Proven Pathology Billing Solutions
< 30
Days in AR
10-15%
Revenue Increase
97%
First Pass Ratio
96%
Collection Ratios
98%
Clean Claims Rate
Overview of Pathology Billing Services
The plight of pathology labs in the USA seems to be worsening day by day. Staff shortages, slashed reimbursements, medical inflation, and stricter regulations accumulatively pose a threat to the financial health and success of managed and independent pathology practices.
However, the effects can be overturned when labs and diagnostic centers outsource pathology billing services and let professionals manage different processes of the revenue cycle. From accurate pathology billing and coding to provider credentialing and performance reporting, third-party revenue cycle management (RCM) service providers, like MediBill MD, handle all the complexities, boosting operational efficiency and the bottom line.
Common Challenges in Pathology Medical Billing
From Medicare and Medicaid to private and commercial insurance payers, all rely on automation for the initial processing of medical claims. Their systems are trained to detect and trigger denial codes when the information is incomplete, inaccurate, does not support the procedure's medical necessity, or reports a non-covered service.
Moreover, in the post-Theranos era, non-compliance is seen as a form of fraud, and legal actions can jeopardize the reputation and survival of the pathology practice. Pathology medical billing specialists must navigate these common pitfalls to reduce missed or denied payments and increase cash flow.
Documentation Errors
Documentation errors or gaps are a recurring issue in pathology medical billing. The pathology labs daily perform a high volume of diagnostic tests, screenings, and examinations. Hence, the medical claims are processed and submitted in bulk, which leads to typing errors or missing reports/ referral letters.
Regulatory Non-Compliance
You will face consequences, whether it is your fee schedule, code reporting, claim creation, additional document submission, or practice management that is non-compliant with federal/ state laws, industry regulations, or payer policies. Minor instances of non-compliance result in claim denials, while major ones lead to lawsuits and financial penalties.
Uncovered Tests
Many pathology tests are not covered by government and private insurers. For example, Medicare does not cover routine blood tests, hormone tests, and wellness screenings. Similarly, specialized pathology tests like genetic testing, experimental screenings, and non-FDA-approved diagnostic procedures are also uncovered. Insurance payers straight-up refuse reimbursements for uncovered services.
Underpayments
Whether it is because of Medicare budget cuts or the hospital’s contract with the insurance payers, pathologists are frequently underpaid for their services. The reduced reimbursements adversely affect the pathology practice’s revenue cycle, making it difficult to cover overhead costs and improve the facility's day-to-day operations.
Outsource Pathology Billing Services to MediBill MD
You are the bridge between science and medicine, while we are the bridge between pathology services and accurate reimbursements. From the very first day of taking over your accounts, our efforts are directed towards increasing your clean claim submissions, obtaining higher reimbursements, reducing bad debts, and improving the financial performance of your pathology practice.
We work as an extension of your team. Our affordable and customizable pathology billing services include accurate coding, effective practice management, timely follow-ups, and reporting for holistic revenue cycle management (RCM). By choosing MediBill MD as your trusted pathology billing partner, you get instant access to experienced billers and coders, tech-driven RCM solutions, and industry-compliant medical billing services.
At MediBill MD, we adhere to federal and state laws and follow the requirements of all insurance payers, private and government, to file clean and complaint medical claims. Our HIPAA and ISO certifications are a testament to the high standards we commit to in handling sensitive medical information.
We leverage advanced medical coding and billing software to fast-track communication, streamline data, and file accurate electronic claims on time. However, a human quality-check (QC) component is added to our pathology billing workflow for every task completed using automation to enhance accuracy.
We offer flexible and scalable pathology billing solutions that evolve based on the needs of our clients. Every client is assigned a dedicated account manager who assesses the needs of pathology practice and expands the team or trims it down based on the workload. Services are added or removed on ad hoc.
