The laboratory business continues to struggle with consolidation and margin pressure. The Protecting Access to Medicare Act (PAMA) clinical laboratory fee is just the most recent example of the continuing compression of laboratory reimbursement and revenue cycle management. With this in mind, here are some ways you can combat consolidation and margin pressure within the laboratory business through outsourcing billing:

1. Cut down on inaccurate or incorrect information on claims

Up to 40% of lab claims are known to have inaccurate or incorrect information on them which leads to them being delayed, denied, or even written off. CMS statistics show that only about half of all denied claims are ever returned for processing. Just by making sure the information on the claims is accurate and correct, net sales can be increased by 6-10%.

2. Have accurate net vs. gross revenue recognition

Having inaccurate net vs. gross revenue recognition often creates a lack of visibility when it comes to the actual balance due. This will have a direct negative impact on revenues and creates a compliance liability for the lab. Just having the net vs. gross revenues information correct along with the timely pursuit of balances owed will increase your net sales by an additional 5-10%.

How to Combat these Issues?

Credence Global Solutions’ denials management software can help reduce the amount of inaccurate or incorrect claims. The denials management software helps with a variety of issues that could cause a claim to be denied including: error processing, document management, appeals workflow, insurance discovery, secondary insurance, electronic record retention and refund support. 

These software features assist in ensuring claims are submitted with accurate and correct information, the first time. This reduction in errors cuts the amount of denials and delays.By fixing these issues you could potentially see an increase of 6-10%.