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Follow this guide to avoid those stubborn claim denials

If you are into laboratory medical billing services, you must be aware of what importance does patient eligibility holds. Patient eligibility verification at the front desk of your medical lab is crucial as it ensures accurate and on-time submission of the COB (Coordination of Benefits) details at the very first stage of testing. Payment for patient responsibilities too can and should be addressed at this very stage.

The front office desk of your lab practice should also verify the out-of-network benefits and insurance term dates while carrying out the eligibility verification process. This strategy would help avoid the instances of claim denials and delays in claim submission.

In case, you are wondering why in spite of your keen efforts is your practice observing denials, below can be some reasons you would need to address.

·         Incomplete/Missing/Incorrect Claim Information.

·         Claim submission after the stipulated TFL (timely filing limit).

·         Change in Insurance Details/COB not updated.

·         Expired/Termed Insurance Enrollment.

·         Billing Out-of-Network services.

·         Sending a Duplicate Claim.

·         Missing/Delayed payment of the Deductible from the patient himself.

          Let’s discuss each in some detail.

#1 Incomplete/Missing or Incorrect Claim Information

Now, this incomplete or missing claim information may sound like a simple issue but can result in a huge backlog of claims that we bet you wouldn’t want to work upon, ever. Even that smallest error while filling the patient’s name, address or other demographic information can invite that dreaded claim denial.

The front desk staff of your lab practice should, therefore, take extra care while keying in information about a patient’s demographics to avert issues that may adversely affect the claim-submission process.

The staff should take out time to match the information in the database with what has been filled by the patient in the claim form. Collecting correct information and cover data at the initial the stage will further enhance the screening process resulting in increased control over the patient eligibility verification process while allowing you to carry out efficient laboratory medical billing services.

#2 Claim filing after the TFL

In a typical laboratory medical billing scenario, insurance companies allow a maximum of 60-90 days from the date of service for making a claim submission. Any claims submissions made after this period are liable to be rejected or to be more precise, denied. Unless your lab practice has the supportive documents or valid reasons for late submission, the claims are not processed and the payments not released.

In cases of a medical emergency, keeping the insurance payer in the loop about the patient details is a prudent exercise. Thus, it is the front desk of your lab practice that plays a crucial role in avoiding financial liabilities by informing the insurance company proactively about the reasons for a delay in claim submission.

#3 COB details not updated

There are instances when a patient has changed his/her insurance policy, yet has missed out on updating the same in the COB (Coordination of Benefits) document. Therefore, it becomes important to review the details of the insurance plan and confirm the same with the patient before actually going ahead and submitting the claim for a review from the insurance side.

Once the insurance details have been verified, the front desk of your lab practice needs to update the same on their system and conduct an eligibility verification test. Failure to do so can further lead to payment denials and you certainly won’t like that.

#4 Expired/Termed Insurance Enrollment

Apart from updates or changes in the insurance policy, there are instances when a patient’s policy has expired and the same has not been updated on The COB. Unaware of the fact, the front desk staff files the claim and suffers a denial. Termed insurance coverage leads to claim rejections right away.

The electronic billing software that you use for filing claims also has the provision to check the insurance eligibility online without having to call the insurance representatives and waiting tirelessly for hours to get them to verify the information for you.

#5 Billing Out-of-network Services

A majority of health insurance providers recommend billing only for the services that are covered in a patient’s health plan, which they deem as in-network benefits from an in-network lab service provider. Any tests from any lab service provider, outside their network, are deemed out-of-network and not covered under the health plan. And billing such lab tests would only bring in claim denials.

Some insurance providers in the US have also defined regions in which they provide insurance coverage. For example, a health plan like BCBS of Kansas won’t pay for the lab tests that are carried out in some other state, say Texas. So, in this case, BCBS of Texas will be covering these test charges while BCBS of Kansas will be regarding these tests as out-of-network.

So make sure which insurance provider is the patient’s plan related to and bill accordingly.

#6 Filing a duplicate claim or service

Billing for services that have been billed earlier invites unnecessary denials. A majority of insurance providers have a limit over the quantity and times a test can be billed in a period. Any tests billed over and beyond that limit, are denied.

