UNLOCKING PATHOLOGY REVENUE POTENTIAL
Tackling pathology RCM challenges head-on
Pathology practices face unique challenges in revenue cycle management that require specialized insight.
The complexity of billing for molecular diagnostics, the need for accurate coding, and the frequent necessity of retroactive prior authorizations present significant obstacles, leading to delayed reimbursements, high denial rates, and gaps in revenue.
Many pathology practices rely on outdated billing processes and general RCM outsourcing vendors that don’t account for pathology-specific needs. Critical aspects are often overlooked like reviewing managed care contracts and updating fee schedules, leading to underpayments and revenue leakage. Retroactive prior authorizations and inconsistent eligibility checks further complicate revenue collection, creating financial strain.
In a thriving practice, these challenges are met head-on by partnering with a specialized RCM vendor with expertise in pathology. By leveraging AI-driven automation and advanced workforce management technology, they streamline revenue cycle workflows to drive consistent revenue growth, improve cash flow, and enhance patient satisfaction.
EMPOWERING PATHOLOGY PRACTICES
Pathology RCM set up for success
Our tech-enabled pathology revenue cycle solutions are specifically designed to tackle the unique financial challenges faced by pathology practices.
Specialized coding and billing processes
- Minimize denials with our certified coders who specialize in clinical and anatomic pathology.
- Enhance patient satisfaction with dedicated call center support for queries, scheduling, and billing concerns.
- Secure accurate and timely reimbursements through advanced workflows tailored to pathology needs.
Managed care contracting, credentialing, and litigation support
- Increase revenue with contracts and credentialing processes that reflect the true value of pathology services.
- Protect your practice with litigation support for reimbursement disputes, ensuring fair compensation and compliance with payer guidelines.
Automated prior authorization and eligibility verification
- Expedite prior authorizations, even retroactive ones, to avoid delays in patient care.
- Ensure real-time eligibility verification to prevent coverage gaps and reduce claim denials.
Tech-enabled A/R and denials management
- Improve cash flow and obtain actionable insights with AI-driven analytics and automation that prioritizes claims management for maximum recovery.
- Enhance operational efficiency by reducing manual tasks and speeding up processes.
EXPERT PATHOLOGY CODING AND BILLING
Precision in every claim
Our specialized coding and billing processes are crafted to meet the unique demands of pathology practices, ensuring both professional services and tests are accurately captured and billed, leading to fewer denials and maximized reimbursement.
Certified pathology coders
Our certified coders specialize in clinical and anatomic pathology, managing the complexities of coding for both professional services and laboratory tests. This ensures precise, compliant coding that reflects the full value of your services.
Expert billing specialists
We handle the entire billing process, from claim submission to resolution, ensuring that both the technical and professional components are properly billed.
Patient call center support
Our dedicated call center team handles patient inquiries, scheduling, and billing questions, enhancing patient satisfaction and ensuring smooth communication.
CREDENTIALING SUPPORT
Pathology credentialing and compliance
Credentialing and compliance are critical components of revenue cycle management for pathology practices. Proper authorization by payers and adherence to the latest regulations are essential to avoiding disruptions in your revenue cycle.
Specialized pathology credentialing
We manage all aspects of credentialing, including ensuring your providers and labs are compliant with pathology-specific certifications like CLIA. This helps prevent payment delays and denials, keeping your practice in continuous compliance.
Quarterly compliance audits
Regular audits for both clinical and anatomic pathology identify potential issues early, allowing for corrective action to minimize revenue loss. This includes telepathology compliance, which is vital for remote diagnostic services.
Ongoing compliance monitoring
Our continuous monitoring keeps your practice up-to-date with regulatory changes and payer requirements. We also ensure multidisciplinary collaboration compliance, reducing the risk of denials and maximizing revenue.
PAYMENT OPTIMIZATION
Payer contract and reimbursement reviews
Securing proper reimbursement for pathology services requires vigilant contract management and proactive negotiations. We ensure your practice receives the maximum allowable payments by thoroughly reviewing contracts with both payers and hospitals.
Payer contract reviews
Regularly evaluate contracts to confirm that they cover the professional components of pathology services, preventing underpayments.
