Do’s and Don’ts Of Laboratory Medical Billing Services – A Practical Guide

Healthcare labs play a crucial role in the healthcare industry because they lay the foundation of medical procedure decision-making. Therefore, it is essential to ensure compliance and reduce risks to proceed with laboratory billing services. Lab bills are prepared using diagnostic medical codes i.e. ICD (International Classification of Diseases). Laboratory billing and coding specialists should make sure that they follow the right billing protocols to collect reimbursements and contribute to the revenue growth of healthcare labs.  

Labs are the most unique area of the healthcare field, appearing in different sizes and iterations. Most healthcare labs are located in or near hospital facilities where they support healthcare providers as they diagnose and prescribe treatment to their patients. 

While a hospital’s lab only accounts for 3 to 5% of the total revenue of a hospital, its finding makeup 70 to 80% of a patient’s electronic health record (EHR). It also constitutes the most critical component of medical treatment decisions. In fact, a study by CDC establishes that 70% of medical decisions depend on lab test results.

When healthcare labs will be able to leverage potential cash flow then they’ll be able to advance in technology, staffing, and providing better services to the patients which means it’ll improve patient outcomes significantly. 

Now, we’ve understood why revenue is a critical point for healthcare laboratories, now we must realize that the primary workers who make up the majority of lab employees and directly influence it i.e. lab technicians. Mostly, healthcare labs have a limited staff, therefore, they are unable to involve in medical billing and coding tasks. 

That’s why most healthcare labs tend to outsource lab billing services to reliable medical billing companies in the USA. It spares the work stress of administrative responsibilities from lab technicians. In this way, they are able to focus on the laboratory information system (LIS), procedural equipment, and most importantly, they are able to progress in their pursuit to succeed in their business goals. 

As such, laboratory medical billing and coding services require a program built around the unique services provided to an independent healthcare lab vs the lab services offered by a hospital-associated or clinical lab. 

Lab medical labs are prepared by using a set of Current Procedural Terminology (CPT) codes and they specialized skills to proceed with complex laboratory billing and coding services. 

In this article, I have shared some insights into the do’s and don’ts of laboratory billing services that can help you align the workflow protocols for your practice; 

Do’s Of Laboratory Billing Services

• Apply Accurate Lab Billing Codes:

Lab medical billing services utilize two primary sets of medical codes set forth to meet the billing needs of healthcare labs. 

• ICD (International Classification of Diseases): Introduced and maintained by the World Health Organization (WHO), it is accepted as the international diagnostic and epidemiological standard. It provides a well-defined framework of diagnostic codes that are used to classify diseases, symptoms, injuries, and other complaints. 
• CPT (Current Procedural Terminology): The CPT code set describes all the various medical, surgical, and diagnostic services that are performed by healthcare providers in the US. This code set is designed to provide a set of uniform classifications to medical providers, medical coders, healthcare insurance companies, and other payers. 

These medical codes keep changing with the passage of time. Therefore, lab coding specialists should stay updated with the latest medical codes. For example, the ICD-9 codes were obsoleted and the ICD-10 codes were introduced on or after October 1, 2015. Now, ICD-10-CMS and ICD-10-PCS are effective and lab medical coding specialists should be well-versed in the nuances of the ever-changing medical coding environment. 

• Pre-Screen and Verify Insurance Eligibility: 

It is important for medical labs to proceed with pre-screen and insurance eligibility verification for patients. Not every patient has a coverage plan for lab tests, therefore, hospitals, physicians, and healthcare labs should make sure that the patient’s coverage plan benefits the patient for lab tests. 

It helps lab professionals to identify revenue sources and collect payments accurately and efficiently.

Also, by knowing what is covered by the patient’s insurers and what’s not, you’ll be able to reduce your chances of ending up with a patient and insurer who simply are not responsible to pay your dues. 

However, if you don’t have sufficient resources or solutions to proceed with pre-screening and insurance eligibility verification then you can outsource laboratory medical billing and coding services to a professional medical billing company. 

So they can handle your pre-screening and insurance eligibility verification procedures in a professional manner and more efficiently. 

• Double Check Medical Billing & Coding Procedures: 

If you want to ensure compliance and avoid claim errors then it is essential to have a well-functioning system in place that catches errors before the medical claims are submitted to insurance companies. 

Although human errors are bound to happen every now and then, using digital solutions for claim scrubbing, rule engines, etc. can help you drastically reduce the errors and mistakes in medical billing claims. It reduces the chances of claim denials/rejections and helps you save your revenue from slipping through the cracks in medical billing procedures. 

Another effective solution is to outsource laboratory billing and coding services to a reliable medical billing company. A professional lab billing agency has all the software and resources to carry out your billing procedures. Also, they are able to expand their medical billing and coding team to meet the growing needs of your business. So you don’t have to invest a capital amount in buying medical billing software solutions and hire medical billers and coders consistently with the passage of time. 

Now, you have insights into the best practices to ensure the accuracy and efficiency of laboratory medical billing and coding services. However, there are some things that you need to avoid while proceeding with your billing tasks mentioned above; 

Don’ts Of Laboratory Billing Services

• Don’t Stress About Claim Denials:  

If you’re following the right protocols and complying with legal standards of medical billing then you become able to significantly reduce your chances of claim denials and rejections. However, despite an almost perfect medical billing compliance process, claim denials are bound to happen anyways due to ever-changing medical codes, human errors, and eligibility verification issues. 

So even if you’re facing claim denials then you should consult with a reliable medical billing company. It will help you get guidance from subject-matter experts and you can get professional medical billing services. 

• Don’t Assume an In-House Medical Billing Team Is the Way To Go:

Did you know? According to a study, 70% of healthcare providers tend to outsource medical billing and coding services. There’s a reason why outsourcing medical billing services has a hype these days. 

It enables healthcare providers to connect with professional medical billing and coding specialists who process your medical bills, follow up with the insurance companies and patients to collect your payments, and regularly provide you reports about the progress of your practice’s healthcare revenue cycle management. For example, CureCloudMD is a well-experienced medical billing company in the USA that offers highly cost-effective medical billing and coding services to every size of healthcare lab. 

We offer a free medical billing audit before onboarding our clients and provide customized packages of our lab medical billing services, medical coding services, medical credentialing services, account receivable (AR) recovery services, claim denial management services and regular medical billing audit services. Request your on-demand demo of our laboratory billing and coding solutions now!