Automated Demographic Verification Should Be Every Laboratory’s First Line of Defense Against Revenue Leakage

Many laboratories continue to face financial challenges due to persistent downward pricing pressure. This makes it essential to capture payment on all earned revenue. Laboratories are not typically the first stop in a patient encounter. Patients often arrive at the lab without their health insurance or Medicare card, so labs are forced to rely on the primary care provider or hospital to forward the patient billing information. Unfortunately, this can result in insufficient or poor quality demographic and payer data, which leaves patients feeling frustrated when their insurance isn’t properly billed, as well as slowing down the billing and reimbursement process.

Automated demographic verification is a best practice for improving reimbursement

Faulty patient demographic data is the primary reason for denied claims. Any missing, incomplete, or incorrect patient demographic data results in delays in claim payment. Automated patient demographic verification plays a key role in keeping the billing and reimbursement process running smoothly. Having accurate patient information up front is a lab’s first line of defense against revenue leakage: it accelerates claim processing, enforces compliance, and mitigates the risk of reduced or delayed reimbursement.

Automated patient demographic verification tools screen patient-provided demographic information for accuracy and completeness. A best-in-class demographic verification tool can automatically verify or correct critical pre-billing data elements, including:

·       Patient name (first, last, middle)

·       Current and previous addresses

·       Date of birth

·       Current phone numbers and types

·       Social security number

These tools locate missing information, which subsequently improves insurance discovery hit rates. Using an automated demographic verification tool, billers can quickly and easily obtain complete and accurate information for each patient and claim. When applied at the front end of the billing process, demographic verification technology improves statement delivery, reduces the cost of claims, and accelerates payments. Benefits of the automated process include:

·       Improved statement delivery rates with 60% less returned mail

·       Reduced operational expenses

·       Fewer claim rejections and payment delays

·       Minimized HIPAA compliance risk

Automated demographic verification relieves much of the administrative burden on both laboratories and provider staff by automatically capturing, discovering, verifying, and enhancing patient information. Using this technology, it takes mere seconds to discover and verify patient data—a process that would take several minutes to accomplish manually. The tool eliminates the game of telephone tag between lab billing teams and provider offices or patients.

Billing and accounts receivable technologies are stronger when used together

Leveraging demographic verification technology reduces errors and administrative burden, and labs of any size benefit from the automation, streamlined workflow, operational efficiency, and faster reimbursement. Some demographic verification tools can be used as a standalone or in conjunction with complementary, real-time accounts receivable optimization (AR) tools. By using these tools together, labs can further simplify and expedite the pre-billing process and maximize payments. Insurance discovery and insurance verification tools, for example, deliver accurate data, reveal hidden, billable coverage, and drive self-pay and high-deductible conversions.

Other valuable technologies include automated self-pay analysis, deductible monitoring, and claims monitoring. Self-pay analysis identifies those patients most likely to pay and pinpoints those who qualify for a hardship discount or Medicaid. Deductible monitoring equips revenue cycle professionals with the ability to drop claims with surgical precision increasing the likelihood of receiving proper reimbursement while reducing self-pay collections costs. Finally, automated claims monitoring lets lab staff know the status of claims without having to inquire with payers. The result is higher self-pay conversion rates and lower collection agency expenses.

When applied at the front end of the billing process, automated demographic verification can make laboratory billing teams more efficient and defend against preventable revenue loss due to rejected claims, collection agency fees, and bad debt write-offs. Used in combination with other AR optimization tools, labs can enjoy higher self-pay conversion rates, lower staffing costs, and maximum revenue.

This content is sponsored by ZOLL Data Systems.