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.