Running a clinical laboratory has become more challenging than ever, with intensified oversight, increased audits, and reimbursement rates on the decline. Rising operating costs only add to the pressure, especially in a competitive landscape with high client turnover. For many labs, these factors make it a constant struggle to stay financially viable. Now more than ever, refining your documentation and billing processes is crucial.
In today’s clinical lab landscape, financial pressures are intensifying. With increased regulatory oversight, more frequent audits, rising operating costs, and lower reimbursement rates, many labs are finding it harder to stay financially afloat, especially amid high competition and client turnover. Tightening up documentation and clinical lab billing processes has never been more crucial to ensure sustainable revenue flow and cost recovery.
The Protecting Access to Medicare Act (PAMA), enacted in 2014 with new payment rates kicking in by 2018, sent shockwaves through the industry, bringing stricter reporting requirements and payment cuts. With even steeper PAMA cuts looming, the financial strain on small and medium-sized labs is growing, making profitability challenging. On top of that, labs face issues in securing insurance contracts and dealing with increasingly narrow reimbursement rates, coupled with difficulties in collecting patient payments. These challenges make a streamlined, expertly managed revenue cycle critical for labs to thrive and stay competitive.
However, the outlook for most clinical laboratories doesn’t have to be so bleak. Significant improvements can be made with timely and efficient adjustments to both front-office and back-office operations. Submitting complete and accurate claims is now more crucial than ever for your lab’s success.
It’s essential not only for CPT and ICD-10 codes to be correct but also for claims to be coded with the highest level of specificity to prove medical necessity. Time is also critical—the tight deadlines for submitting clinical diagnoses and claims mean your lab’s billing processes may need to adjust accordingly. This can become particularly challenging when the ordering provider submits incomplete or incorrect information requisitions, adding another layer of complexity to the billing cycle.
