Compliance plays a significant role in toxicology testing. The two biggest items usually overlooked are how often high complexity testing is done for repeat patients, along with the collection of patient balances. Guidelines state testing on patients should be individual to the patient’s specific medical history; standing orders or custom panels that apply to all the physician’s patients is not individualized. The clinician’s documentation must be patient specific and accurately reflect the need for each test. We assist ensuring that confirmatory tests should be performed to confirm a positive qualitative result and the rationale for each confirmatory test should be supported by the ordering clinician’s documentation.
The other factor involved is related to patient balances. Many toxicology tests are billed out at three to four times higher than the allowable amount, which as a result, causes the billed amount to be quite higher, usually in range of $400 to $500. As we mentioned above, eligibility verification comes into play due to the fact many carriers perceive this as a non-covered benefit and/or it is applied to their out of network deductible due to the testing facility not participating. This leads to extremely high bills on the patient side of the equation.
This creates frustration for the patient and the primary care provider because of the high balance owing. In order to combat this, many toxicology laboratories will inform their provider clients to disregard the bill; when in fact this is against healthcare industry guidelines.
Remaining compliant is a key factor in toxicology billing. Coronis works to assist the labs with fee schedules, setting up discounts and payments plans in order to stay compliant, generate increased revenue and keep both the provider and patient happy.
Learn more about toxicology here.