Laboratory billing in California is a world unto itself. For anyone who has handled medical billing here, you are well aware of the fact that thanks to an ever changing and more complex coding system in the state, taking care of billing both your patients and their insurance companies has become very time consuming.
Consider how long it can take you to find an employee who understands the current complexities of dealing with insurance companies such as Anthem Blue Cross of California. According to recent data supplied by the AMA, Anthem has a well-earned reputation for paying far less per claim than any other health care insurance company in the state and they show no signs of changing this. Now when you add in the fact that ICD-10 coding is more complex, you are going to need a highly trained employees.
After you have spent the money to train employees and they suddenly decide that you need to move your laboratory, you are going to be right back where you started. This is where you are likely to find that outsourcing your medical billing to a company like Ibex RCM can really pay off. Not only do we have a highly skilled staff on hand, but we continuously research and train our employees to stay on top of the constant changes in coding and reimbursement rules that occur in medical billing.
We appeal the underpayments and take the necessary steps to ensure that you get paid. And if this isn’t bad enough, you are going to have to deal with California Medicaid or as it is more commonly referred to, Medi-Cal, which is one of the most difficult medical insurance payers in the country. Records show that not only does Medi-Cal have more claims denied than any other payer, there are more mistakes made per capita and more “lost” claims than any other insurer in the United States. That’s right, of the thousands of insurers and 50 state Medicaids, Medi-Cal ranks dead last.
When you have to rely on a significant part of your overall collections from patients with Medi-Cal, not only do you have to deal with all of these paperwork problems, you are faced with the fact that the contracted rates paid by California Medi-Cal are some of the lowest in the country. This means that you have make sure you collect every dollar you deserve.
In many cases when you are out of network provider for Blue Cross of CA or Blue Shield of CA, which is the case for many labs since they typically have closed panels, they are going to send the payments directly to the patient instead of the laboratory. This can be a very bad situation as these companies do not send out EOBs and you are likely to have no idea if they have paid or how much they have paid. We will contact the payer after thirty days and find out how much they actually paid the patient so that we can bill the patient for the full amount before they can decide to spend it instead of paying you the money you are entitled to.
Finally you are going to have to deal with patients who are covered under California Workers Compensation insurance. Once again, you are going to find the CA workers comp billing is very different from that of most other states. The reason for this is that the fee schedule is far more negotiable than most states and you have options such as a lien process to help you get paid should there be a dispute. You can use the 1997 CPT codes but there are others including CMS clinical lab codes and certain CA workers comp codes that are required in order for you to get paid.
As you can see, due to the massive complexity of California medical billing, if you want to ensure that you receive maximum compensation for your services you may need to find a medical billing company that has a large client base, expertise, and operations in California. Ibex RCM is a medical billing company that specializes in working with physician’s offices, diagnostic testing facilities, and surgery centers. Our range of services is intended to help you realize the highest possible return on your billing utilizing a team of highly experienced coders and employees.