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Regional Reference Labs
Regional Reference Labs face many challenges. Some of the most important include Medicare reimbursement, insurance claims, competition, cost containment and regulatory requirements. CSS can make significant contributions to your business in each of these areas.
If you do your billing manually, don’t have electronic outreach or your LIS isn’t fully integrated with your billing or other enterprise software, CSS End to End Lab Automation can:
- Reduce Medicare DSO (Days Sales Outstanding) by about one third
- Cut Bad Debt by up to 75%
- Drive down Denials by approximately a third
- Trim Re-work by about two thirds
- Slash Billing staff time by nearly half
- Reduce Lab Staff time by about 20%
- Eliminate potential for lab error by a large margin
- Lower compliance issues substantially
And substantially increase patient, client and clinician satisfaction in the process.
Medicare Reimbursement
Currently, the dollar weighted Medicare denial rate for lab claims is about 9% and has been as high as 17.7% in recent years. While some of these denied claim dollars are eventually recovered, re-work on lab claims, which tend to be small compared to claims for physician |
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services, may not always be cost effective. Therefore, to run a profitable lab you must drive down denials. Further, it is essential to know, in advance of testing, if claim documentation is questionable and to obtain a properly executed Advance Beneficiary Notices (ABN) if necessary.
CSS software flags inadequate documentation before testing and automatically creates an ABN, when necessary. This helps you to systematically drive down denials and eliminates profit sapping re-work on denials.
CSS software also helps you to quickly and accurately perform line item Medicare claim reconciliation of payments, which reduces the time necessary to identify and correct denied claims.
Insurance Claims
CSS software allows you to determine private insurance eligibility, before testing, and then helps you to properly document insurance claims and meet managed care plan rules.
CSS software then submits ANSI 4010a1 electronic claims to over 2100 private plans nationwide. |
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Competition
Regional reference labs face unprecedented competition from national, as well as regional competitors.
CSS helps you offer superior client service and patient convenience. For example, with CSS WebOrdersView™ and WebResultsView™, your clients are able to place orders, label specimens and get results, securely across the Internet with nothing more than a web browser and Internet access. Likewise, their patients can retrieve their results from any place in the world via the web.
Additionally, by using CSS partner Emdeon’s fully integrated Direct Patient Billing And Payment Portal patients are able to check their accounts and make payments online.
Efficient specimen collection helps assure client satisfaction and contributes to a stronger bottom line. CSS software gives you complete control over specimen collections routes, stops and driver assignments. It aslo provides management reports on routes, stops, drivers and revenue by route and test volume by route.
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Cost Containment
Payroll is typically the largest expense for regional reference labs; so, with shortages of qualified laboratorians in many areas and the fully burdened cost (wages, insurance, benefits and payroll taxes) of a laboratorian approaching $70,000 per year, increasing the number of tests per unit of labor to obtain efficient production of quality work is crucial. |
The CSS Laboratory Information system (LIS) is designed specifically for batch oriented, high volume reference lab production and is currently in use by dozens of regional reference labs with volumes up to 10,000 accessions per day.
Regulatory Requirements
CSS software is designed to not only help you comply fully with HIPAA, CLIA, HCFA and state regulations but, also to help document compliance.
Additionally, the software is also designed to help you comply with common requirements of certifying agencies such as CAP, ASCP, and JCAHO. For example, CSS software keeps a log to document phone calls reporting critical results and can print copies of that log at survey time, if requested.
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