Learn how your pathology lab can collect all the money to which it is legally entitled
Anatomic pathologists who expect to be properly paid for claims they submit to managed care plans are likely to be surprised at how often those claims are reimbursed at less than contracted rates. This issue has become particularly acute during this economic recession, when some payers have become particularly tight-fisted in their approach to settling claims for anatomic pathology services.
“It is not unusual for us to review a prospective billing client and find that the pathology group is being underpaid by a factor of 5% or MORE across the numerous managed care contracts they hold with various payers in their region,” stated Laura Chaney, CPA, Vice President of Operations for Pathology Service Asssociates, LLC, of Florence, South Carolina. “That is a substantial reduction to pathologist income, particularly when the amount of such under-reimbursements may compound over several years.”
For medium to large pathology groups, this can represent a reduction in expected reimbursement by tens or even hundreds of thousands of dollars per year—reimbursement to which the pathology group is fully entitled. What makes this situation particularly aggravating for pathologists and their practice administrators is that, in many cases, the pathology group has accepted rock-bottom pricing from a health plan in order to become a network provider. Thus, some pathologists consider payer policies that result in these under-payments to be adding “insult to injury.”
“There several effective solutions available to pathologists who want to correct the problem of arbitrary claims denials and a pattern of underpayment for other claims,” observed Chaney. “These solutions are relatively easy to implement and quick to return positive results. However, it does take discipline and follow-through to get timely corrective action from payers.
Chaney recommends that anatomic pathology laboratories pursue three strategies to assess the amount of underpayments and identify sources of denied or under-reimbursed claims:
- “One, start with existing managed care contracts. Your pathology group should build a simple table that shows the key elements for each contract, including contracted pricing.
- “Two, compare recent claims settlements with these contract terms. This is always a surprise for pathology practice administrators doing this for the first time. The number of incorrectly-reimbursed claims—and the dollars associated with those claims—is often shockingly significant!
- “Three, document the specific ways that each payer has failed to meet the terms of your pathology lab’s managed care contract, contact the payer, and start the process of resolving these issues with the goal of achieving full and accurate payment for claims submitted per the managed care contract.”
Laura Chaney will share the most effective ways for anatomic pathology practices to turbo-charge their managed care contracting program at a valuable audio conference. “New Managed Care Contracting Trends, Issues, and Opportunities for Clinical Labs and Pathology Groups” will take place on Thursday, September 17, 2009 at 1 p.m. EDT; 12 p.m. CDT; 11 a.m. MDT; 10 a.m. PDT. For information and to register, visit http://darkdaily.com/audio-conferences/new-managed-care-contracting-trends-issues-and-opportunities-for-clinical-labs-and-pathology-groups.
Along with addressing how to improve reimbursement to the pathology group, Chaney will discuss the “must do’s” and “must avoids” when negotiating the best pricing and terms during the pathology lab’s next round of managed care contract negotiations.
To complement Chaney’s insights about up-to-date issues in managed care contracting for anatomic pathology groups, this unique audio conference call also features Michael Snyder, President, Laboratory Management Services, LLC, of Hauppauge, New York. He will address important new developments in managed care contracting for clinical laboratories. Both speakers will provide participants at the audio conference with specific action items that can swiftly raise the cash collections for their laboratories.
For you and those on your team responsible for managed care contracting, this is a “must attend” session. Chaney and Snyder, because of their regular interaction with health insurance plans throughout the country, will take you inside the 2009-2010 priorities that the managed care industry have for their lab testing contract negotiations. You’ll master the best ways to negotiate a preferred, value added provider status for your laboratory with the most important payer plans in your region.
Join the experts! This is a valuable “twofer” and gives you unprecedented access to Laura Chaney’s savvy (anatomic pathology) and Michael Snyder’s expertise (clinical laboratory). This hard-hitting audio conference will arm your laboratory with the strategies and insights it needs when negotiating with managed care companies. Better yet, the interactive question-and-answer sessions during the audio conference give you a front row seat to ask your important questions and get personalized answers to your lab’s unique needs and interests. Reserve your participation in this highly valuable audio conference by registering today!
THE DARK REPORT AUDIO CONFERENCE AT A GLANCE
DATE: Thursday, September 17, 2009
TIME: 1 p.m. EDT; 12 p.m. CDT; 11 a.m. MDT; 10 a.m. PDT
PLACE: Your telephone or speakerphone
COST: $245 per dial-in site (unlimited attendance per site)
TO REGISTER: Click here or call 1-800-560-6363 toll-free