensure clean claims go out the door the first time. Practices don’t routinely audit their coding and because of that they dramatically under code. The other thing we see is practices not getting paid according to the contracted rates agreed to with the insurance carriers, and that type of pattern can go on for years with significant losses of revenue.
As discussed earlier, pathology billing and coding have complex regulations and rules leading to denied claims which end in unmanageable AR. MedicalBillersandCoders (MBC) can assist you in collecting accurate insurance reimbursements; pending accounts receivable amounts; hence reducing AR days. To clean up your pathology AR, we identify trends by Payers, Providers, Locations, CPT/ICD data; redefines ‘actionable claims’; and execute the predictive analysis. While working to reduce account receivables, we also ensure you will accurate insurance reimbursements by reducing eligibility errors; accurate front-end charge capture; documentation errors; and underpayments. To know more about our pathology billing services, contact us at info@medicalbillersandcoders.com/ 888-357-3226
