pathology

ImagineSoftware: Automating Pathology
March 29, 2024

While still attending high school, Dr. Kevin Homer developed his own pathology software billing package for his father’s pathology business. This custom software package was ideal, even years later when Dr. Homer acquired his father’s practice. However, with the implementation of ICD-10 it became imperative for him to find a billing software that was robust enough to handle the volume of procedures his office charged for as well as one that could handle the coding necessary for the office to operate successfully.

pathology coding case study

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In 2015, Dr. Homer began searching for a billing software that could handle the number of procedures and codes that his office generated every year, he ultimately decided to go with the ImagineBillingTM platform combined with ImagineAppliance® to help automate his revenue cycle process.

According to Dr. Homer, ImagineBillingTM is a very robust software package that is able to handle the multiple thousands of procedures his office handles every month and ensure they are processed correctly and accurately.

But it’s not just Imagine’s software that has kept them as loyal customers for the last five years. It’s also Imagine’s dedication to innovation and customer service that keeps Dr. Homer and his billing team happy and enthusiastic clients.

“Imagine has never been a ‘drop it in your lap and see you later’ company. They are partners with us. One of the things I really enjoy and appreciate about our relationship is the biweekly scheduled conference calls we have with our Client Success Manager to address any issues that come up. Our environment isn’t static; it’s constantly changing. Having a reliable partner like Imagine that helps us work through issues and create solutions as our business needs change is essential to our success.”

Another aspect of ImagineSoftware’s platform that Dr. Homer has implemented is the ImagineAppliance®, Imagine’s automated medical billing solution. With the Appliance®, Dr. Homer’s facility is able to push a high level of procedures through every month and have a relatively low level of outliers.

“We make it a priority to automate as much of our process as possible. If we discover repeated outliers, we write a rule so that they start flowing through the system. Our staff works with Imagine’s Client Success Managers to ensure that we don’t have to revisit the same process repeatedly,” Dr. Homer says.

ImagineAppliance® allows for custom rule writing, auto-coding, data validation and electronic remittance all in one place. In effect it allows the staff to be customer facing rather than account facing.

Due to the powerful ImagineSoftware platform his office has implemented they are not only processing thousands of procedures they also are collecting more data than they did previously. They have a higher level of insight into their office and can access the data in their system any time through ImagineIntelligence™. Every night the software takes a snapshot of the business which Dr. Homer can manipulate and query without slowing down the system his employees are working on.

“Who are our top 5 referring physicians? What day is our busiest? How is the work divided among the pathologist? I can easily find answers to these questions with the ImagineIntelligence™ product. Those are the answers I need to have in order to run the business. Having the ability to build those custom reports is phenomenal and has become an integral part of running my business,” Homer stated.

Beyond the billing software and automation capabilities, Dr. Homer continues to tout the relationship he has built with ImagineSoftware’s dedicated team of managers. “Our Client Success Manager continually goes above and beyond for us. She knows how to work our system and pull the right levers within Imagine to get us the help we need, and if our CSM doesn’t know the answer they find someone that does.”

Above all is ImagineSoftware’s level of customer service. “All of the people at Imagine are always so nice and friendly. But it’s just not enough that they treat you nice; they also have to be good at what they do. What I appreciate is that I don’t have to make the choice between a company that does things right or is friendly, with Imagine I get both.”

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Pathology Billing in 2021 & Beyond
March 29, 2024

The Pathology Industry was put through the test during the last 12 months. Between developing vaccines and conducting research, new regulations are adding more to your plates (or petri dishes). Is your group prepared for these continuous changes? Do you know what is ahead, in 2021, for your industry and group?

Join us as we discuss the ways Pathology Practices can best adapt to new regulations and increasing volumes. In this webinar, hear from Pathology Professionals, including clinical directors and industry consultants, of technologies and best practices to prepare your own team for 2021 and beyond.

On the panel we welcome Mick Raich, President/CEO of Vachette Practice Management, Dr. Kevin Homer - Laboratory Director of Texas Pathology Consultants, and Jill Lewis, Practice Administrator of Histopath Inc.

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Pathology Billing KPIs: 3 Metrics for Tracking Your Performance
March 29, 2024

Definition

Key performance indicators in pathology billing are a measure of pathology billing performance in select areas like clinical and anatomical pathology billing using criteria such as time and money that are important to the operations of a laboratory or physician billing practices.

