The process of laboratory billing is clearly the interaction between a pathology center and a clinical lab with the payer. It starts with coding after the lab services are provided with the assignment of the diagnosis and the procedure codes.
The codes help the insurance company to determine the medical necessity and the coverage. After the determination of the procedure and the diagnosis codes, the lab billing enters the collections or the RCM phase.
Usually the payer is billed electronically by formatting the claim as an ANSI 837 file, using a data interchange to submit the claim file to the payer directly or through clearing house. The approved claims are reimbursed for a certain percentage of the billed services. The rates are pre negotiated between the provider and the insurance company. Most commonly, the rejected or denied claims are returned to the in the form of EOB or ERA.
We are well aware of the fact that Anthem, one of the country’s largest anatomic pathology groups are announcing price cuts for pathology services of 50% to 70% of the Medicare fees. Anthem is also planning to move pathology contracts out of its professional services unit and over to the ancillary services unit that typically contracts with the clinical labs. For your laboratory billing services, you will need the efficiency of a complete healthcare RCM destination that can offer superior pre as well as post billing support.
Let Sunknowledge Assist You in Your Laboratory Billing
Over the last decade Sunknowledge Services Inc. has been delivering superior support in both front end as well as back end revenue cycle management to some of the leading providers of the country across more than 28 specialties.
Our team has the ability to work as a reliable operational extension , and offer cutting edge support that transforms your cash flow with our extensive understanding of the claims adjudication mandates of the industry.
We are unique as we work with some of the lading MSO’s, insurance payers of the country apart from our medical billing services extended to the healthcare providers. It gives us the edge to deliver state of the art support which is unparalleled in the market place.
With a task specific approach to eligibility verification, prior authorization, denial management and accounts receivable recovery, we deliver the right action plan for your Laboratory billing needs.
Also, we can meet or beat any price in the market and currently offer our services at 2.75% of collections or dedicated support at just $7 per hour. Let our team share with you, our functional best practices and what difference we bring to the table as a complete healthcare revenue cycle management company.