PATHOLOGY BILLING SERVICES:

You Need To Have In-Depth Knowledge

Unique billing requirements create challenges for pathology practices, groups and labs. In order to successfully submit and collect on claims, billers and coders need to have in-depth knowledge of the sub-specialties in pathology, and they must have a current working knowledge of billing guidelines and updates about CPT codes for pathology services. With increasing scrutiny and tightening restrictions on laboratory billing practice management, it is imperative that clinical pathology labs implement stringent compliance procedures in accordance with changing laws and regulations.

Merit-Based Incentive Payment System

Perhaps an even greater challenge than federal and commercial guidelines, however, is the Merit-Based Incentive Payment System (MIPS), which determines Medicare payments according to scores in four performance categories: Quality, Cost, Improvement Activities (IA), and Promoting Interoperability (PI). To prevent payment cuts in 2020, and to earn the maximum incentive, pathology labs must report on six Quality measures and up to two IA measures.

It is critical to manage Documentation And Reporting

The future revenue cycle management of your lab depends on accurate documentation and proper reporting. It is critical to adjust front-office and back-office procedures to ensure maximum reimbursement from all payers. Many insurance companies have narrowed their provider networks, and pathology labs are increasingly deemed, out-of-network providers. Adding to the challenge is the fact that health insurers are placing greater limitations on benefits. It’s becoming more and more difficult to collect payments from insurers and patients alike. You may not be able to do anything about coverage, but you can avoid these types of denied claims and collection accounts by verifying eligibility before providing services.

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