Labs have faced challenges and have undergone an incredible amount of change over the past few years. With a new year on the horizon, labs will have to be adaptable to new rules, regulations, and overall economic conditions. It’s important to know what hurdles are waiting ahead and to be as prepared as possible. Given the information we have now, what tools can labs use to set themselves up for success in 2023?
End of the Federal Public Health Emergency (PHE)
The U.S. Department of Health and Human Services (HHS) latest extension for the PHE is effective through January 11, 2023. Once expired, payers can treat COVID-19 like any other test and structure rules limiting reimbursement.
It’s also essential to gain insights into future trends using TELCOR’s in-depth reporting and analytics. This allows labs to track reimbursement in real-time to understand how these changes are impacting the organization to make stronger business decisions as more information is obtained.
Enforcement of the No Surprises Act
Beginning January 1, patients or the government can hold providers or insurance carriers responsible for violating the No Surprises Act. This applies to non-emergency services performed by a non-participating provider (such as a lab or pathology practice) when a patient is seen at certain participating healthcare facilities. To remain compliant, labs will need to be cognizant of the different variables within each requisition.
Labs using TELCOR RCM can configure rules to hold and review a patient statement to prevent overbilling. These rules can be customized based on client, test, payer, etc., ensuring only the necessary statements are being stopped. This functionality maintains a high level of efficiency and compliance, by automatically sending out compliant statements and holding the flagged ones for further manual review.
New Year, New Deductibles
With insurance deductibles resetting at the beginning of the year, labs will bill patients until their deductible is met. Collections can take a dip at the beginning of the year until patient deductibles are met and payers start reimbursing those claims.
A patient-centric billing solution can make collecting patient payments easier. When a patient calls regarding a bill, the staff member can enter the patient’s first and last name to see a list of services specific to that patient, rather than having to search by date of service. This allows questions regarding demographics, services provided, invoicing, claims, etc., to be answered quickly and efficiently putting less strain on billers.
Patient confusion can be reduced by sending a single, monthly statement rather than many statements split by each date of service. Labs using TELCOR iLabBill® Account allow patients to access an online portal to update demographic and insurance information. Patients can also view services provided, account balance, and easily make payments using a credit card. Payments are then posted directly into TELCOR RCM, providing real-time status of patient accounts.
Updated Medicare Fee Schedules
Medicare is set to publish a new fee schedule in early 2023. With many tests priced based on this fee schedule, it’s critical for labs to implement this pricing as soon as possible.
With TELCOR RCM, labs can easily upload and adjust rate schedules as needed directly within the application. The rates can be set with effective and discontinue dates, so pricing can be loaded at any time and the updated pricing will begin on the correct effective date. This function can be done by the lab in-house or with the help of TELCOR customer support.
TELCOR supports hundreds of labs across the country, providing industry-leading revenue cycle management and billing service solutions. By providing real-time visibility into analytics and improving workflow efficiency, TELCOR empowers labs to take control of their billing and positively impact their bottom line. Learn more about TELCOR billing solutions.