Logistics inside Molecular Testing Labs

Molecular’s Revenue Cycle team includes Patient Registration, Customer Service, Coding Compliance, Contracting, Billing and Collections. Revenue Cycle prides itself on having compliant coding and billing practices and that our patients have an exceptional experience.

There are more than 2,000 small and large insurance companies in the United States. The industry tends to favor a couple of national laboratories and it is often difficult to convince an insurance plan to let us into their exclusive laboratory network. An out of network status can lead to denied claims and higher out of pocket cost for our patients. Our ordering provider partners prefer to work with us, over the other national laboratories, because of the personal service we offer, our extensive testing menu, our online ordering platform and the timely delivery and easy to read laboratory reports. We are able to use testimony from these provider partners to help in our efforts to grow our network of contracted insurance carriers. This hard work has meant a steady increase in our in-network list of payors and has significantly reduced out of pocket cost for our patients. (of course I expect James will have a lot to offer here and I welcome his input).

In addition to our tenured staff, Molecular has invested in partnerships with several organizations to ensure timely, accurate and compliant billing. FrontRunnerHC® helps ensure that insurance information collected for our patients is accurate and effective on the date of service. XIFIN® RPM, our preferred billing software, has federal and state coverage and coding policies built in to help ensure our coding compliance is superior. XIFIN® also allows for quick and easy online patient payments, and they provide resources to help ensure updated and compliant billing practices are being followed.

Navigating the world of health insurance billing and collections is extremely complicated due to the sheer volume of health plans in our country and the complexity of insurance coverage and billing policies. Our billing and collections team members each have more than 20 years of Revenue Cycle experience making them some of the best in the industry. That experience is used to help influence policy change, improve insurance payments, reduce denials and reduce patient out of pocket costs. We wish our patients never had to receive a bill for the cost of their laboratory services, but when they do, we know we have done everything we can to prevent it and we pride ourselves in making the patient collection process as stress free as possible for our patients.

In addition to the above, Revenue Cycle has a robust internal auditing system. This system has been programmed to detect non-compliant ordering practice. This allows us to immediately identify opportunities to educate our ordering providers. Internal audits are also conducted to identify educational opportunities for our staff and to ensure automated processes are working as designed. Discovered opportunities are immediately recorded and action plans are put into place to rectify the issue and avoid recurring problems.

Molecular’s Revenue Cycle team works tirelessly to eradicate any roadblocks to the diagnostic lab testing our patients need at little no cost to the patient. We do this by increasing the size of our payor network, fighting to change medical policy and advocating for our patients.