To ensure that your front desk staff doesn’t bill for the same tests again, it is important that they are educated about the health plan a patient is covered in, so they know the details and avert the instances of claim denials.

#7 Missing/Delayed payment of the Deductible

Some insurance plans require patients to pay a certain amount termed as deductible before they start to pay for the lab tests. Even if the stipulated deductible amount is not paid completely, and the patient has an active insurance policy, where he is making the premium payments regularly, the insurance will pay for the tests. However, in the opposite scenario when a patient is irregular in making premium payments and the policy is dormant, payment for the claim will be denied. Making it a provision to check policy details upfront will surely help prevent such cases.

The final word

Verifying the insurance eligibility upfront is of utmost importance. It gives your lab practice a picture of the patient’s insurance details and whether or not to continue with the claims filing process. If you find any difficulty in carrying out these procedures, you can seek help from the providers of outsourced laboratory medical billing services.

Bikham healthcare is a provider of efficient yet affordable outsourced laboratory medical billing solutions and can help take the pain away from the complex insurance eligibility verification process.

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With a plethora of medical billing companies offering laboratory medical billing solutions, it might become difficult to select the one that caters to your practice specific requirements. Make sure you don’t fall into a trap of incompetent partners in billing. Bikham Healthcare with its 14+ years of varied expertise in laboratory medical billing delivers its clients with fully-customized outsourced services to make sure that your practice stays on top of its accounts receivables.

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Handling small patient balances can eat up most of your precious time. Seek help the experts at Bikham Healthcare and discover vast revenue opportunities as they take care of every aspect of the complex medical billing process.

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Why you should Outsource Laboratory Medical Billing Services

A lab practice is as good as its backend office staff. The people in charge of the billing and coding responsibilities serve as an invisible engine in the success of the billing business. It is their job to ensure that the billing is done accurately and the reimbursement is received on time.

At the same time, keeping up with the numerous code updates and guidelines changes can be cumbersome. Laboratory Medical billing can be a challenging task for those who do not have access to the required manpower. In the process of ensuring a profitable lab billing practice, laboratory owners often end up outsourcing their laboratory billing processes to outsourced lab medical billing service providers.

Outsourcing not only assists in the core billing tasks but also gives lab owners a much-needed ability and time to focus on business growth. Here are some reasons why you should outsource your lab billing service too.

Time-Saving

Outsourcing helps in streamlining the process, allowing you to focus on your laboratory's performance. When the time-consuming lab billing work is shifted over to a third-party provider of outsourced lab billing services, you get ample time to work on business development and draw in prospects by focusing on your core business: taking care of your patients.

Reduction in Costs

Operational costs observe a cut-down in the form of costs associated with setting up the required infrastructure, training the staff, purchasing software licenses, and more. A Reduced overhead costs also contribute to significant growth in your lab’s revenue.

Increased Profitability

When outsourcing, you are more able to concentrate on your core business, meaning you are more profitable.  You are more able to spend time with your patients which directly affects relations with them. You are more likely to obtain referrals from those who are happy with your services. All in all, this leads to an increase in the profitability of your laboratory billing business.

Full Compliance and Information Security

Outsourcing laboratory billing services is a safe choice. Well-established laboratory billing companies offer a very transparent billing workflow. A majority of them practice 100% HIPAA-compliance and 100% secure laboratory medical billing services to safeguard sensitive health information against any hacking attempts. Lab owners need to have an assurance that their patient’s data is secure, and providers of outsourced lab billing have the required competence to offer a safe haven for lab billing outsourcing services.

Adherence to the latest lab billing standards

Implementation of ICD-10 is a rising concern among the medical and lab testing community. The changes to lab codes in medical billing have made a great impact on the outcomes of lab medical billing. Outsourcing laboratory medical billing will ensure that any changes through ICD 10 are handled effectively.

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Taking care of the entire revenue cycle management in medical billing requires proactive measures and efficient strategies to collect AR as quickly as possible. As difficult as it may seem, everything becomes possible with the expert team at Bikham Healthcare. With a strong expertise in AR follow up, denial management, and AR and AP management backed up by a strong technological foundation, the team makes it possible to expedite the claims reimbursement process by at least 60%. And as an icing to the cake, overall practice operations become seamless and revenue grows exponentially.