By: Angela Granlund, Executive Client Administrator
We recently had a pathology group whose hospital upgraded its Laboratory Information System (LIS). Initially, everything appeared to be working smoothly after the upgrade. However, while reviewing date of service procedure volumes a couple months later, I noticed that two of the CPT codes that the group normally performs had no volumes being shown as billed out. The group had not changed their testing capabilities, so I contacted their billing agency to find out why these two codes were not being billed.
The billing company said they had not noticed the drop in volume or questioned it. After researching the issue, the biller found that the codes were no longer coming through the feed from the hospital. Upon further investigation with the hospital, they learned that when the hospital updated to the new version of the LIS, a glitch caused these two codes from the feed to the billing company.
If this error had not been caught, it would have cost the group about $13,000 in revenue. But once the omission was identified, the hospital fixed the issue, created a file of the missing codes reaching back to the date of the LIS update and sent it over to the billing company, who then filed the claims. Fortunately, the issue was identified soon enough that no denials for timely filing occurred.
What do you need to do to make sure this doesn’t happen to you?
- Make sure you are in the loop when it comes to hospital or laboratory system updates or upgrades.
- Alert the billing staff or company when you know system changes are scheduled.
- Require your billing staff or company to track procedural volumes every month as well as review the data and question any variances.
Do you get regular feedback from your biller? Are you confident that they haven’t missed billing anything for you? If not, give us a call at 517-486-4262 – we can help you find out!