A smooth Medical billing and coding process is essential to any healthcare practice, including Pathology. If uncounted for, physicians can lose up to 20% of their probable revenue. It is imperative to understand the complex rules that are often used by insurance companies to ascertain pathology claims. Hence, pathology billing requires attention to detail, obtaining of accurate data and auditing it for maximizing revenues.
Revenue Cycle Management is a proven tool for more increasing productivity in the billing and collections process. Medical billing services such as filing of claims, patient billing, and accounts receivables (increased A/R attention leads to increased revenues) should be in experienced hands. Pathology reimbursements require that every dollar is collected for lab testing services.
Medical billing thus, happens to be the financial backbone where a sound financial health is of dire importance. The foremost way to increase reimbursements and avoid denials is by checking the demographics (ID number, address, insurance coverage) of the patient. A single alphabet/number entered incorrectly can cause a quick denial. Medical billing can go wrong and not incur any payments if there are diagnosis-related errors. E.g. if a patient gets an added test done which was not suggested by the physician, it becomes an automatic denial.
Also, the insurance card must be updated at all times. A quick call to the insurance provider to enquire if the patient is covered can make a difference. Regular training of new and existing staff members is also crucial to medical billing. The practice manager should work with the registration staff to resolve issues and generate error-free claims. Again, the claims must be filed in a timely manner to ensure timely and accurate payments.
Also, if a precertification is not done or done incorrectly, it results in a denial. In this case, if a patient enters a hospital without a precert, the hospital and its radiologist conduct that procedure for free. Issuing an ABN allows the hospital/pathology lab to bill the patient directly if the insurance denies it, and the claim does not need to be written off. If there is a claim denial, appealing the claim is but natural. And if a patient writes to the insurance provider about the claim, the insurance agency does take notice to sort out the claim fault faster.
However, while filing the appeal, one needs to know if it should be a phone or written appeal. Understanding the guidelines for both helps in accelerating the process. Medical billing could also suffer due to processing errors by the insurance company. Also, it is important for a radiologist/pathologist to be aware of the Medicare rules and guidelines to follow for reimbursements.
It is imperative to provide superior services and bill accurately at the same time. For apt medical billing, include reports such as clinical history, specimen source and its type, dx for each specimen, gross and microscopic description, references and results of all frozen and consult sections etc. One should do what is medically necessary, document each report, and bill for the document along with an understanding of codes and compliances.