Genetic testing is a rapidly evolving profession, and one of the reasons medical billing is so complex is that billing codes simply cannot keep up. Molecular testing is offering answers to more problems and assisting physicians in making vital decisions, but it can be costly, so insurers are hesitant to approve tests.
To be successful in molecular lab billing, you must not only understand the billing codes, but also have familiarity with all of the necessary details. It is also beneficial to have prior experience working with insurance companies. A refused or rejected claim must be challenged, and your biller’s knowledge of what to tell the insurer to show medical necessity increases your chances of getting reimbursed.
Medcare MSO provides specialized molecular, genetic, and diagnostic laboratory billing services to ensure claims are properly coded and submitted in a timely manner with all supporting documentation. Our certified medical billing specialists are experts at what they do, and they stay up to date on all changes to CPT codes. Our specialized knowledge and experience mean that we submit accurate claims the first time and see increased collections on A/R accounts.
Due to constant developments in the field, CPT codes are updated on a frequent basis, making it difficult for in-house billers to keep up with the current modifications. In certain circumstances, a single code can be used for 10 different genes, while in others, the gene is not mentioned, therefore the claim must be billed with an unlisted code. In addition, there is another layer of administration to deal with in MolDX enterprises, as well as code constraints.
These data all point to one conclusion: outsourcing medical billing for molecular testing is an excellent solution for labs. The workforce has a break from dealing with claims, while Medcare MSO’s dedicated billing team pays claims.
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