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Myndshft Blog

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July 29, 2019

Why Billing is Complex at Diagnostics Labs

by Patrick | Revenue Cycle Management

Revenue cycle departments at diagnostics labs face some really daunting challenges when it comes to managing patient copays and billing. 

We wanted to get a better understanding for the pain points that they face on a day-to-day basis, so we commissioned a market research firm to conduct a series of interviews with revenue cycle executives from across a spectrum of lab services types. This is the fourth in a series of five blog posts that reveals the findings from these interviews. To start reading from the first installment in the series, click here. You can also download the full report

Myndshft Report cover

Billing Complexity at Diagnostics Labs

Billing complexity was cited as a significant pain point by many of those interviewed.
Contributing to this is the fact that several hand-offs occur between stakeholders, systems, workflows, and contracts as part of the revenue cycle process, creating an environment ripe for errors that lead to revenue leakage.

As an example, certain procedures need to be bundled before a claim is sent to the payer. In addition, payers have differing billing process requirements, and these lack of standards make it difficult to successfully submit claims from health plan to health plan.

Compounding the complexity is the unpredictable response by payers to new lab offerings. Even though new lab offerings are introduced to the market on a regular basis, it’s not easy to predict how each payer will respond and on what timeframe.

Even when a payer makes a coverage determination on a new lab service, it may take weeks for claims adjudication systems to properly accommodate all the rules. Lab service personnel often keep cheat sheets that detail the particular rules for each of the large payers. Because these rules are continuously changing, however, these cheat sheets quickly become outdated.

Inconsistencies in how each payer reimburses for services also creates complexity for the providers and labs that must track across these entities. Contracting which determines covered services and payment levels for members and providers, respectively adds to the complexity. The process grows even more complex if dealing with patients who are covered by multiple insurance plans.

Conclusion:

The confluence of differing systems, methods, participants — combined with continuously changing payer rules — make billing a more complicated, elaborate process for diagnostics labs.

As a result, lab owners leave money on the table that they should rightfully collect.

Many of the variances that lead to so many manual errors, however, can be addressed by automating processes like eligibility verification, patient financial responsibility, and prior authorization.

To download our entire report, “Diagnostics Lab Execs Reveal Their Biggest Revenue Cycle Challenges,” click here.

To learn more about how Myndshft automates and accelerates patient intake and revenue cycle management, please click here.