From Test Order to Payment: How Pre-Analytics Shapes Lab Billing

Introduction

In today’s increasingly complex billing landscape, small laboratories face immense challenges in securing proper compensation for their services. The intricacies in submitting a seamless claim are growing, riddled with potential pitfalls. Enter Diagnose - an innovative Laboratory Information System (LIS) designed to understand the post-analytic phase, ensuring your billing system or company receives comprehensive information to facilitate prompt payment.

Ensuring the Validity of Diagnosis Codes

A pivotal aspect of ensuring payment is the provision of ICD-10 codes that corroborate the tests ordered. Conducting tests based on insufficient or inaccurate diagnosis codes can create extensive post-testing work, often resulting in payment denial. Diagnose addresses this pain point by integrating a diagnosis validity check during the ordering process. This functionality cross-references the provided ICD-10 codes against an extensive ruleset of recognized LCD & NCD guidelines and any additional custom rules instituted by the laboratory. Consequently, ordering providers receive instant feedback on the adequacy of their provided ICD-10 codes from an insurance viewpoint, streamlining the entire process.

Patient Demographics: Accuracy Matters

Correct diagnosis codes are important, but they won’t help if sent to the wrong insurance company. Diagnose offers tools to nullify these issues. Most important is our integrated eligibility check. At the start of every order, users receive real-time insurance status directly from the insurance company. Additionally, Diagnose integrates with USPS to ensure the precision of Zip/City/State details. We believe in enabling your billing team to focus on appeals rather than correcting basic information that should’ve been validated from the outset.

Affordability

While there are other software options offering similar features, many treat them as add-ons, often accompanied by significant cost hikes. Diagnose stands out as the only LIS in its price bracket with such advanced capabilities and a no-contract payment structure. At Anima Software, our mission is to champion the success of small laboratories. We understand that an affordable system, adept at navigating billing complexities, is pivotal for a laboratory’s thriving operation.

Test Configuration

Navigating the tangled web of test configuration in an LIS is like wading through a swamp of confusion. We’re talking about panels, reflexes, profiles, calculations, and more mysterious settings. Who’s left to untangle this mess? The beleaguered billing team, of course! They’re on a wild goose chase figuring out what tests were done, which tests should be lumped under one cryptic CPT Code, or even where these tests took place. Diagnose uses its data models, aiming to give the billing team a clearer picture of what tests were done with their respective codes. Remember navigating through sub-tests in a Complete Blood Count? Now, it’s streamlined to just a single, more digestible CPT, as outlined in the test definition.

Summary

Diagnose was created to solve the problems of the small laboratory. A harsh reality many face is getting paid for the work performed. The intricacies of today’s billing process heavily favor insurance companies. However, Diagnose is here to level the playing field, ensuring you have all the information required to achieve prompt payment without the unnecessary runaround of unchecked boxes.

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