Running a medical laboratory can be a challenging endeavor that involves a wide range of complicated tasks and responsibilities, the primary of which is medical billing. The efficiency of your current medical billing system is crucial to the continued operation of your laboratory since the revenue cycle depends on it.

Unfortunately, even though most labs are aware of the importance of efficient invoicing and payment processes, there are a lot of obstacles that prevent them from optimizing their billing practices. So here are some significant hurdles associated with medical laboratory billing operations that you need to be aware of.

Top 9 Medical Laboratory Billing Challenges

1.   High Claim Denial Volumes

The intricacy and extent of claim denials are a significant problem for providers of laboratory and diagnostic services. The billing team has a tough time keeping track of the various health plans and associated price schedules that can even number in the thousands for more extensive labs.

The fact that different payers have different requirements for communicating denials of claims to providers only exacerbates the problem. With so many factors to consider, it can be challenging to establish a claims denial strategy that works reliably.

2.   Lack of Patient Awareness

Patients typically have a limited understanding of how their medical bills get generated. Some individuals may be completely unaware that the service they’re attempting to obtain necessitates a referral or authorization. They might not even know why the coverage provided by their insurer got revised.

Also, there are numerous instances in which patients are unaware that the service they require is no longer covered by their insurance until it is time to pay for the procedure. They may happen because of changing employment or another factor of a similar nature. The most obvious option is to provide patients with information and guidance about their financial responsibilities and validate a patient’s insurance coverage every single time.

However, a challenge that all labs confront is figuring out how to keep their patients informed regarding their billing. It has been observed that the likelihood of a patient making their payment increases when they have a greater understanding of their bill, including the amount owed, the various payment methods, and the options available to them.

3.   Inaccurate Coding

Inaccurate coding is among the most prevalent problems that come up during medical billing processes. Multiple variables can be responsible for this issue. The most effective way to overcome this obstacle is to employ a medical management solution integrated with an automated coding system.

4.   Incomplete and Inaccurate Patient Information

Requests that are either inadequate or contain inaccurate details and information about the patients are common reasons for an insurance company to reject a claim. The reason for denials can vary from incomplete information, such as missing required fields, to simple errors, like misspelled words.

5.   Inadequate Supporting Documentation

In order to settle specific claims, insurance providers demand supporting documents. They will not have second thoughts about denying a claim if the necessary documentation is missing. Generic medical laboratory billing solutions reduce the chances of missing out on substantial documentation. Additionally, inadequate hands-on staff training on claim filing can pose a problem.

6.   Payment-Associated Challenges

It might be challenging to ensure that you receive payment promptly, regardless of whether the payment comes from the patient’s insurance provider or the patients themselves.

In most cases, the software you are now utilizing is to blame for most payment errors. Moreover, if you’re currently outsourcing to a service provider who offers fewer alternatives for clients to make payments, you’re more likely to observe a decline in the percentage of customers who pay on time.

Make sure that you offer a variety of payment methods, including those that can be completed online instantaneously and via bank card. Providing greater convenience and access is always a step in the right direction. Some providers of medical billing systems offer assistance to improve the percentage of patients who make timely payments.

7.   Delivering Top-Notch Customer Support Services

Your medical billing solutions provider should offer high-quality support services based in the United States. This way, you can guarantee that your team will always have access to help in case there are any operational issues, obstacles, or difficulties in comprehending new processes. A service provider with limited or no access to high-quality customer assistance might also find it difficult to fully maximize the potential of their technology and enhance its application.

8.   Multiple Claims Filing

The requirement to file repeated claims is not pleasant for most laboratories, especially for labs offering specialty healthcare testing services.

As there is no instrument for generating multiple claims at once, labs might have to submit each claim separately. This has a significant detrimental effect on the overall functionality of the laboratory in question.

9.   Technology and Workforce Management

Efficient handling of thousands of claims, the rising intensity of prior authorization demands that need a response, and the immense complications of the billing procedures all make revenue cycle management several degrees more difficult at diagnostics laboratories than in conventional healthcare settings.

The employees in charge of the revenue cycle must be capable of handling all the subtleties associated with changes in payer policies, reductions in reimbursement, and the transition between fee-based and value-based billing.

There needs to be a concerted endeavor to boost productivity, profitability, and service quality in your laboratory. Thus, it is usually a good idea for your lab to outsource billing services. Innovative Lab Solutions is willing to help you overcome the complications associated with laboratory medical billing if you cannot devote sufficient time or resources to this task. We also offer revenue cycle management services to help you maximize profits and scale your laboratory. Contact us right away for further information!