Blog

Billing & Collections

Finding the “Backdoor” into Payer Networks

By Steve Selbst bio I am delighted to be able to share with you a key “secret to success” about payer contracting. Today’s article is about getting in the “backdoor” with payers and complementing your payer network by building your patient/customer base. In my journey navigating tens of thousands of payer contracts’ negotiations, it has become clear to me that there are times when a payer will close its network to certain provider types, based on its network need. Don’t despair; there are other “paths to Oz.” Certainly, there are ways to build value propositions and ways to escalate up the payer management chain. These are topics for another day. Today, we’ll talk about an even easier to implement alternative: complementary payers! Complementary payers What is a complementary payer? Looking… . . . read more

Employment Law Update

New overtime rule now in effect

By Mike O’Brien bio Jan. 1, 2020 was the deadline to comply with new FLSA overtime rule. At the end of September the Department of Labor issued its long-awaited final rule updating the salary level test for white-collar overtime exemptions under the Fair Labor Standards Act. Under the new rule, the minimum salary level for exemption is raised from $455 a week to $684 a week, or $35,568 annually. The change marks the first increase in the minimum salary level to take effect in more than 15 years. It is expected to bring overtime eligibility to over a million employees who are ineligible under the current threshold. Although the DOL released a final rule raising the salary level in 2016, the rule was blocked by a federal district court and… . . . read more

BILLING & COLLECTIONS

Accessions Disappearing or Not Getting Billed?

By Sean McSweeney bio Ever get that feeling that there should be more charges in the billing system? How many times have you or someone else said something like “we did 3000 samples last month, but we only see 2500 that got billed”? Are salespeople complaining that all their samples aren’t in there? How can you tell if they are just complaining, whether the referral source didn’t send as many as they think or claim (which we all know happens), or if there were more samples sent or received and instead of getting billed they are just going “poof”? Where can revenue be lost? Tons of places. Most people in the laboratory world are familiar with the concept that not all claims get paid. Everyone is used to this concept… . . . read more

BILLING & COLLECTIONS

5 ways to break down bureaucracies to get payer contracts

By Steve Selbst bio It is important to remember that payers are large companies, with protocols, policies and business practices. As with any large company, there are bureaucracies, and they are necessary to maintain the order and success of these organizations. Therefore, the first tip is to understand that to get contracted you need to identify the right department and right person to send your request to get contracted. This is usually the payer contracting department and payer contracts’ manager. Generally, you will be sending your requests to the payer contracts’ manager in your state. A common mistake is to—instead—send these requests to provider relations or to another department. This brings us to our second tip. That is, figure out the approach the payer is using to establish its fee… . . . read more

Why Cleaning Up Your Dirty Data is Critical to Clinical Interoperability and Financial Survival

By Gregg Church bio
Hospital-based and commercial labs are flooded with all types of mismatched patient data. However, disparate systems coupled with a lack of universally mandated data standards and protocols means that big data just gets bigger—and clinical interoperability challenges just get larger…

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