Jul 1, 2016 | Coding, Billing, and Collections, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
This phenomenon is a response to the tens of millions of patients who now have high deductibles that must be met before their insurance kicks in
There’s a new wrinkle on bundled pricing for medical laboratory tests and other healthcare services. Some providers and payers are creating bundled pricing options specifically for the tens of millions of patients now covered by high-deductible health plans (HDHPs).
Patients covered by HDHPs are responsible to pay thousands of dollars out of pocket before their health insurance kicks in. Thus, it should not surprise clinical laboratory professionals that providers and health insurers are collaborating to created bundled pricing (AKA packaged pricing) options that cater to self-pay patients.
Bundling is a method in which healthcare services are grouped together for one pre-determined price. It is intended to decrease costs while providing patients with increased access to high-quality care. Clinical labs and pathology groups will need to negotiate with the organizers of these bundled medical services in order to get adequate payment for their testing services.
Bundled service options are gaining in popularity because more Americans are paying out-of-pocket for medical care. Some people have no health insurance coverage at all. Meanwhile, tens of millions of Americans are enrolled in high-deductible health plans. These patients are typically responsible for paying thousands of dollars in out-of-pocket expenses before their health insurance begins paying for medical services. With so many people seeking more economical choices for their healthcare needs, providers, hospitals, and health insurers are exploring the options bundled pricing offers. (more…)
May 23, 2016 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
By rethinking how their medical labs relate to health insurers, physicians, and patients, a handful of progressive lab companies are enjoying increased revenue while also lifting patient and payer satisfaction
There is widespread agreement across the clinical laboratory industry that it is becoming ever more difficult to have health plans reimburse claims for common tests, molecular assays, and genetic tests in a reliable and consistent manner. Many lab companies report that they are experiencing high rates of denied claims. Moreover—even for claims reimbursed by payers—the amount paid will vary on claims for the same type of lab test.
“Essentially, on this point, the consistent theme we hear from many lab companies—particularly those labs with a menu of proprietary, specialized molecular and genetic tests—is that it is now almost a crap-shoot to submit lab test claims to many payers and see timely and predictable reimbursement for those claims,” stated Robert L. Michel, Editor-In-Chief of Dark Daily’s sister publication, The Dark Report. “One could say that, today, the function of billing patients and payers for clinical lab testing has become financial quicksand for most labs. By following traditional coding, billing, and collection practices, in today’s healthcare market, they find themselves sinking steadily deeper in this financial quicksand.” (more…)
Jun 15, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory Pathology, Laboratory Testing
One Arizona medical laboratory focused on collecting from patients who were overdue on amounts averaging just $40 and, in 18 months, collected $3.2 million!
In today’s clinical laboratory marketplace, competency in revenue management is becoming just as important as clinical excellence. Blame it on these multi-year trends: shrinking lab budgets, Medicare price cuts, and payers excluding labs from narrow networks.
At the dawn of this decade—just five years ago—few pathologists and clinical lab executives would have predicted that the financial survival of their lab organizations would depend upon becoming more proficient and more sophisticated with billing and collections. Yet this is now a necessary response to the year-over-year decline in lab prices and revenue experienced since 2010. (more…)
Jul 28, 2014 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Management & Operations
Medical laboratories can increase revenue and reduce bad debt by using technology to verify patient ID and insurance information before a specimen is provided
Due to a need to collect payment directly from the growing number of patients with high-deductible health plans, many clinical laboratories and anatomic pathology groups are experiencing flat or even declining cash flow. This issue has medical lab CFOs scrambling to find solutions.
Moreover, this problem is noticeably greater in 2014 than it was in 2013. One factor behind this worrisome trend is the Affordable Care Act (ACA). As of January 1, most newly insured patients enrolled under ACA have high-deductible health plans (HDHPs) that require substantial copayments when patients receive healthcare services. Employers are also increasingly shifting their employees to HDHPs, as well.
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Feb 7, 2014 | Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing
Pathology groups and medical laboratories here in the United States still have few opportunities to provide reference or esoteric diagnostic services to healthcare providers in other countries
Despite the lack of publicity, medical tourism continues to enjoy vigorous growth as an increasing number of Americans prove willing to cross international borders to obtain healthcare that is considered of acceptable quality, but at a price that significantly cheaper than here in the United States.
What makes the trends in medical tourism relevant for clinical laboratory managers and pathologists is that it shows how U.S. consumers are reacting to high healthcare prices and other problems within the American healthcare system. In particular, our nation is experimenting with putting tens of millions of Americans in high-deductible health plans. How these consumers decide to price-shop because of their $3,000 to $10,000 per year individual and family deductibles remains to be seen. < (more…)
