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Chapter 36 : Approaches to Billing Laboratory Services

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Approaches to Billing Laboratory Services, Page 1 of 2

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Abstract:

As the billing entity, the laboratory has total fiscal responsibility and complete financial liability for the procedures the physician may have ordered rightly or wrongly. This chapter illustrates the importance of hiring individuals well versed in all aspects of correct coding, including the rules and regulations. It discusses the importance of having a comprehensive information technology platform and software resources that ensure accuracy and completeness. The chapter explains the need for laboratory personnel to be involved in the billing process and to maintain a close working relationship with members of the billing department. It talks about the relationship between complete and accurate billing and the generation of sufficient income to continue to perform expected functions. The billing department must employ individuals who are well versed in all aspects of correct coding and who are knowledgeable about the myriad rules and regulations pertaining to each payor. It is critical that laboratorians remain involved in the billing process and maintain a close working relationship with members of the billing department. For clinical laboratories, the key to survival is in complete and accurate billing for all services performed so that timely and comprehensive payment can be made for those services. Regardless of the corporate structure of the laboratory one practices in, the generation of sufficient income to continue to perform expected functions is absolutely essential.

Citation: Baselski V, Weissfeld A, Sorrell F. 2014. Approaches to Billing Laboratory Services, p 637-645. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch36

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Diagnosis
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Figures

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Figure 36.1

Payor-provider interactions in reimbursement. POL, physician office laboratory. doi:10.1128/9781555817282.ch36.f1

Citation: Baselski V, Weissfeld A, Sorrell F. 2014. Approaches to Billing Laboratory Services, p 637-645. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch36
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Image of Figure 36.2
Figure 36.2

Generic billing flowchart: third-party. LIS, laboratory information system. doi:10.1128/9781555817282.ch36.f2

Citation: Baselski V, Weissfeld A, Sorrell F. 2014. Approaches to Billing Laboratory Services, p 637-645. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch36
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Image of Figure 36.3
Figure 36.3

Generic billing flowchart: client or patient. LIS, laboratory information system. doi:10.1128/9781555817282.ch36.f3

Citation: Baselski V, Weissfeld A, Sorrell F. 2014. Approaches to Billing Laboratory Services, p 637-645. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch36
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References

/content/book/10.1128/9781555817282.chap36
1. Adams, D. L.,, H. Norman,, and V. J. Burroughs. 2002. Addressing medical coding and billing. Part II. A strategy for achieving compliance. A risk management approach for reducing coding and billing errors. J. Natl. Med. Assoc. 94:430447. [PubMed]
2. Alwell, M. 2003. Stem revenue losses with effective CDM management. Healthc. Financ. Manag. 57:8488. [PubMed]
3. Barber, R. L. 2002. Prompt payment depends on revenue-cycle diligence. Healthc. Financ. Manag. 56:5259. [PubMed]
4. Cohen, D.,, and P. Hoffman. 2003. When putting patients first fits the bill. Healthc. Financ. Manag. 57:9096. [PubMed]
5. Eckhart, J.,, and N. Mathahs. 2001. Physicians and compliance: developing a system that works. Clin. Leadersh. Manag. Rev. 15:222229. [PubMed]
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10.The Lewin Group. 2008. Laboratory Medicine. A National Status Report. https://www.futurelabmedicine.org/pdfs/2007%20status%20report%20laboratory_medicine_-_a_national_status_report_from_the_lewin_group.pdf, accessed October 15, 2012.
11. McNeely, M. D. 2002. The use of expert systems for improving test use and enhancing the accuracy of diagnosis. Clin. Lab. Med. 22:515528. [PubMed]
12. Moss, M. M.,, and S. M. Schexnayder. 2001. Coding and billing in the pediatric intensive care unit. Pediatr. Clin. N. Am. 48:783793. [PubMed]
13. Segal, M. J.,, S. Morris,, and J. M. Rubin. 2002. Automated claim and payment verification. J. Med. Pract. Manag. 17:297301. [PubMed]
14. Smith-Shoemake, M. A. 2002. Solving the claims conundrum. Manag. Care Q. 10:1314. [PubMed]
15. Welter, T.,, and P. Stevenson. 2001. Calculating five types of typical underpayments. Healthc. Financ. Manag. 55:4650. [PubMed]
16. Wolf, P. 2001. Charge-process strategies for outpatient prospective payment. Healthc. Financ. Manag. 55:5861. [PubMed]

Tables

Generic image for table
Table 36.1

Types of laboratory services

Citation: Baselski V, Weissfeld A, Sorrell F. 2014. Approaches to Billing Laboratory Services, p 637-645. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch36
Generic image for table
Table 36.2

Payment for services

DRG, diagnosis-related group.

APC, ambulatory payment classification.

Citation: Baselski V, Weissfeld A, Sorrell F. 2014. Approaches to Billing Laboratory Services, p 637-645. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch36
Generic image for table
Table 36.3

Billing process: invoice versus claims

Citation: Baselski V, Weissfeld A, Sorrell F. 2014. Approaches to Billing Laboratory Services, p 637-645. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch36

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