We make billing the first screen the pathologist sees when the report is to be signed out. It is our practice’s policy that the pathologist is responsible for the billing on the case they sign out, so they have a vested interest in this process.
It helps to have subspecialty practices in place. When you get new people, it becomes relatively easy to clone that. Getting them trained and able to understand what the gaps are quickly leads to better revenue capture, because billing does not see that a small biopsy charge was multiplied by 20,000. They don’t pay attention to the small charges that add up to a lot of lost money.
Dr. Cardona, pathology residents sometimes get short shrift in professional management activities such as billing and others. What do you undertake at Wake Forest to mitigate this as you train residents and bring new pathologists in?
Dr. Cardona (Wake Forest): These nondiagnostic but important educational initiatives have been historically a challenge for programs because residents just want to learn pathology, yet the everyday practice elements are equally important in the real world. We have apprenticeship models in which they go into the lab, they learn about being a medical director, but they also go through all the elements, whether it’s IT or billing, as part of the apprenticeship.
North Carolina has four academic departments among Duke, University of North Carolina, Wake Forest, and East Carolina University. About two years ago the state pathology society started holding lectures bimonthly on what residents said they wanted to learn. We tackle problems like how to get paid, how CPT/RUC works, and how to negotiate a contract when looking for a job. Most traditional training programs don’t touch on these. Now we’re entering a quarterly cadence and the reviews from the trainees in the state have been great.
This would seem to be one element of getting to a gold-card type status.
Dr. Cardona (Wake Forest): It’s a critical component of it.
Andi Brooks, what’s your take on the narrowing of networks as a way to control costs?
Andi Brooks (APS Medical Billing): Carriers are increasingly narrowing networks to preferred laboratories. Outreach and physician office laboratories, independent labs, et cetera, are trying to compete with the national labs for this preferred status. National labs are extremely high volume and high output and therefore more apt and able to accept a 40 percent of Medicare rate. The health care systems treat all patients, that’s their job, and labs handle downstream laboratory testing. If a patient had a preferred national lab, the performing lab receives a denial for payment; we’re seeing increases in those denials. This dynamic places pressure on independent labs and reinforces the need for improved operational efficiencies and revenue optimization.
Dr. Cardona, what is your experience at Advocate Clinical Laboratories with narrowing networks?
Dr. Cardona (Wake Forest): Our size helps protect us from being carved out of various payer plans. That said, we’re seeing concerns from smaller practices that have been looped out of network and now have to deal with the No Surprises Act. We all want to protect patients from large bills, but it’s an advantage for the payers because you have to meet a threshold before you can take it to arbitration. Even that is risky and costly. It’s not a system in favor of the provider.
The large commercial labs are also raising concerns that with PAMA and the looming cuts, they too can’t bear the reductions. It’s important for the broader laboratory community to be aligned in pushing back on these cuts. At this point, I don’t care who you are in health care, you’re feeling the pressure from every angle.