The topic of balance billing is in the news again, closely associated with the newer term, “surprise billing.” Patient experiences such as those of Drew Calver, who received an unexpected $109K bill following treatment for his heart attack, have focused new attention on this long-standing issue.
Is your cash stranded in the vastness of your lab’s accounts receivable (A/R)? Targeted revenue search and rescue efforts can improve your lab’s financial performance. Know where to send the search party—monitor key performance indicators (KPIs) Days in A/R and Aged A/R.
When it comes to gaining coverage for a Laboratory Developed Test (LDT), insurance companies are not the enemy. Payers are willing to cover and reimburse for an LDT that is clinically relevant, improves patient outcomes and hopefully reduces healthcare spend. So, what gets in the way of a laboratory achieving clinical relevance for their new tests?
Centers for Medicare and Medicaid Services (CMS) published its final rule with comment period revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) for 2018. Labs that provide services to hospital outpatients may want to review the new OPPS rule changes, particularly the revisions to the laboratory date of service (DOS) policy (see CMS excerpt highlighted below).
The financial impact of PAMA to your laboratory depends largely on the type of testing you perform. With the recent publication of the 2018 Medicare CLFS reimbursement rates, it is clear that high-volume clinical laboratory testing is facing substantial downward pricing pressure while much of the advanced molecular diagnostics and genomic testing market reimbursement is neutral to positive. [...]