The Reimbursement

Landscape for Laboratories

This year, the reimbursement landscape for laboratories remains dynamic, undergoing constant changes. With TELCOR, you can be sure you are optimizing your reimbursement and establishing financial security while legislative changes, including those related to Medicare payment rates, IDR entity fees, LDTs, SALSA, NCCI edits, the CLFS, and the No Surprises Act. Amid this ongoing transformation, laboratories are striving to maintain profitability by proactively implementing new processes and procedures to align with evolving requirements. TELCOR strives to maintain profitability by implementing new processes and procedures aligning with all requirements currently happening.

What does this mean for labs?

Ensuring financial stability and operational efficiency is paramount for laboratories navigating reimbursement challenges. Two common pitfalls are the:

  1. Failure to stay informed about coding and payer policy changes
  2. Inadequate billing procedures

These issues often lead to insufficient verification of insurance coverage, incomplete documentation, inefficiencies in denial and accounts receivable management, and pose a potential risk for non-compliant billing.

Many labs rely on outdated software which may lack the functionality required for contemporary laboratory billing. This can result in convoluted processes that are difficult to update and manage. In response, labs may add personnel to handle manual tracking of benefits eligibility or prior authorization, leading to increased labor costs. Additionally, the manual handling of denied claims, often without proper management of appeals, can result in missed revenue opportunities.

To avoid these pitfalls, laboratories can invest in modern billing software to enhance accuracy and efficiency. Choosing software built on logic, with rules and automation for handling diverse scenarios, is essential. Finding a comprehensive solution to manage the entire billing cycle within one platform eliminates the need to add personnel for handling specific situations, ensuring a streamlined and cost-effective approach.

What can labs do?

First, maintain current credentials with payers, negotiate favorable contracts, ensure thorough documentation, and systematically track and analyze claim denials form integral components. Maintaining a skilled billing team with extensive payer knowledge is vital for addressing the complexities of payer billing effectively and ensuring compliant billing.

Second, create a circular process to tackle issues at the front end, such as documentation and data optimization, while ensuring a smooth transition from billing front end to generating bills. Continuous follow-up on claims, along with root cause solutions to reduce denials, should occur in parallel. Utilize back-end data to enhance front-end processes and improve collections, effectively addressing both ends of the reimbursement spectrum.

Third, when introducing new tests, consider coverage, coding, and payment aspects, verify payer willingness to cover the service, determine the payment structure, and establish a billing mechanism. Early engagement with payers to discuss reimbursement strategies for new tests is a proactive measure to navigate the evolving landscape. Since obtaining reimbursement for new tests may take time, labs need to strategize interim payment solutions. Checking benefits eligibility and obtaining prior authorization, even if initially denied, sets the groundwork for the test landscape. Offering patient-friendly payment options, including an online portal, facilitates payment for newly introduced tests not covered by insurance.

TELCOR is here to navigate current changes and working with laboratories of all types and sizes to ensure our software and solutions can tackle the most challenging changes that may come up in the future. For more information, contact us at or call 855-489-1207.

Positively Impact Your Profitability with TELCOR RCM

With TELCOR RCM, laboratories gain access to an industry leading solution that increases workflow efficiency, improves collections and provides real-time access into your data and anlaytics. Our solution will enhance your billing functionality.


The TELCOR Product Line

Outsourced Lab Billing

TELCOR Revenue Cycle Services allows labs to outsource their billing to experienced revenue cycle professionals, while gaining complete access and transparency to their data.

Revenue Cycle Management

TELCOR RCM empowers laboratories to control their revenue cycle and billing functions better than any solution on the market today. By switching to TELCOR, labs gain unparalleled visibility to manage its revenue ensuring collections are increased and operating costs are minimized.

Point of Care

Used by more than 2,500 hospitals across the country to manage rapidly expanding POC programs, TELCOR QML® is the most comprehensive POC data management and connectivity system in the market today. QML provides workflow efficiency, scalability, and compliance as hospital POC programs encompass new device types and ambulatory facilities.