By: Dyana Williams, Client Engagement Manager, LLS RCM Solutions
For hospital-based pathology groups, mastering the complex revenue cycle management processes surrounding the capture and billing of Professional Component of Clinical Laboratory (PCCP) services is paramount when the group is not being otherwise compensated through their contract with the facility.
The shifting healthcare landscape, including transitions to new electronic medical record (EMR) platforms such as EPIC, adjustments to billing file formats, and alterations to transmission methods, has served to complicate this matter for several of our clients across the spectrum of Lighthouse Laboratory Services clients. Our staff is able to assist those facing similar challenges in facilitating collaboration among lab personnel, facility personnel, and billing personnel to effectively address and rectify these gaps.
Consequences of charge volume gaps
Overlooking gaps in PCCP charge volumes can result in disruptive revenue cycles and additional financial uncertainty for pathology groups and labs. To address this critical issue, our company consults with client stakeholders to assist in identifying and shoring up processes that can detect and mitigate these gaps proactively.
Some of the areas we encourage stakeholders to focus on include:
- Regular Data Monitoring and Analysis: Creation of automated systems that continuously monitor billing data and volumes. This proactive approach enables timely identification of trends, anomalies, and sudden fluctuations in charge volumes.
- Alert Systems and Notifications: Customized alert systems can instantly notify key stakeholders when substantial drops in charge volumes, file sizes, or other predefined thresholds are detected.
- Real-time Reporting: Real-time reporting dashboards that present critical data performance indicators related to charge volumes provide transparency to laboratory and billing personnel.
- Facility Charge Master Review: Conduct a thorough review of facility charge masters, ensuring comprehensive identification of services which contain a PCCP service element and would therefore be eligible for billing by the pathology group.
- Engaging Communication Channels: Maintain robust communication with hospital IT departments, expediting the resolution of any technical issues that may arise.
- Thorough Testing and Validation: Conduct rigorous testing and validation before system changes, thoroughly documenting processes and logic, to aid in the completion of a Gap Analysis after changes have been made.
By specializing and working with laboratories and pathologists, our team has insight into industry trends and key payer issues that are affecting health providers today. Contact us today for a free consultation.