In 2019 we discussed many thought-provoking topics and trends regarding laboratories, medical billing, revenue cycle management, and much more. Here is a short recap of the top 5 most-influential blog posts:
1. Hidden Landmines in Revenue Cycle Management: Industry Challenges, Patient Engagement, and Denial Trends
Many trends in payor behaviors and reimbursement go unnoticed due to outdated RCM management practices. Additionally, even known areas of reimbursement deficiency, such as medical necessity denials or increasing patient bad debt, can be easily neglected due to lack of resources or knowledge of an effective resolution.
Within the last two to three years, we’ve seen the true calculation of bad debt increase from an average of 10% up to an average of 15%, depending on location, payor mix, and patient demographics where the pathology practice or laboratory serves. A major influencer in the uptick in the increase of bad debt has been a swell in payor denials. To combat this landmine, labs should get in the habit of measuring successful appeals processes associated with those denials to develop a quantitative method for improving payment outcomes and shortening the payment cycle.
Discover more about patient bad debt and the rest of the hidden landmines found in prior authorization, consumerism, and patient engagement in the full blog post here:Read Now
2. United Healthcare Reimbursement Policy Update for Molecular Pathology
United Healthcare announced that the effective date of its reimbursement policy update for molecular pathology has moved from dates of service beginning September 1, 2019, to dates of service beginning November 1, 2019.
This reimbursement policy change affects claims submitted with codes for Tier 1 and Tier 2 Molecular Pathology. Tier 2 Molecular Pathology codes are 81400 – 81408, and are to be used when there is no Tier 1 code for the service that was performed. These codes are assigned by the American Medical Association (AMA) and indicate the level of effort associated with the service performed. If neither a Tier 1 nor a Tier 2 code is assigned for a service, an unlisted code, such as 81479 can be used.
The AMA guidance also provides claim designation codes in the molecular pathology gene table that represent specific genes that are being tested. UnitedHealthcare will require providers to append the AMA claim designation to identify the specific gene when submitting a Tier 2 Molecular Pathology code. If there is no claim designation assigned, the provider should submit the abbreviated gene name. This information can be found in the CPT Molecular Pathology Gene Table or the specific analyte is listed after each Tier 2 code descriptor.
For more information on this policy update from United Healthcare read the full blog post here:
3. How the Most Successful Laboratories in the Country Continue to Thrive in the Midst of an Increasingly Complex Reimbursement Environment
The most successful laboratories in the country have the clinical resources and technology to process tens of thousands of test orders per night and return a quality result to their ordering providers, typically the very next day. Part of their success hinges on their ability to ensure the integrity of the data they need for claim submission and reimbursement. Here are some tips on implementing workflow capabilities that efficiently ensure timely submission AND reimbursement:
For more information on how the top laboratories are functioning at such a high level, read the full blog post here:Read Now
4. Digital Pathology Primary Diagnosis Is Approved – Is Your Lab Ready for the Future?
In 2019, Leica received its FDA 510(k) clearance to market a digital pathology whole slide imaging system for primary diagnosis, making it the second company to receive such clearance. These advancements are initiating significant momentum in the adoption of digital pathology platforms for clinical use.
In preparation for the full adoption of digital pathology for primary diagnosis, it is critical that labs consider how it will be integrated into the lab workflow and overall IT infrastructure. Successful digital pathology system integration will allow the lab to take advantage of the following:
Get the full breakdown of everything your lab needs to embrace the adoption of a digital pathology platform in the full blog post here:
5. Congress Passes LAB Act; PAMA Reporting Delayed by One Year
On December 19th, after multiple years of uproar from ACLA and other stakeholders on behalf of seniors who rely on lab tests, Congress has officially passed the Laboratory Access for Beneficiaries Act, also known as the LAB Act. This bill delays the reporting of lab payment data required by PAMA (Protecting Access to Medicare Act) by one year.
Anticipated to be a huge win for the labs and patients, the LAB Act should increase hospital lab participation in data reporting and, in turn, boost payment rates, according to ACLA; "Fortunately, Congress’ decisive action today puts us on the path to enact meaningful PAMA reforms that will protect seniors’ access to essential lab services, as the law originally intended," said American Clinical Laboratory Association President Julie Khani.
Discover more about the LAB act and its potential impact on labs in the full blog post here: