We're not reinventing the wheel. We're just changing the tires.
Trust begins with transparency.
Q: Is there a risk of insurance carriers not paying for our new lab services?
A: Yes. Insurance companies make money by charging plan premiums and not paying claims. It is no different than in your practice. The good news is that through our analysis before you start your services, you should know what you can expect.
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What if? There's typically an appeals process. nearly 80% of denied claims never get appealed. If your appeal meets coverage criterion and it's in the medical record at the time of provision, then you have a great opportunity to capture that revenue.
Q: Can we bill patients for services that insurance won't pay for?
A: Typically yes. There may be state laws prohibiting this practice with Medicaid recipients. Medicare patients can be addressed by providing an ABN (Advanced Beneficiary Notice) form that informs the patient that there will be a charge.
Q: How do I price my services?
A: You will need to develop what is called a customary charge that is uniform across your laboratory program that is uniform regardless of the insurer. We can help you set that rate.
Q: How long does a laboratory take to get up and running?
A: It can take as little as two months depending on what is required. That includes specific state licensing requirements, location of personnel, and availability of equipment and supplies. Your consultant will inform you of your particular outlook before you make the decision to commit to services.
Q: Can you help us with contract renegotiations and renewals?
A: Yes.