Medical necessity rules are a growing concern for healthcare providers. The policies are not a new phenomenon, but their impact on cash flow is increasingly sharp.
Healthcare may be the only industry where a company has no idea how much it will get paid for services rendered, or whether or not it will be paid at all. This is especially challenging for laboratories that are on the cutting edge with new procedures and technology.
In the world before molecular diagnostic CPT codes and payer required prior-authorization, labs could develop, validate, and immediately go to market with a new test. Labs focused their accession workflows on delivering rapid turnaround times and deferring reimbursement efforts until after test results were reported. Today, many payers require
pre
-test authorization for genetic and [...]
Patient responsibility has always been a liability for providers. Unlike automated claims processing that submits electronic 837s to an established group of payers, the ability to collect on patient responsibility requires individual patient billing and often involves manual processing and time-intensive follow-up.
