When it comes time to submit billing to government and private insurance carriers, the process can become extremely labor intensive to ensure that the payment is received. Time is money when it comes to the laboratory billing process so ensuring your office has adequate software and protocols in place. Outstanding ones will make sure the eligibility is completed and any referrals or per-authorizations are obtained prior to billing. There are roadblocks that can slow down the submission and subsequent payment of submitting billing.
Incorrect Demographics and Insurance Information
Ensuring that the billing office receives the proper patient demographic and insurance information is key. A single digit or letter in an insurance identification number can slow down the process of billing quite a bit. This will result in tracking down the patient or referring physician to obtain the correct information and can delay billing for days, if not weeks in the worst case scenario. To combat the insurance ID card discrepancy, obtain a copy of the patient's insurance card and upload it to the billing software. To help fight misspellings of names and addresses, obtain a copy of the patient's state ID or driver's license and upload that to the billing software as well.
No Active Insurance
Obtaining active medical insurance policy information to submit bills to the carrier is important. If a patient presents an insurance card that is thought to be active but later turns out to be inactive can slow down the billing process. If there are issues with eligibility that the patient needs to contend with through their employer, they no longer are covered by the plan or the insurance information provided is incorrect, this will adversely hurt the bottom line as the bill will not be able to submitted until active coverage is obtained.
Not Verifying Eligibility
One of the best features of a billing software is the ability to verify the eligibility of an insurance policy quickly, efficiently and to confirm the network payer status. By verifying eligibility proactively, the billing remains efficient and avoids any problems weeks later once the denial is obtained from the payer. Utilizing a laboratory billing software that can turn a half hour phone call to a payer into a 1 minute (or less) verification online will save time that can be dedicated to other resources and in turn, save money.
In or Out of Network Status
The way that a claim processes in network versus out of network are vastly different. Many policies do not cover out of network services so having proper billing software capable of handling these types of denials and adequately tracking them is vital to successfully performing laboratory billing. As patients present new insurance carriers nearly daily, it is important to be able to track the claims processing of the out of network versus in network payers for payment trends and denial trends.
Denial Management
Tracking denials is a huge piece that can delay revenue. If a claim is submitted to a carrier for payment and is denied for a coordination of benefits update from a patient, this can be resolved by simply reaching out to the patient to request they update the information with the carrier if nothing has changed with their coverage. If this denial is left mismanaged by the one submitting the bill, it could lead to unnecessary delays in payment. With adequate software, this type of denial can be easily managed, worked and result in payment in less time.
Learn More About Laboratory Billing
If you notice that you are having problems with resolving your laboratory billing and need assistance. Advanced Data System Corporation is here to help you. Contact us to discuss your billing needs to maximize your company's potential today.