At MediBill MD, we employ a skilled and experienced team of AAPC-certified professional coders, medical billing experts, and revenue cycle managers. They proficiently handle the complex, intricate, and time-consuming aspects of your practice’s medical billing so you can focus on diagnosing, preventing, and treating diseases.
Nationwide reach and localized expertise! Whether you are part of a hospital-based pathology group in Orlando, Florida, or manage an independent testing lab in Anchorage, Alaska, our tailored and reliable pathology billing services are available coast to coast, serving most to the least accessible pathology practices.
The crux of compliance rests on state laws. Hence, we fine-tune our services to match the specific requirements in each state
Overcome Pathology Billing Challenges with MediBill MD
Pathologists across the country are already bearing the brunt of Medicare budget cuts. With an overall 2% reduction in pathology reimbursements, pathology labs cannot afford to leave more money on the table. They must overcome the pathology billing challenges that frequently lead to reimbursement delays and claim denials and keep their practices afloat. Understanding is the first step in avoiding pathology medical billing pitfalls and ensuring maximum reimbursements.
| Common Pathology Billing Challenges | MediBill MD Solution | |
|---|---|---|
| Bundling of Professional and Technical Components of Clinical Pathology Tests Leads to Underpayments | Our AAPC-certified coders use the most appropriate codes and modifiers to bill the technical and professional components of the tests separately. It ensures pathologists receive accurate reimbursements for interpreting test results. | |
| Unbilled Tests Due to the High Volume of Tests Performed at a Pathology Laboratory | Our pathology medical billing team uses a centralized system to streamline the billing processes. Tasks are created, assigned, and followed up on to ensure the seamless completion of processes. | |
| Lack of Technological Integration with the Electronic Health Records (EHRs) and Electronic Medical Records (EMRs). | Our internal systems smoothly integrate with the pathology EHRs and EMRs, helping us efficiently gather, examine, and report laboratory data for accurate claims creation and denial prevention. | |
| Lower Reimbursements Due to Hospital-Payer Contracts | Some hospitals charge insurers directly for the professional component of pathology lab tests. We study these contracts and ensure that pathologists receive rightful reimbursements for analysis and reporting. | |
| Not Verifying Patient’s Eligibility for Specialized Pathology Tests like Genetic Testing or Experimental Screenings | Before the tests are performed, our pathology billing team diligently verifies the patient’s insurance coverage for the service and gets prior approvals for specialized or non-FDA-approved tests. | |
| Missing or Inaccurate Information/Documentation Submission During Bulk Billing | Processing and filing claims in bulk increases the chances of errors and missing documentation, leading to denials. Our team uses claim scrubbing tools to identify documentation gaps and typos. | |
At MediBill MD, you get unmatched pathology billing services at unmatched prices! We only charge a fraction of your gross monthly collections, ensuring that you take the biggest cut home every time.
Price Comparison Calculator
Based on your annual collections, we will calculate the in-house medical billing cost and compare it with the MediBill MD service charges.
Get In Touch With Our Pathology Billing Experts
Ready to accelerate revenue growth with accurate and compliant pathology medical billing and efficient practice management? Speak to our medical billing specialists today and feel the MediBill MD difference!
FAQs
MediBill MD is the perfect choice for pathology billing services. This partnership means working with a team of experts who utilize automated and scalable pathology billing solutions to file government and payer-compliant claims. With a 98% clean claims rate, 96% collection ratio, and less than 30 days in AR, we are at the top of our game.
Outsourcing pathology billing services to MediBill MD is more cost-effective than in-house billing. We only charge between 2% and 5% of gross monthly collections for our professional billing services for pathology practices.
Maintaining accuracy during coding is the most challenging aspect of pathology medical billing. The CPT code sets for pathology include several services and procedures like clinical pathology consultations, molecular pathology services, surgical pathology examinations, lab tests, and more. Coding these tests and procedures to the highest level of specificity is a complex task. Moreover, the American Medical Association (AMA) revises the code sets annually, so keeping up with the additions and deletions adds to the difficulties.
