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Stepwise Success

Charge Reconciliation

Published September 28, 2016 3:32 PM by Scott Warner

Here’s a reality check: if we don’t get paid, the doors don’t stay open. Sure, that’s the problem of the billing office, collection agencies, and insurance companies. Bench techs don’t need to worry about that stuff. Right?

Depends on who you ask, I guess. It’s the manager’s responsibility to bill accurately and timely for each test performed, and that includes reflex charges (in-house and referral), supplemental charges, and late charges. Ideally, this should be done on a daily basis to capture as much revenue as possible and not wait until an invoice arrives weeks after the date of service.

Referral testing as made this task especially onerous. It’s common to have “exploding” charges attached to panels that conflict or duplicate what is already ordered for the day. Along with medical necessity, ABNs, and registration issues, the modern laboratory has become a compliance nightmare.

Still, a bench tech can remain blissfully ignorant, I suppose, depending on the size and function of the laboratory. An awareness of what drives our business never hurts. It can be quite eye-opening.

At a basic level, for example, we have to get paid for the work that we do. But what do we do that we get paid for? A close examination of this may change your practice. For example, in the 2016 CPT Code book the following are listed:

85004 Blood count; automated differential WBC count
85007    blood smear, microscopic examination with manual differential WBC count
85008    blood smear, microscopic examination without manual differential WBC count
etc.

The indented descriptions are clue that these are just variations of the parent; in other words 85007 and 85008 are just variations of 85004 (most use 85025). That makes sense, but it means you can’t bill the codes together, even with a modifier. Since reimbursement may be immaterial (especially in the DRG world), does it make sense to perform manual differentials? Are we getting paid for our extra labor? The short answer: not really.

At a more basic level, bean counters compare apples to apples in benchmarking your billable tests compared to other labs of similar size. Lab tests that take longer but don’t add value to the report will decrease your productivity. Our business has become all about making widgets, it seems. Counting the widgets accurately per hour worked can be compared to a standard. While this makes a certain sense, it doesn’t begin to capture to complexity of what we do.

With labs everywhere under fire to do more with less, push older techs to outperform competitors, and create innovation out of thin air, there has never been a more important time to bill accurately and get paid for what we do. But knowing that our charges drop accurately and timely is nearly as difficult a problem to resolve as report distribution. We largely assume our information system does both. Does it?

NEXT: The Power of Listening

posted by Scott Warner
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About this Blog


    Scott Warner, MLT(ASCP)
    Occupation: Laboratory Manager
    Setting: Critical Access Hospital
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