Ask The Expert

Maximizing Your Lab Reimbursement

Let’s face it. The current economic environment that most medical practices deal with everyday is hostile at best. Declining reimbursements, an ever increasing government presence, and a public that wants the most for their medical dollar makes you want to give up and sell oranges at an interstate off ramp.

So how do you do more with less? How do you work smarter not harder?

Here are some steps that can help you to make your practice more profitable and keep your bottom line above water.

1. Get paid for what you do. Sounds simple, right? Millions of dollars in reimbursement go out the window every year due to sloppy recordkeeping. If you running 25 CBC’s a day, but only bill for 16, you are losing about $90.00 a day after costs. At the end of every day the lab should check the tests performed against the tests billed for. This means that the lab has to accurately record all tests performed either on paper or electronically. I recently went into one office that I found was losing over $38,000.00 a year in unbilled tests simply because the lab did not record all the tests performed and the billing office did not check to see how many tests were done. On the flip side, recording and charging for tests not performed is called FRAUD. For instance, if a patient comes in for a physical and has a standard workup of a CBC and urinalysis. If the urine is never collected, the charge should be struck from the charge ticket, or the charge should not be marked until it collected and tested.
2. Roll with the changes. ICD-9 and CPT codes change every year. Make sure that you are billing the most current and relevant codes available. Get a current code book and check your charges against the codes listed. Improper coding can also be considered fraud, even it is done unintentionally.
3. Kick the tires. At least twice a year you should shop around to multiple vendors to be sure you are getting the lowest prices possible for your medical supply needs. I urge clinics to create a top 50 list of the items they order most often. Shop the list to several vendors. GO with the best price. If you find better prices, do not go to your original vendor and let them match the price. In essence, you would be rewarding them for overcharging you. Sometimes you can just let your current vendor know that you intend to shop around and go with the best prices offered. Give them the opportunity to drop the prices them are currently charging. One office saved around 12% just by threatening to shop around!
4. Go electronic. If you have more than one automated analyzer, it would save you money in the long run to invest in a LIS (Laboratory Information System). Time savings, increased productivity, and less paperwork are worth the cost. I know of a four physician practice that increased production by 35% without adding additional people and paid for the LIS in less than 6 months.

I hope these tips will help. Remember, it is your money you are saving. Every penny saved increases your chances of retaining your job and retaining testing the physicians need.

What is the best way to make sure I pass my Proficiency Testing without breaking any rules?

The best way is to make sure your instruments and tests are calibrated and maintained according to schedule. If your equipment is in good shape, you are in good shape.

Make sure the people performing PT are trained and competent. After all, if they can’t perform the PT correctly, what are they doing to the patient samples?

Check the PT package when it arrives. Make sure it is cool or cold, not damaged, that no items are missing and that it is tested and resulted within the timeframe given.

I am having trouble reading my dipstick tests such as Strep A, Mono, etc. The lighting is not good in the lab. Any lighting tips?

I prefer on of the gooseneck lamps that has the “natural sunlight” bulbs. This gives great lighting for visual reads. Also, it will help your readings if you hold the dipstick in front of a white background such as copy paper. The white background enhances you visual field and color perception.