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New Report Helps Clinical Laboratories Level the Playing Field with Private Health Plans to Overcome Unpredictable Payer Policies and Get More COVID-19 Test Claims Paid in Full

·4-min read

Since the outbreak of the SARS-CoV-2 pandemic, clinical laboratories submitting legitimate claims for COVID-19 tests regularly find themselves battling to get paid because certain private health plans simply denied these claims, often with no explanation for the denial. There are even cases where some private payers ignored federal and state laws requiring payment for COVID-19 test claims. But the result is always the same: labs performed the COVID-19 test requested by the doctor, but the payer did not reimburse the claim.

Many labs continue to lose tens or even hundreds of thousands of dollars from unpaid COVID-19 test claims as payers do what they frequently do: create reasons to deny a claim and hope that the clinical lab will not appeal or resubmit.

To level the playing field and give the nation’s vital clinical laboratories the knowledge and tools they need to submit clean COVID-19 test claims and receive fast, full payment, The Dark Report and its sister publication, Dark Daily, just released the report Getting Paid for COVID-19 Test Claims: What Every Clinical Lab Needs to Know to Maximize Collected Dollars.

This is the nation’s first comprehensive guide and roadmap that clinical laboratories can use to understand proven ways to address burdensome policies payers enact specifically to reject COVID-19 test claims and avoid paying labs, even when required by federal and state law. Fifteen nationally recognized experts in lab test coding, collections, law, and managed care contracting share their expertise and recommendations on the proven ways for labs to submit clean COVID-19 lab test claims.

"It is shameful that, in the midst of an historic pandemic, so many health insurers deliberately place hurdles in the COVID-19 test claims submission and payment process that are designed to deny or delay payment to the nation’s clinical labs, who are the front line for SARS-CoV-2 testing," stated Robert L. Michel, Editor-in-Chief of The Dark Report and publisher of this report. "The experts who contributed to this report understand these unwelcome payer actions and explain often simple steps labs can take to lift the number of clean COVID-19 test claims they submit, to speed reimbursement, and to receive full payment for these claims."

Our experts’ goal is for you to submit clean COVID-19 test claims, get paid for a larger proportion of your claims, and have the documentation to defend those claims when the health plans’ auditors show up at your lab. Doing better at each of these steps means more cash flow for your lab. At 118-pages, Getting Paid for COVID-19 Test Claims: What Every Clinical Lab Needs to Know to Maximize Collected Dollars, will increase your lab’s collected revenue and cash flow by helping you with practical information and actionable intelligence across the following chapters:

  • Understanding Sources of Risk in Getting Paid for COVID-19 Testing, by Kimberly Scott

  • How to Use This Report, by Kimberly Scott

  • Why Submitting COVID-19 Test Claims Is Difficult: Considerations for Billing and Reimbursement, by Danielle Holley Tangorre, Esq., O’Connell and Aronowitz

  • Federal Requirements for Billing and Reimbursement of COVID-19 Testing, by David Gee, Esq., Kathryn F. Edgerton, Esq., and Caitlin Forsyth, Esq., Davis Wright Tremaine

  • State Law Requirements Regarding Payment for COVID-19 Testing, by Paul L. Garcia, Esq. and Erin Sclar, Esq., Hooper Lundy & Bookman, PC

  • General Practices or Billing and Collecting from Consumers and Patients For COVID-19 Testing, by Ann Lambrix and Alex Mitchell, Vachette Pathology

  • Coding COVID-19 Test Claims: Codes, Rates, and Special Considerations 59, by Diana W. Voorhees, DV & Associates Inc.

  • Auditing and Medical Necessity Documentation for COVID-19 Tests, by Courtney G. Tito, Esq., Richard S. Cooper, Esq., Elizabeth Sullivan, Esq., and Emily Johnson, Esq., McDonald Hopkins, LLC

  • The Anti-Kickback Statute, Stark Law, and EKRA in the Time of COVID-19: What Clinical Laboratories Should Know, by Courtney G. Tito, Esq., Richard S. Cooper, Esq., Elizabeth Sullivan, Esq., and Emily Johnson, Esq., McDonald Hopkins, LLC

  • Requirements for Reporting COVID-19 Test Results to Authorities, by Kimberly Scott

  • Critical Laboratory Information System Capabilities and Opportunities for End-to-End COVID-19 Testing, by Kiran Ganda, Sunquest Information Systems

Learn more or order this essential report here.

For additional information, contact Amanda Curtis, 512-264-7103

About The Dark Report

Established in 1995, The Dark Report is the leading source of exclusive business intelligence for laboratory CEOs, COOs, CFOs, pathologists, and senior industry executives. It is widely read by leaders in laboratory medicine and diagnostics. The Dark Report produces DarkDaily, as well as the renowned Executive War College on Laboratory and Pathology Management.

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Kristen Noonan