Hospital agreements
Collaborate with hospitals to ensure that pathology services are not unfairly bundled into facility fees, ensuring your practice receives its rightful share.
Fee schedule monitoring
Keep contracts aligned with the latest fee schedules to maximize reimbursements.
ELIGIBILITY VERIFICATION
Accurate eligibility verification for pathology services
Thorough eligibility verification is crucial in pathology to avoid denials, especially given the complexity of bundled services and out-of-network considerations.
Key challenges
- Verify that all components of bundled services, including lab tests and professional interpretations, are covered to prevent gaps in reimbursement.
- Confirm coverage for specialized out-of-network tests and inform patients of potential out-of-pocket costs.
Real-time verifications
- Provide real-time updates on coverage to confirm eligibility before services are rendered, preventing financial losses.
- Verify specifics like deductibles and co-pays at the service level to minimize billing surprises.
Handling complex scenarios
- Verify eligibility across multiple insurance plans, including primary and secondary coverage, which is crucial for high-cost pathology services.
- Ensure coverage for services related to clinical research or experimental treatments, reducing the likelihood of denied claims.
Our eligibility verification solution is part of our Patient Access Plus platform, providing comprehensive checks powered by AI and automation.
PRIOR AUTHORIZATION
Ensure timely and accurate pathology prior authorizations
Prior authorization is critical for high-cost or specialized pathology tests, such as genetic sequencing and molecular diagnostics, to avoid claim denials and ensure timely reimbursement.
Key procedures requiring authorization
- Genetic tests and molecular diagnostics often need detailed clinical justification.
- Certain biopsy procedures, especially those involving specialized equipment, require all CPT codes to be included.
Handling retroactive authorizations
- Retroactive authorizations may be necessary for urgent procedures or updated insurance information.
- Quick submission and proper documentation are crucial for approval.
AI-powered workflows
- Our prior authorization solution in Patient Access Plus expedites authorizations, with specialists stepping in when automated workflows aren’t possible.
LITIGATION SUPPORT
Specialized legal support for pathology practices
Pathology practices often face complex reimbursement disputes, particularly for high-cost or experimental procedures. Our legal support services are designed to help your practice navigate these challenges and secure the reimbursement you deserve.
Strategic litigation for reimbursement disputes
In cases of unjust denials or underpayments, particularly for complex pathology services, our legal team provides the expertise needed to defend your revenue. We work to secure fair reimbursement, ensuring that your practice is compensated for the services provided.
Proactive defense of revenue
Legal challenges in pathology can be daunting, especially with new or experimental procedures. Our team proactively addresses these challenges, helping to protect your revenue and reduce financial risks.
Comprehensive support for complex cases
From appeals to litigation, our legal experts are equipped to handle the most complex pathology-related reimbursement issues, ensuring that your practice receives the compensation it deserves.
PATIENT ENGAGEMENT
Comprehensive call center support for pathology services
Our call center, utilizing both onshore and offshore teams, ensures seamless communication and support for your pathology practice.
Patient Queries
- Handle patient inquiries regarding test results, procedures, and billing with accurate and timely information.
- Provide continuous support, including after-hours assistance, to ensure patient satisfaction.
Soft Collections
- Manage billing discussions with sensitivity, focusing on soft collections to maintain a positive patient experience.
- Conduct follow-ups on outstanding balances, ensuring a balance between patient care and financial recovery.
Our approach to patient queries and soft collections ensures that patients feel informed and supported throughout their experience with your pathology services.
AL-A-CARTE AUTOMATIONS
You choose which automations you would like to start with
Reduce the time your team is spending on repetitive admin tasks. Let our RCM Automation platform complete those tasks instead. With our a la carte RPA automation options, you can decide which tasks make the most sense to automate for your team.
Here are some of the RCM tasks you can automate:
- Patient access
- Billing
- Payment posting
- Claims submissions, updates,
and follow-up - Denials and appeals follow-up
- Referral order check
- Physician credentials verification
- State license search
- DEA & malpractice checks
- Attestation in CAQH portal
- Application status checks
- EHR data entry and extraction
We are proudly SOC2 Type2 certified and HIPAA compliant
