Although similar to medical billing, laboratory billing has a specific and unique process related to diagnostic tests and procedures conducted in a lab. This could include anything from imaging to blood draws and every lab procedure in between; laboratory billing is a specialized type of medical billing for those specialized procedures.
To properly obtain payment for lab-related tests and procedures, lab billing staff must have a thorough knowledge of the specific lab-related codes and proficiency in medical billing and coding. Due to regulations, strict compliance with current pathology/laboratory-related regulations and payer guidelines is necessitated. It also requires the right technology to process billing claims.
1. Consistent & Reliable Process
All laboratories, from private laboratories like physician-owned or independent labs to those within hospitals or nursing home labs, must follow the same nuanced procedure. However, because of the specific medical billing and coding skillset, many labs often lack properly trained staff to handle laboratory billing.
Outsourcing laboratory billing gives labs access to laboratory billing experts who can easily and comfortably handle the technical laboratory billing process. Even better, outsourcing laboratory billing means your lab has access to an entire team of revenue cycle management experts who will work to keep your process running smoothly. Outsourcing also provides access to a scalable workforce who can meet the lab’s demands, whatever they may be and whether they fluctuate.
2. Regulatory Compliance
Just like with medical billing and coding, laboratory billing is bound to specific regulations, and compliance with those regulations is non-negotiable. If a lab is found to not bill in accordance with regulations, it could face steep penalties ranging from fines to criminal penalties.
Especially when working with government-funded programs like Medicaid and Medicare, laboratory billing processes must strictly adhere to the billing regulations and stay current with constantly changing government regulations. By billing correctly the first time with an outsourced laboratory billing firm, healthcare providers and labs alike can enjoy faster payment and fewer denials while avoiding costly fines.
3. Technology Requirements
When it comes to medical billing and coding, certain technologies make life easier. Patient balances are more prevalent in today’s high-deductible insurance world, thus requiring a systemic patient engagement platform. Software like iConnect can help facilitate faster payment, but even beyond that, the software even required to process claims is always advancing. Consider that it’s far more than just installing the software—having IT professionals on hand to provide analytics, reporting, and troubleshooting can increase the technology costs required to handle laboratory billing in-house.
Beyond the technological requirements and IT staff, it can take time to train internal staff on the program, then retrain when there are updates and get new staff up to speed. On the other hand, if your lab takes advantage of outsourcing laboratory billing, it won’t have to worry about investing in any part of a billing system, resulting in a noticeable reduction of overhead costs.
4. Mitigate Claim Denials
Whether it’s a result of the changing regulations or instances of increased errors in medical billing, all medical-related claims are under increased scrutiny, and laboratory billing is no different. While the goal is not to have laboratory billing claims denied, it does occasionally happen, whether from an incorrect code or an error on the insurance company’s side.
An outsourced laboratory billing company can take the time to monitor claims, investigate the reason if a claim is denied, and do the work to make sure the claim gets paid without sacrificing other operations. This could include resubmitting the claim or following up with insurance providers to ensure they are processing the claim correctly.
5. Reduced Operating Costs
There is a reason that medical billing and coding is its own field! Medical billing and coding, as well as specialized laboratory billing, is a field that requires training, continuing education, and a technical skillset to properly submit, monitor, and process claims. Most laboratories do not have the budget or trained staff to handle the technical laboratory billing claims, let alone have the flexibility to adapt to changes in varying billing volumes. Outsourcing this work allows labs to roll with fluctuating volumes without training new staff, overworking current staff, or laying off employees during a slow period.
Additionally, the technological requirements for laboratory billing software can come at a hefty price, which can increase operating costs. It’s not just the initial investment that costs a large sum; it’s the maintenance, staff training, and software changes that add up. Laboratories could experience reduced operating costs, which is a significant benefit of choosing an outsourced laboratory billing company.
6. Revenue Cycle Management and Medical Billing Expertise
Another massive benefit of choosing to outsource laboratory billing is that companies that can handle laboratory billing often offer related services, such as revenue cycle management. Revenue cycle management optimizes every part of a laboratory’s finances, from the patient’s first contact to the final bill payment. Bundling these services provides labs with unprecedented scalability and flexibility with the benefit of having expert financial guidance.
Whether it’s dealing with an out-of-network reimbursement or monitoring claims, having the entire billing process optimized through revenue cycle management could change your lab’s profitability for the better. Choosing to work with an outsourced laboratory billing company gives your lab the upper hand; your team can focus on what they do best, while an RCM and laboratory billing team can take care of getting your lab paid.
Outsource Your Laboratory Billing to The Experts
If you’re ready to save money and get access to revenue cycle management and laboratory billing experts, it’s time to outsource your laboratory billing processes. Connect with Credence Global Solutions today to optimize your lab’s billing procedures and learn more about how your lab could benefit from our services.
