Convincing the C-Suite
Winning administrative support for outsourcing medical billing can be a major challenge. Internal resistance to change, turf battles, and a general lack of knowledge about the outreach lab business may derail the best-laid plans. That’s why it’s vital lab administrators develop a comprehensive strategy for securing C-suite buy-in.
By carefully identifying key decision makers, clearly articulating the benefits of outsourcing, and addressing all questions and concerns openly, lab leaders can often convince even the most hardened skeptic that outsourcing outreach billing is in the best interest of both the lab and hospital.
Crunch the Numbers and Emphasize Benefits
The first step in creating a successful buy-in strategy is to clearly document the limitations of the existing system and the resulting financial impact. This involves evaluating denials, quantifying small-balance write-offs, and analyzing bad debt. Then, present this information within the context of the lab’s existing financials to demonstrate how improved billing management could benefit the bottom line.
Next, work with an outsourcing vendor to develop a comprehensive overview of the full range of benefits. An experienced vendor will be able to assess current claims and provide estimates for both revenue gains as well as reductions in A/R days, bad debt, and billing expenses.
Look for a vendor that offers:
- A proven ability to increase collections through a best-practices operational approach
- Staff experienced in handling high-volume, small-dollar lab claims (to reduce write-offs)
- Automated front-end rules engines capable of producing clean claims (to reduce back-end errors and denials)
- Electronic claims submission and remittance
- Receivables monitoring to ensure payers are reimbursing according to contract terms
- Assistance with managed-care contract negotiations
- Monitoring of client statistics to aid in physician education
- Robust compliance monitoring to reduce regulatory risk
- Comprehensive daily reporting, including a full range of practice metrics, denial-management data, revenue-by-clinician, and national comparative benchmarking
Make the Case
When preparing your presentation, be sure to include a description of the vendor’s scope-oftraining for billing staff and its experience with labs and payers across the country.
Next, use comparisons to illustrate the differences between the hospital’s current outreach-lab reporting capabilities (if any exist) and the range of detailed reporting available through the vendor. Today’s advanced laboratory billing applications produce a wealth of highly granular information that can help managers make more informed operational and strategic decisions.
Additionally, explain the ”24x7” web-based systems that allow administrators to monitor performance via dashboards, with the ability to drill down to assess a full range of key performance indicators. Managers can use the dashboards for benchmarking and customizable data mining, so they don’t have to wait for month-end reporting to explore and correct issues.
Finally, in developing a winning strategy, pay special attention to the vendor’s compliance tools and its knowledge in the laboratory regulatory arena. Given today’s complex and constantly changing regulatory environment, few laboratories—regardless of how capable—have the resources required to stay fully abreast of all compliance issues. In contrast, a national billing firm often has multiple individuals dedicated to carefully tracking both public and commercial compliance matters, which enables the vendor to alert laboratories to substantive changes or new rule interpretations. Because the penalties for federal and state non-compliance have never been higher, and enforcement activities never more aggressive, any steps that can reduce exposure are vital for both the lab and hospital.
For example, under the Protecting Access to Medicare Act (PAMA), applicable laboratories are required to report private payor data including the code, reimbursement per code, and volume per test for January 1–June 30, 2019. While affected labs have until March 31, 2020 to report the data, hospital outreach laboratories needed to have systems in place to capture this data at the CPT®/HCPCS 1 code level beginning January 1. To encourage labs to report full and accurate data, the PAMA law authorizes CMS to impose up to $10,000 2 per day in civil penalties on laboratories that fail to report, or for each omission or misrepresentation in reporting.
Target the Decision Makers
Once you have all relevant information assembled, the next task is to identify your organization’s key decision makers and construct a time line and process for presenting the data.
Generally, several individuals will want or need to be a part of the decision-making process. However, it’s essential to understand at the outset where the true ‘go/no-go’ power lies so you can focus your efforts. After identifying this authority, you can request decision criteria to ensure all points are addressed, then schedule a series of meetings to present the information.
Anticipate and Prepare
The key to a persuasive presentation is to not only present your case, but to also anticipate the questions you will receive and prepare your answers in advance. This will show decision makers you’re in tune with their concerns and you’ve done your homework, and ultimately, it will help to streamline the debate process.
Though it may seem counter-intuitive, if questions you’ve anticipated aren’t posed during presentations, it’s in your best interest to share them proactively. This enables you to cover all bases and reduces the possibility your strategy is later denied behind closed doors due to concerns you didn’t get a chance to address. You can further solidify your presentation by preparing an ‘FAQ’ document with the questions and answers for later reference; this will also keep your team on the same page with responses.