Clinical Lab Billing

As a clinical laboratory, you probably feel like you’ve been under siege lately. Increased oversight and audits, rising operating costs, and falling reimbursement rates have created an uphill financial battle for clinical labs. And many are struggling to survive, especially in a highly competitive market with a lot of client turnover. Now, more than ever, it’s critical to tighten up the documentation and clinical lab billing processes to ensure you are recovering costs. Many labs felt an initial shock wave in 2014 when the Protecting Access to Medicare Act (PAMA) was signed into law, and again in 2018 when new payment rates became effective. But with additional restrictions and reporting requirements, as well as deeper PAMA payment cuts on the horizon, clinical labs are bracing for the full impact. For many small and medium labs, it will prove difficult to make a profit, and some may struggle to break even. This is especially true when you consider the existing challenge of obtaining insurance contracts and receiving appropriate reimbursement. Narrowing insurance payments and issues collecting patient payments only make matters worse.

The sure ways solutions offers tailored billing solutions for clinical labs. Our certified medical billing specialists stay up to date on regulatory and medical lab billing standards and our professional clinical laboratories billing services ensure increased revenue stream and maximizes profitability. With accurate coding, timely submission of completed claims, and aggressive follow-up on denials, clinical lab billing specialists help you shape a long-term plan to succeed amidst all of the changes in store for laboratories.

Some health care policies exclude mental health care altogether, and those that include it have a wide range of policies. The Affordable Care Act (ACA) requires Marketplace plans to include mental health and substance use disorder services but does not detail what must be covered. Though it is more widely covered than it has been in the past, the rules for therapy may even vary from state to state by the same insurer. As a psychology billing company, we stay updated with the complicated rules.

However, for the majority of clinical laboratories, the outlook doesn’t have to be so dismal. Making efficient and timely adjustments to both back-office and front-office procedures can make all the difference. Submitting complete and accurate claims has never been more important to the success of your lab. Not only is it imperative that CPT and ICD-10 codes be correct, but claims must also be coded to the highest level of specificity to prove medical necessity. And time is of the essence – the limited window for reporting clinical diagnoses and submitting claims means you may have to adjust the pace of your administrative and clinical lab billing processes. This can especially be challenging when the ordering provider sends a requisition with missing, incomplete, or incorrect information.

The sure ways solutions is an industry leader and trusted name in medical accounts receivable collections because we know how to get results. Our mastery of complex medical coding and AR management services sets us apart. But it’s our breadth of knowledge that allows us to shine. Our medical billing company successfully serves healthcare facilities of all types and sizes, and we specialize in medical billing for physicians, laboratories, radiology & imaging centers, and hospitals. We know it’s difficult to remain entirely focused on patient care when you’re worried about your bottom line. If you’re spending valuable time and energy trying to diagnose finances, then perhaps it’s time to enlist the aid of a professional medical billing company like The sure ways solutions.