KPIs are the things that management is happy to see. If you ask your average CFO about their biggest concerns, most will tell you that increasing cash flow is a high priority. In order to succeed in this, you must know which key performance indicators to track that have a direct impact of cash flow, identify the mistakes or bottlenecks preventing you from improving your performance, and have a means for collecting and disseminating that information to the people responsible for making those improvements.

pathology billing key performance indicators

Key Performance Indicators for Pathology

The best way to know if you’re making progress on the things that fuel your business is by monitoring them. It will help you stay the course and help build confidence as you see the process you’re making in real time. Start by identifying key performance indicators (KPIs) with the highest potential for improvement, followed by having reports set up specific to those KPIs.

  • Net Collection Rate (%): Net Charges ÷ Net Collections. The national average is between 88-92%. Below average might mean your staff isn’t following up as quickly as they should.
  • Bad Debt (%): Total Amount Written off ÷ Total amount that was eligible to collect. 10-12% is considered good to great in pathology. A great bad debt percentage is the product of higher collections due to better propensity to pay.
  • Denial Rate (%): Total number of claims denied ÷ Total number of claims remitted. You can also take the total dollar amount in denied claims divided by total dollar amount in claims submitted for remittance. This KPI tracks the percentage of denied claims and provides insight into how efficiently your claims process is operating.
ImagineIntelligenceTM provides custom reports and intelligence at scale to help you make data-driven decisions.

Reimbursement Challenges in Pathology Billing

In a 2019 survey conducted by independent research firm Laboratory Economics, 82.4% of laboratories and pathologists cited declining reimbursement as one of their biggest challenges. Pathology billing is comprised of several interconnected functions between multiple parties inside and outside a medical practice. Medical groups and large practices do close to 350,000 annually. Errors to watch for that slow down or reduce revenue growth include:

  • Missing billable tests- high volume testing leads to some billable tests being missed. Electronic interface between LIS systems and your billing platform reduces the number of tests being lost between front-end and back-end processes. This still requires careful due diligence. Patient insurance, demographics, and charge information between systems need to align or else may result in a higher denial rate.
  • Issues in eligibility - Eligibility errors comprise of 35-40% of denials even among the most well-run medical groups and practices. Online eligibility checks, insurance verification are effective methods for reducing these errors. Eligibility information being readily available within your billing system means that co-pay and deductibles can be collected prior or immediately following a test. In cases where insurance does not cover a test, patients can be given options for coverage or offered a discount depending on their propensity to pay. All this information can and should be available within the system.
  • Documentation errors- ICD-10 adds complexity since the lab and pathologist are now dependent on the referring provider for the actual ICD-10 code. There is also a need to make sure documentation captures all work done accurately and in a way that minimizes downstream denials. Pathology groups and practices should receive feedback through regular reporting.

 

Pathology Billing KPI Dashboard

A pathology billing KPI dashboard gives billing staff, managers, and executives immediate access to both basic and advanced data to help them better understand the current state of their billing. Even if your billing is running smoothly, you still need a dashboard to let you know in what direction your pathology billing KPIs are trending. When searching for a pathology billing dashboard, it should have the following capabilities:

  • The ability to drill into key performance areas including all KPIs and challenge spots. Separate and list denials by insurance plan according to which ones need to be worked.
  • Enough flexibility to accommodate different needs. Not every practice will have the same set of priorities. Dashboard that accommodates an assortment of filters and measures (ex. total claims, average reimbursement, days in A/R) and dimensions (ex. service date, payers, locations). Saving to a private folder or shared folder for everyone. Schedule to refresh data every day, week or month. Finance cube (denials by carrier, refunds, charge payments) Employee Productivity (ex. What they’re currently working on. “Show Me The Money” answers what is currently outstanding in your system (ex. Charges and claims on hold, statements being reviewed).
  • Accessible feedback mechanisms like email notifications and scheduled reports for communicating up and down the chain of command. No one should be in the dark on how your practice is performing ever again.
Get in touch with one of our Revenue Success Managers to learn how practices have grown by rethinking the way they report on performance.
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Pathology Billing Software
March 29, 2024
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