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Our AHIMA and AAPC-approved CCS, CCS-P, and SCP-certified coders and billers understand the billing complexities for various pathology procedures, including surgical pathology, clinical pathology, and cytogenetics. This in-depth billing knowledge allows them to ensure accurate coding and maximize reimbursements for your pathology practice. Our experts will combine their knowledge with advanced software to streamline your pathological billing process. Here’s how we will do it for you:
- Integrate digital tools like electronic medical records (EMRs), electronic health records (EHRs), electronic data interchange (EDI), and other capabilities into pathology-specific billing software to manage processes from electronic claims processing to electronic payment posting.
- Collate all patient details (demographics, medical history, referrals) and verify complete insurance information (coverage, prior authorization status with effective dates, expiration dates, and claims address) to minimize errors and streamline claims processing.
- Prepare and process pre-authorization documentation to insurance payers with detailed clinical justification for the service or procedure.
- Expertise in handling diverse pathology billing models, including fee-for-service billing, value-based billing, global billing, capitation billing, etc.
- Stay current on any updates on the AMA-specified CPT codes ranging from 80047- 89398 for pathological billing services, the P2028-P9615 HCPCS Level II code range, ICD-10-CM codes, and modifiers.
- Ensure code specificity while covering billing for a range of pathology and laboratory procedures, including, but not limited to, Biopsy, Autopsy, Histopathology, Cytopathology, Immunohistochemistry, Immunology, Gross examination, Polymerase chain reaction (PCR), Digital pathology, etc.
- Stay updated on any fee schedules or payment guidelines changes for government insurers like Medicare (Part B, Part C), Medicaid, Affordable Care Act (ACA) Marketplace Plans, Tricare, VHAs, etc, and private insurers like Kaiser Permanente and Aetna.
- Review EOBs closely to identify potential payment discrepancies and accordingly initiate an appeals process to get maximum reimbursement for your pathology services.
- Follow-up EOBs to get a clear picture of a patient’s out-of-pocket expenses, such as deductibles, copayments, and coinsurance.
- Inform patients about their covered services and payment responsibilities to prevent unpaid bills. This will result in maximum revenue for our clients.
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