In the world of laboratory reimbursement, the first and most critical step is collecting patient demographics and insurance information and verifying that those benefits are indeed available to the patient. Whether testing is being accessed at a hospital-based lab or a reference lab collection site, insurance must be determined to be valid and benefits verified to ensure maximum reimbursement is captured.
Additionally, patient service centers are accepting patients through ordering providers, and many patients arrive unscheduled. In these situations, insurance verification must be performed immediately to ensure correct copays and coinsurances are collected up front. With more and more patients opting for high deductible healthcare plans, this process has reached a critical phase in the healthcare payment lifecycle.
Laboratory Insurance Verification Benefits
With an automated laboratory insurance verification solution that works in concert with your existing Laboratory Information System (LIS), you can authenticate the patient’s available benefits, as well as discover remaining deductible amounts, tests that are covered, and annual maximums reached. This will benefit your organization in the following ways, all culminating in improved reimbursement capture and bottom-line results.
Real-Time Data Available Instantly
—Today, through APIs and HL7 technology, clinical and administrative data can be safely and securely shared between applications. This means that once a patient’s insurance eligibility and benefits have been determined, they can be accessed for scheduling and reimbursement management purposes. APIs and HL7 allow integration of patient data from separate silos into a cooperative LIS maximizing patient care and outcomes, as well as the payment and collection process.
Scheduling and Walk-In Benefits to the Patient
—It is especially imperative to have a seamless insurance verification and benefits solution where patients arrive as walk-in clients with the expectation of immediate service. In these cases, real-time access to verified insurance eligibility reduces the administrative burden of manual eligibility verification. It also has a positive effect on the collections process with patients paying accurate estimations at the time of service.
—With precise and timely information at your fingertips, the reimbursement process is simplified, and payment velocity is increased substantially. Real-time insurance verification allows your RCM team to increase efficiency and collections while greatly reducing rework and additional handling of claims due to denials.
In case you think this doesn’t affect your organization, according to the Medical Group Management Association (MGMA), the average cost to rework a denied claim is over $25.00, and as many as 65% of denied claims are simply abandoned. With an effective, upfront insurance verification and benefits solution, many of these denials can be alleviated from the start, and reimbursement can be expedited.
Securing revenue for testing that has been performed is second only to patient care in ensuring a thriving organization. With today’s technological advancements in artificial intelligence and machine learning, processes such as insurance verification and benefit eligibility, coupled with prior authorization solutions, more revenue is flowing directly to the bottom line. Laboratories are in a much more proactive stance with state-of-the-art automation to manage their insurance carrier contractual relationships and increase revenue flow.
Contact us today to talk about automating your laboratory insurance verification and benefits requests.