Unnecessary testing is one of the highest cost components in healthcare and a frequent area of third-party payer scrutiny. Educating referral sources can have a significant impact on reducing denials and improving the bottom line.
Brigette LaBar, Revenue Cycle Executive, XIFIN (San Diego): There are many factors driving the over-utilization of unnecessary testing, but one of the primary causes is that referring physicians don't know which test is best to assist in the diagnosis of their patients' condition. There are often conflicting recommendations from the various medical specialty groups and information about the latest technology isn’t readily available. And some patients just insist on a test they heard about.
So given the pressure, what can you do to prevent limited coverage denials? Educate your referral sources on the criteria and appropriateness of the tests provided. You can share the local and national coverage limitations with referring physicians because the information is public knowledge. Education is a more powerful marketing tool than donuts and coffee mugs in referral-driven healthcare.
If you would like to share your RCM best practices, please email Carrie Pallardy at cpallardy@beckershealthcare.com to be featured in the "RCM tip of the day" series.