Based in Manasquan, N.J., Meridian Laboratory Physicians provides pathology services for four Meridian Health System hospitals in east-central New Jersey. The group’s 16 physicians annually perform about 300,400 clinical procedures and about 152,700 anatomical procedures.
In 2003, Meridian turned to Change Healthcare to shore up coding and billing. The practice had been working with a regional billing vendor that had neither the expertise nor capacity to meeting a range of essential revenue cycle management needs, including billing for the professional component of clinical pathology. Additional mission-critical requirements included CPT coding oversight, audits of billed work, regulatory compliance, and contract negotiations.
In recent years, Meridian has battled to make up for declining hospital volume, a changing payer mix, and reductions in Medicare and commercial reimbursements.
Once on board, Change Healthcare was able to successfully bill on the group’s behalf for the professional component of clinical pathology. The company was one of the fi rst vendors in the Northeast capable of addressing the complexities of professional billing, and those additional revenues helped Meridian initially increase collections by 15-to-20%. Change Healthcare also established electronic interfaces with Meridian’s affiliated hospitals to expedite the transfer of demographic and clinical data and to help submit clean and timely claims. At the same time, the company implemented comprehensive revenue cycle management procedures, including proactive denial management, coding audits, and rigorous compliance practices. More recently, Change Healthcare has worked side-by-side with Meridian to support the group’s continued expansion of its outreach business. Meridian provides services to a variety of external clinical organizations, including surgery centers and specialty clinics. The services from Change Healthcare range from tracking outside RVUs and referral physician trends to compliance with billing guidelines.
Change Healthcare continues to support Meridian’s facility-based and outreach businesses by overseeing the complex billing and accounting requirements associated with providing third-party services. As part of this effort, Change Healthcare has created a range of productivity tools that help the organization optimize efficiency across all operations.
Change Healthcare also offers market assessments designed to help the Meridian identify new business opportunities. Similarly, Change Healthcare conducts ongoing analysis of the group’s existing revenue sources, payer trends, and patient demographics to help Meridian fine-tune its referral mix and optimize revenue collection. Overall, the efforts have helped Meridian maintain financial stability during a period of market uncertainty and declines in traditional business opportunities.
Change Healthcare regularly renegotiates managed care agreements for the group and has consistently secured equitable rates, despite downward priced pressure exerted by payers. Separately, the company provides annual updates on changes in regulatory issues and CPT codes, and offered ongoing guidance and preparation during the shift to ICD-10.
“Change Healthcare has done an excellent job for us,” reports Anis Rangwala, M.D., president of Meridian.
“They’ve helped us increase our reimbursement during a time when many labs are seeing their revenues decline. Our client manager works aggressively and diligently to meet our needs. I truly can’t say enough about how beneficial this relationship has been for Meridian.”