Medical Claims

Being a healthcare provider_ make sure that you’re making enough money besides serving your community for a better cause. Because even a high patient volume isn’t beneficial until you get completely paid for the healthcare services rendered. Whether you have stepped into a new venture or are in your business’s growth stage. You want to be sure that your lab business is set up for success in terms of both patient satisfaction improved bottom-line.

Providing exceptional healthcare services is undoubtedly the primary objective of every lab practitioner. But it’s also a fact that everyone dreams of staying ahead of the competitors and doesn’t want to lose money. There are many components of a lab practice that need to be taken into consideration. For instance, a loyal customer base (that is possible through providing quality care services) an efficient lab billing system.

So, in order to keep your laboratory practice afloat, you need to maintain the highest efficiency levels in both obligations. For this purpose, you must have forward-thinking, proactive solutions and undoubtedly an efficient administrative team. That can keep you informed of your financial well-being and how to sustain it.

Get Real Insights

The accurate data and complete insights into business operations are required to run your lab revenue cycle management system efficiently. If you are not collecting what you’re owed. Then it’s the right time to find the cracks in your laboratory billing system. It has been observed that lab practitioners leave millions of dollars on the table just because of frequent claim denials. As a financial executive or lab administrator, you know the fact that insurance denials are constant headaches. That negatively affects your billing collections, cash reserves operational efficiency.

Additionally, some laboratory practices even see denial rates on first billing as high as 15-20%. They not only lose significant revenue but also increase the financial and administrative burden. For example, rework costs for a single denied claim is approximately $25. Just think about the total costs when you deal with a pile of unresolved medical claims. For those providers, who are currently struggling to get their lab practice out of the financial crisis. They must invest time and money in upgrading their lab billing system from denial management to prevention.

Stay Well-versed With Billing Model

As a laboratory practitioner, you need to get a complete understanding of the processes involved in claims management. Here is a breakdown of personnel and activities within a billing process that you need to understand. 

Frontend Staff:

Registration staff of your healthcare practice is responsible for:

  • Patients’ scheduling.
  • Capture patients’ demographic and insurance information.
  • Verify insurance eligibility.
  • Conduct prior authorization and obtain referrals.
  • Collect co-pays & deductibles.

Back-end Staff: 

Responsibilities for staff dealing with back-end tasks are including;

  • Prepare comprehensive medical claims.
  • Ensure timely submission of claims to the insurance companies.
  • Follow up on outstanding A/R balances.
  • Resubmit claim denials
  • Accurate payment posting.


  • Ensure communication with all stakeholders.
  • Monitor staff performance.
  • Review revenue cycle metrics, analyzing trends regularly.

Tips to Improve Claims Acceptance Rate

Are you falling behind on your revenue goals & struggling with the high percentage of claim denials? It has been estimated that approximately 90% of denials are preventable. You should implement the following strategies to keep your revenue cycle management tight.

1. Verify Patients Insurance Eligibility

It is the responsibility of your registration staff to verify the insurance coverage of new and regular patients. They should ask the patients to bring their insurance cards at every visit. Because it is possible that patients have recently switched their jobs or healthcare plans. And if you process the medical claims with outdated insurance information, then you have to face declined or partial payments. Moreover, it is the responsibility of your front desk staff to make sure that the patient’s coverage hasn’t been terminated, their maximum benefit hasn’t been met. And their plan covers the service you’re providing.

2. Collect Complete Information

Do you know just leaving one required field blank on a claim form can lead to denials? Yes, it’s true. Most of the time, insurance agencies reject the claims due to certain reasons. For example, incomplete information: wrong plan code can hold practitioners back from getting reimbursed and slows down the laboratory billing services. 

So, make sure that your staff capture accurate information including;

  • Patients’ names.
  • Date of birth.
  • Gender.
  • Address/Phone number
  • Insurance payer.
  • Name of the Insured.
  • Policy number.
  • Primary insurance (in the case of multiple insurances).

3. Ensure Specificity in Coding

In order to ensure the accurate transformation of patients’ diagnosis, treatments, equipment, and laboratory services into precise medical codes. You should hand over this responsibility to the highly trained medical coders, having in-depth knowledge about ICD-10. CPT,  HCPCS, etc.

4. Embrace Innovation

Adopting innovation is the key to survive in the highly competitive healthcare market. But the majority of the laboratory practitioners are still using the orthodox methods to collect and process data. Even if they submit the claims manually, that always leaves a huge room for errors. Which eventually results in the claim denials. However, in order to make your ‘growth plan’ effective, it’s crucial to implement cutting-edge lab billing solutions. Let’s talk about automation. The best way to prevent billing errors, caused by human negligence. Healthcare practitioners should deploy smart billing tools.

For this purpose, the implementation of EHR is the most effective solution to take your patients’ records from paper to digital form. It provides real-time access to healthcare records, whenever needed. Electronic Health Records increase the efficiency of clinical documentation and helps you to prevent coding and billing errors. Furthermore, the claims that are being submitted electronically get processed faster as compared to those filed through manual methods. As a result, healthcare providers get their revenue back in accounts without waiting for months or years.

5. Hire a Top-Notch Lab Billing Company

Gone are the days, when lab technicians put the billing responsibilities to the existing staff, with zero to little knowledge. Now, the growing complexities in the RCM process require specific expertise and skills. So, lab technicians always need the assistance of a well-trained medical billing team to meet their financial needs. But it can be very challenging for healthcare practitioners to invest a hefty amount in managing an in-house billing department. As they are already struggling with the revenue loss. 

In such circumstances, outsourcing billing and coding services to a dependable lab billing company always make sense. In this way, you get access to a large talent pool by just paying a fixed amount. In addition to this, outsourcing can benefit your practice in the following ways:

  • Ensure HIPAA compliance.
  • Help you to keep pace with the ever-evolving medical industry.
  • Mitigate billing errors and prevent claim denials.
  • Optimize medical accounts receivable collections.
  • Take the excessive administrative burden off your shoulders.
  • Cut the excessive capital costs associated with the in-house lab billing services.

Have you decided to outsource your revenue collections management to a trusted third party? Laboratory Billings is here to meet all your financial needs. It has been helping the lab technicians to make their businesses profitable. Consult with our RCM experts and take a big leap in your business.