Why Outreach is Vital to your Lab's Future

 

Outreach 101: Q&A

Following the Outreach 101: Why Initiating an Outreach Program Is Vital to Your Lab’s Future Webinar presentation, the Huntsville Hospital team of Kelli Powers, Vicky McClain and Kristie Campbell generously took time to respond to a variety of questions. Their responses are provided below. Have further questions or ideas on outreach? Click on CONNECT above to share.

Q: Can you share any information regarding the structure of your laboratory within your organization? Are you considered a part of the hospital or a reference laboratory?

“Our outreach program functions within the hospital laboratory structure. We continue to bill as a hospital laboratory on a UB. As a result, if the hospital has a contract with a payer, then the lab is also able to bill the payer. There are pros and cons to this, but over the years the financial pro forma for the lab and the hospital were reviewed periodically to ensure that this model was still the best financial option for our institution. "

Q: If you primarily bill insurance, is it appropriate to bill the client any charges that are denied by insurance due to non-medical necessity?

“To alleviate the possibility of client dissatisfaction, we try to educate our clients who consistently order tests that do not meet medical necessity. Typically, this is only an issue with clients who send in specimens. We monitor the clients for compliance with medical necessity and provide education for clients that order tests that do not meet medical necessity. This approach has worked well for us.”

Q: What percentage was billed to the client or institution?

“Less than five percent were billed to a client or institution.”

Q: What connectivity software does your outreach program use

“We currently use Atlas, although we began interfacing EMRs prior to installing Atlas.”

Q: What type of courier service do you have? Have you hired your own courier staff and purchased vehicles or do you partner with an established courier service in your area? If you have your own service, how many vehicles do you have? How much cost is allocated to courier services as a percent of the total cost of your outreach program?

“We began the program using a contracted courier service, which was acceptable for about the first two years of the program. Today, we use a dedicated hospital courier service that’s managed by another department, but the vehicles and staff are allocated back to the lab. Currently, we have 10 vehicles and about nine FTEs allocated to the outreach program.”

Q: How would you go about selling outreach to a site that uses a large, commercial lab because of insurance contracts?

“I think the first thing you would need to do is gain a better understanding of the client’s insurance contracts. If you’re billing as a hospital lab like we do, then there will be a difference in terms of the charges and possibly co-pays for the patient. If you are billing as an independent lab, then this may not be such an obstacle. My recommendation would be to work with the client on a trial basis to test the billing system for the patients. You’ll want to follow the billing carefully to determine if there are truly any issues.”

Q: Is your lab a participating provider for all insurances, and if not, how do you handle where specimens sent from practices with in-office phlebotomy services? How do you resolve patient billing issues due to non-participating provider status?

“As a hospital lab, we’re a participating provider for all payers. The main billing issue we experience is with a patient who has a large co-pay due to a hospital facility fee, which can range anywhere from $50 to $250. Today, patients are becoming more knowledgeable about their healthcare plan coverage, so this issue doesn’t arise as often.”

Q: Do you use any contracted phlebotomy services?

“No, we currently do not use these services.”

Q: Do you receive electronic orders into the lab system? Are physicians providing an e-order requisition to the patient to present at the PSC?

“Yes, our lab is set up to receive electronic orders from many EMRs, which are filed into our Atlas software system. 

When a patient arrives at a PSC, the orders are available for processing without the need for a requisition.”

 

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