By: Dyana Williams, Client Engagement Manager, Lighthouse RCM Solutions

Recently, a Lighthouse RCM Solutions client asked their billing vendor: What is our commercial reimbursement rate as a percentage of Medicare for CPT 88305?

Utilizing our RCM Spotlight billing and denial management tool, our team was able to compile the following information for the client in under 10 minutes. This analysis lets us see at a high level how various plans compare to one another and other geographic areas in the United States.

• READ MORE DENIAL SPOTLIGHT ENTRIES:
  • Utilizing Billing Data to Bolster Payer Contract Negotiations
  • Examining Common Reasons for Drug Screening Denials
  • Steps for Mitigating Timely Filing Denials on Laboratory Claims
  • Incorrect Modifier Usage Ties Up $200K in Lab Reimbursements
  • The Significance of Medical Necessity and CO-50 Denials

Using this breakdown, we then drill down from here to do a similar comparison in payer against payer lab reimbursement within the same geographic area to ensure that each payer’s rates are competitive within the marketplace. The data confirmed commercial payers for this provider are allowing an average of 239% of Medicare’s allowable for 88305 services.

 

 

 

 

 

 

 

Expert RCM Insight and Analysis

RCM Spotlight uses a copy of the standard claim remittance data that you exchange with your payers. We then analyze the data in our proprietary AI engine and compare your results with your peers across the country to deliver insights and identify revenue enhancement opportunities.

Interested in learning more about how our RCM services can benefit your lab and bottom line? Contact us today for a free consultation.

 

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