Pathology Billing and Coding: Essential Guidelines for Practice Managers
Katrina Vastag |Without accurate medical billing and coding processes, your pathology practice won’t get paid. But billing isn’t always straightforward. You need to match the right medical codes to the services you perform, meet compliance and regulatory standards, and follow strict procedures set by insurance companies.
This guide can help you understand how to achieve a successful financial outlook with precise and compliant medical billing.
Understanding Pathology Billing
Pathology billing involves coding medical services, submitting claims to the insurance company, and managing payments. Mastering this process helps clinical pathology practices manage the revenue cycle, receive payment for all services, and adhere to federal regulations.
This field of pathology requires extreme precision, both within patient services and the payment process. Documenting services correctly helps prevent claim denials, which happen at an average rate of 19% for anatomic pathology organizations and 13.6% for clinical laboratories. It also promotes faster reimbursements so you can pay your staff and maintain revenue.
Common Challenges in the Billing Process
Understanding prevalent complexities in the billing process can help your practice overcome them. Examples include:
- Complex coding requirements that make it challenging to accurately categorize pathology procedures for insurance companies
- Frequent updates to CPT codes that your pathologists and physicians must stay on top of to avoid inaccuracies
- The necessity for detailed documentation to prove to insurance companies why certain clinical diagnostic laboratory tests were necessary
These challenges make revenue cycle management difficult for pathologists. Many constantly encounter barriers to patient payments, impacting their bottom lines.
Key Components of Pathology Billing
While pathology billing has its challenges, your healthcare practice can overcome them by thoroughly understanding the invoicing and coding processes and looking to professional services for support.
Medical Billing and Coding: What Is It?
Pathology billing requires your office to understand the proper Current Procedural Terminology (CPT) codes for describing medical procedures. Pathologists must assign the right codes to the services they provide for insurance purposes.
The following are a few common CPT codes used in pathology:
- Surgical pathology: 88300-88399
- Cytopathology: 88104-88199
- Molecular pathology: 81105-81599
- Anatomic pathology consultations: 88321-88325
Within these ranges are specific codes for precise procedures; for example, the molecular pathology code for BRAF gene analysis for V600 mutations is 81210.
Your team must stay up to date with CPT codes to assign the proper qualifiers to each practice expense. You must also distinguish between professional components and technical components when invoicing for services.
Professional components refer to a pathologist’s interpretation of a test specimen, while technical components encompass the actual laboratory testing.
Outsourcing Billing Services to Specialized Companies
Many pathologists partner with professional services to improve their billing processes. These companies can:
- Aid claim submissions for insurance, Medicare, and Medicaid services
- Manage claim denials by providing additional information and communicating with insurance carriers
- Monitor your practice’s compliance throughout payment procedures, reducing the risk of malpractice expenses
Consider outsourcing at least some of your pathology billing to a professional. Such billing companies can save your practice a significant amount of time while ensuring accuracy and timely payments.
Best Practices for Effective Pathology Billing
If you want to improve billing processes for your clinical pathology practice, closely examine your current procedures and look for areas that need work. These best practices can also help point your payment procedures in the right direction.
Accurate Documentation To Support Claims
Error-free invoicing starts with thorough, precise documentation. All of the pathologists, physicians, and other healthcare providers on your team should understand the importance of documenting services correctly. If a physician lists a service incorrectly, it will then be billed inaccurately, impacting the insurance claim and eventual payment.
Regular Training and Updates for Regulatory Compliance
Because CPT codes change frequently, your staff must undergo regular training to learn new regulations and updates. Don’t be afraid to quiz staff on current codes and compliance regulations. The American Medical Association is a good source for CPT codes and related resources.
Leveraging Technology To Streamline Processes
If you are not sure about outsourcing bills to a professional service, adopting advanced software may be a good compromise. The right technology can streamline many processes with features like:
- Automated coding suggestions
- Real-time claim tracking
- Compatibility with multiple payment methods
Do you want to learn more about how technology can improve your payment efficiency? Watch the webinar: Streamline Your Billing Workflow With Weave Payments.
The Role of Pathology Billing Services
Accurately billing advanced diagnostic laboratory tests, specific testing for rare diseases, and proprietary laboratory analyses is a job in itself. If your practice simply doesn’t have the time or expertise to manage invoicing, a professional service can provide a wealth of benefits. These organizations offer the following qualities:
- Expertise and efficiency: These experts thoroughly understand complex billing scenarios, allowing them to complete payment processing faster. They are well versed in relevant CPT codes and know how to accurately bill for Medicare, private insurance carriers, and self-pay patients.
- Compliance assurance: You won’t have to worry about your organization overlooking new regulations or updates to codes. These services can ensure your compliance and reduce the risk of audits, penalties, and malpractice claims.
- Financial benefits: Your pathology organization can benefit from increased reimbursements and improved cash flow with a professional overseeing your payments. These services know how to maximize the services that require payments and reduce claim denials.
Your practice can focus on providing an excellent experience for patients while a seasoned team handles medical bills and codes.
Support Your Practice’s Success With Weave
Pathologists must understand the importance of accurate coding and pathology billing for the success of their practices. Using specialized payment services and software can help you enhance efficiency within these processes, minimize errors, and even boost your bottom line.
Are you looking for other ways to streamline practice management? Weave is a comprehensive communication platform for healthcare providers. Our solutions help you improve patient engagement and retention, simplify patient payments, and promote a range of other benefits.
Contact us today to get a demo and explore Weave’s offerings.
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