America’s laboratories are scrambling to improve reimbursements and preserve revenue at every point in the patient journey. Like all areas of healthcare, insufficient staffing has caused laboratories to fall so far behind on filing that claims revenue is significantly impacted. However, pinpointing the bottlenecks can be a challenge.
This was the challenge faced by a leading pathology and cancer diagnostic laboratory headquartered in Florida. It offers medical and diagnostic consultations, information technology solutions to physicians and hospital systems, and services to pharmaceutical companies and research organizations working on new cancer treatments. The group has dozens of locations across the United States, including dermatopathology and anatomic practices. Despite being a major laboratory, they were seeing their claim backlog grow sharply each month.
Pre-billing Coding, Demographic, And Eligibility Information Errors Cause Inordinate Numbers Of Denials
For this laboratory, short staffing wasn’t the only issue leading to denials. Upon analysis, the network leaders discovered that inaccurate ICD coding, demographic, and eligibility information entered during pre-billing were causing an inordinate number of denials. Also, as this network was frequently acquiring new locations, leaders recognized that shoring up accuracy for pre-billing information for these new sites would be critical to capturing new acquisition opportunities. Struggling with pre-billing issues, a backlog of claims and unappealed denials continued to grow.
The client also recognized that the ICD code entry errors made by staff stemmed from the fact that different processes were occurring at their dozens of locations. They knew only a standardized process would reduce errors and tame the chaos.
National Laboratory Improves Approvals And Revenues Through Coding Partnership
America’s laboratories are scrambling to improve reimbursements and preserve revenue at every point in the patient journey. Like all areas of healthcare, insufficient staffing has caused laboratories to fall so far behind on filing that claims revenue is significantly impacted. However, pinpointing the bottlenecks can be a challenge.
This was the challenge faced by a leading pathology and cancer diagnostic laboratory headquartered in Florida. It offers offers medical and diagnostic consultations and information technology solutions to physicians and hospital systems. They provide services to pharmaceutical companies and research organizations working on new cancer treatments. The group has dozens of locations across the United States, including dermatopathology and anatomic practices.
Pre-Billing Coding, Demographic, And Eligibility Information Errors Cause Inordinate Numbers Of Denials
In this case, understaffing wasn’t the only issue leading to denials. Upon analysis, the network leaders discovered that inaccurate ICD coding, demographic, and eligibility information entered during pre-billing were causing an inordinate number of denials. Also, as this network was frequently acquiring new locations, leaders recognized that shoring up accuracy for pre-billing information for these new sites would be critical to capturing new acquisition opportunities. Struggling with pre-billing issues, a backlog of claims and unappealed denials grew.
The client also recognized that the ICD code entry errors made by staff stemmed from the fact that different processes were occurring at their dozens of locations. They knew only a standardized process would reduce errors and tame the chaos.
However, given the shortage and increasing costs of qualified, U.S.-based labor, bringing on new hires to take on this streamlining project wasn’t practical. They sought a partner that could provide a labor force of coders and other specialists that not only had experience in laboratory coding, but also was affordable as well.
Diagnostic Lab Selects The Infinx Team
After consulting with one of the top three largest laboratory networks in the United States and evaluating several solutions, this network chose to use our coding team to work on the pre-billing information. They asked us to verify demographics and perform insurance scrubbing so they know information captured in the system is correct before the claim is filed.
Their hope was to clean up pre-billing to decrease the claims backlog. With this step complete, they planned to hire claims staff internally and start fresh.
Our Expert Coders Get to Work
We started out with a pilot project for just one lab.
Working with their regional director of revenue cycle management, we gained access to their medical coding system to review the records. Our coders assigned correct ICD codes and keyed those ICD codes back into the system.
Our team verified and added details, including the patient’s demographic information, collection and received date, location, and bill type, to the diagnostic lab’s system. When specimens were involved, specimen details and other clinical information were added, often transcribed from handwritten notes. Our specialists are trained to watch for important details, such as how the sample is processed.
With this pre-billing information inputted accurately, the group’s system generated the claims forms and billed the payers and patients.
Coding Speed And Accuracy Abolishes Backlog
Our solution was working well, and we were cleaning up the back log. In the meantime, the group kept acquiring locations and expanding their team. The group decided that, rather than hiring more of their own coders—their initial plan—they would instead increase our team. They recognized that they could get the same high level of quality with our coders at less than one-third of the price of hiring their own staff. As a result, they expanded our pre-billing services to all their locations across the U.S.
When issues with denials stemming from incorrect eligibility information arose, they turned these pre-billing tasks over to us as well. We began examining these records and rectifying errors so they could appeal the denials.
All Claims Now Filed On Time
When we entered into a partnership with the client in 2016, their backlog was vast and they were receiving excessive denials due to ICD coding and patient information errors. As we worked to improve pre-billing issues it succeeded in breaking the claims submission bottleneck.
Today, the client is no longer backlogged and all claims are completed in a timely manner. After starting with a handful of our specialists, they now use 53 full-time-equivalent of our workforce for pre-billing tasks, eleven for eligibility rejections and four for payment posting.
For eligibility-related denials, our team consistently gets 30% to 35% approved on appeal, adding to the client’s revenue.
ICD coding-related denials have dropped dramatically. The accuracy on our ICD codes and modifiers has been so high that they have not raised any concerns in the six years of our partnership. When special, one-time coding projects come up, we put this client’s coders on it at no extra charge.
The network is highly satisfied with our services, and awards us a 10 Net Promoter (NPS) score quarter after quarter.
If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.
Are your laboratory’s ICD coding and other pre-billing errors leading to an avalanche of denials? See how a national diagnostic laboratory improved revenue, streamlined pre-billing services, and dropped denials by leveraging expert laboratory coding specialists.