Billing and Accounts Receivable reCAP

In billing, No Surprises and other complexities

Another administrative layer and “up in the air” is how lab billing experts describe what the No Surprises Act requires of laboratories and where things stand. When they met online March 3 with CAP TODAY publisher Bob McGonnagle, they talked about this and digital pathology and the problems of no or slow payments.

CAP TODAY’s guide to billing/accounts receivable/RCM systems begins here.

Whitepaper
Current Trends and Recommended Strategies for Appeals Management for Laboratories and Pathology Practices

May 2023—Front-end edits and configurations help mitigate backend denials. Capturing potential denial-related issues proactively is the most effective way to maintain a manageable AR and improve the propensity for reimbursement. That said, some levels of denials are unavoidable, and not all known issues can be addressed at the front end of the revenue cycle management (RCM) process.

An example of this is denial code CO252, which is an additional information denial. When received, it indicates the payor is requesting a pathology report on services performed before issuing payment – essentially performing an audit to ensure the services billed are warranted and documented. These are not always complex molecular tests; they can be routine pathology claims. These CO252 denials can be appealed with a pathology report. Though it is inevitable, an organization must wait for the denial before it can take action.

In situations such as this, a robust appeals process, with automation, is critical. In molecular testing in particular, appeals carry a heightening impact on revenue collection. In 2020, XiFin found that appeals accounted for 5% of the total revenue generated by XiFin customers. In 2021, that rate increased to 6.5%.

Report
Understanding Laboratory Claim Denial Trends Across Market Segments

In today’s environment of rapidly changing directives and expectations from payors, patients, and health systems, creating opportunities to provide better service, adopting state-of-the-art technologies, and building robust processes and partnerships can make or break the long-term success of a laboratory or pathology practice.

Understanding denial and appeals trends, across market segments – such as clinical laboratory, molecular, and anatomic pathology – is important to developing strategies and practices to maximize both operational and financial results. The team at XiFin, Inc. recently completed an analysis of more than 25 million of its customers’ claims to understand these important trends.