For Diagnostic Laboratories, Billing Errors Can Be More Painful — and Stressful — Than the Procedures Themselves

Doctors’ appointments, medical procedures and test results often result in physical and emotional stress for patients. But for diagnostic laboratories it is the revenue cycle management that is interwoven into the patient process with causes the most pain and anxiety – more than the procedures themselves

According to industry experts, between 30 and 80 percent of all medical bills contain errors, with 25 to 30 percent of said errors being monetarily significant. In fact, according to an audit piloted by Equifax, medical bills totaling $10,000 or more typically feature an average error of $1,300. In most cases, these issues are the result of human error, as the systems healthcare providers employ largely require manual input and static technology, which ultimately lends itself to inconsistencies and delays.

The Healthcare In America article, Billing Errors Are Seriously Hurting Healthcare, details some of these honest mistakes – “a diagnostic code for an exam of both limbs when only one was assessed, or a typo that results in a different (and more expensive) diagnostic code than the one that was prescribed.” Mistakes aside, the critical problem lies with the fact that these errors can lead to reduced reimbursement and worse, patient harm. Value based payments are cut or reduced, industry ratings are lowered and provider and patient satisfaction can reach an all time low.

Complicating medical billing challenges, the classification of diseases through ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification)—grew from 24,000 to 155,000. This added complexity increases the potential for human error.
Teams can spend hours correcting the correct diagnosis, and searching the system for supportive documentation to correct or avoid claims denials. This adds to the anxiety and burden of patients and clinical laboratories alike.

Patients must always remain at the center of care. Claims denials, medical billing mistakes and difficulty in understanding medical bills with cause patients to look elsewhere for alternative laboratory diagnostics.

Research conducted by HIMSS, in partnership with OODA Health, emphasizes that what’s at stake goes far beyond financial ramifications, as dysfunctional patient billing remains bad for the patient’s health. After exploring the specific impacts of billing complexity, researchers “found that the prospect of having to deal with medical billing distracts patients from complying with their care. Sadly and ironically, lower compliance is likely to lead to even more medical bills down the line.”

It is critical that labs deliver high-touch customer service with streamlined medical billing.

It is important for diagnostic laboratories to take a more proactive approach to revenue cycle management to stop problems before they start. An intuitive laboratory billing solution can help. It should include insurance verification and eligibility, claims scrubbing, data matching and online submission and tracking of claims. For patients, clinical laboratories should collect and manage copays at the time of care and enable online access to bills and payment methods.

ISM offers completely customized, sustainable solutions to solve a broad range of business challenges, capture unforeseen opportunities, and achieve exceptional results. Contact us for a free consultation or call 1-844-WANT-ISM (1-844-926-8476) to find out how our experts can help your team cultivate an effective corrective action plan that will nurse and support your organization’s financial health for years to come.

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