Reasons for delayed reimbursements in a laboratory billing process

A laboratory billing process can become extremely labor intensive when it comes to billing federal and commercial insurance payers for timely claim payments.

In a laboratory medical billing setup, billing protocols need to be in place for obtaining timely payments. Efficient medical laboratory billing services providers always ensure that the eligibility is verified and any referrals or pre-authorizations are obtained prior to claim submission.

However, there are certain roadblocks that may slow down the submission process and delay the subsequent reimbursement.

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False Information

Accurate patient demographics and insurance information is the key to ensure timely claim reimbursements. Misinterpretation of facts or even a minute error can result in rejections or denials.

These unintentional but careless clerical errors may result in the long follow up journey of verifying correct information and may further delay the laboratory billing process.

Inactive or Termed Insurance

Successful verification of the patient eligibility with the insurance is important as a failure in doing so may result in denials. There are cases when the insurance coverage has termed and claims are still billed. There are also cases when the patient has an active coverage but the services rendered to the patient are not covered by the plan under which the patient is enrolled with the insurance payer.

Therefore, wrong information regarding insurance is also one of the factors affecting timely reimbursements.

In or Out of Network Status

Claim billing and processing in cases of in-network vs. out-of-network services is very different. Patients unknowingly take services in an area or constituency which is not included in the policy. Where a majority of insurance policies do not cover out of network services.

Therefore, submission after proper identification of such services by the careful reading of medical documents can help in handling denials effectively. Adequate tracking of such areas is vital to successfully perform medical laboratory billing services.

Effective Denial Management

Identification of correct denial reasons is a process that affects claim reimbursements. Suppose if the claim is denied for incorrect COB (Coordination of Benefits), then this issue may be resolved by simply reaching out to the patient and requesting them to update the required insurance information.

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Unnecessary delays in payment may rise if these kinds of denials are not addressed by a laboratory billing consultant in time. With the availability of adequate software, these types of denials can be easily controlled and worked on to ensure timely reimbursement.

Nowadays, many of the medical laboratories are unable to devote the kind of resources and attention required to efficiently manage their laboratory billing process.

Our expert team understands the challenges and complexities of modern and ever-changing billing environment. The dedicated focus enables Bikham Healthcare to make laboratory billing services as an outstanding core competency for its clients.

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