Learn why outreach is vital to your lab's future from the Huntsville Hosp. team of Kelli Powers, CFO, Vicky McClain, Admin. Dir and Kristie Campbell, Lab Manager.
“Our outreach program functions within the hospital laboratory structure. We continue to bill as a hospital laboratory on a UB. As a result, if the hospital has a contract with a payer, then the lab is also able to bill the payer. There are pros and cons to this, but over the years the financial pro forma for the lab and the hospital were reviewed periodically to ensure that this model was still the best financial option for our institution. "
“To alleviate the possibility of client dissatisfaction, we try to educate our clients who consistently order tests that do not meet medical necessity. Typically, this is only an issue with clients who send in specimens. We monitor the clients for compliance with medical necessity and provide education for clients that order tests that do not meet medical necessity. This approach has worked well for us.”
“Less than five percent were billed to a client or institution.”
“We currently use Atlas, although we began interfacing EMRs prior to installing Atlas.”
“We began the program using a contracted courier service, which was acceptable for about the first two years of the program. Today, we use a dedicated hospital courier service that’s managed by another department, but the vehicles and staff are allocated back to the lab. Currently, we have 10 vehicles and about nine FTEs allocated to the outreach program.”
“I think the first thing you would need to do is gain a better understanding of the client’s insurance contracts. If you’re billing as a hospital lab like we do, then there will be a difference in terms of the charges and possibly co-pays for the patient. If you are billing as an independent lab, then this may not be such an obstacle. My recommendation would be to work with the client on a trial basis to test the billing system for the patients. You’ll want to follow the billing carefully to determine if there are truly any issues.”
“As a hospital lab, we’re a participating provider for all payers. The main billing issue we experience is with a patient who has a large co-pay due to a hospital facility fee, which can range anywhere from $50 to $250. Today, patients are becoming more knowledgeable about their healthcare plan coverage, so this issue doesn’t arise as often.”
“No, we currently do not use these services.”
“Yes, our lab is set up to receive electronic orders from many EMRs, which are filed into our Atlas software system.
When a patient arrives at a PSC, the orders are available for processing without the need for a requisition.”