Improving Collections for Diagnostic Lab Tests

This case study details the collaboration between a molecular/genetic laboratory and TELCOR Revenue Cycle Services (RCS) to enhance billing collections for a new proprietary cancer risk assessment test. The laboratory faced challenges in securing reimbursement from Medicare due to complex appeals arising from payers not recognizing the test's medical necessity. TELCOR RCS implemented smart workflows to manage documentation, claim submissions, and appeals, significantly improving the process. The TELCOR Document Management module automated the handling of payer-specific documentation, enhancing visibility into claims and appeals. The results included a 400% increase in average reimbursement rates for the test, a 95% clean claim pass-through rate, and an overall collection rate improvement to 90%. This partnership illustrates the effectiveness of specialized revenue cycle management services in navigating complex appeal processes and achieving higher reimbursements for new diagnostic tests.