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January 2014:
Billing / Consulting / Management


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Billing and Consulting: Molecular Diagnostic Tests
Jaleh Mansouri, M.D.


Molecular pathology tests have become an increasingly important tool for the pathologist in determining the diagnosis, prognosis, and appropriate therapeutic course for a number of diseases as new genes and their respective functions continue to be discovered and characterized. This growing trend in diagnostic pathology has increased both the cost of laboratory testing as well as the complexity of coding and billing for reimbursement by third-party payers. As a result, the American Medical Association Current Procedural Terminology (CPT)® implemented a new scheme for coding molecular tests (MoPath codes) that went into effect on January 1, 2013. This two-tiered system replaced “stacking”, a process whereby assigned codes were based on the type of assays performed to obtain specific testing results. Tier 1 includes high-volume molecular tests for a single analyte. Tier 2 includes low-volume tests classified into nine different ascending levels based on the type of procedures used and the interpretation of test results by physicians.

While this new system streamlines the coding process through the identification of analytes rather than technical assays, its integration into the current health care system still faces many challenges such as the determination of appropriate reimbursement fees for third-party payers. To address this issue, pathology laboratories and billing offices may benefit from seeking the advice of various legal and financial consulting agencies (e.g. Quorum Consulting, G2 Intelligence) with expertise in current market trends as well as health economics outcome research.

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AdvantEDGE Healthcare Solutions (AHS). Powerful pathology coding, billing and practice management services. We use incredible technology to maximize revenue and decrease costs, frequently in dramatic ways. AHS pathology clients see net collections increase 10 to 30%—with better control and understanding of their practice. Billing expertise in both anatomic and clinical pathology. The AHS promise to each pathology client is: More money, faster; Practice financial data anytime, anywhere; Regulatory compliance, built-in; and Client First service. Call toll-free now 877-501-1611 or email info@ahsrcm.com.

McKesson / Pathology Service Associates, LLC. PSA is a leading provider of pathology and laboratory billing, marketing, and business support services. PSA is dedicated to providing comprehensive business solutions to clients seeking to gain a competitive advantage within their markets. PSA's services assist clients in optimizing collections, facilitating additional referrals, acquiring new technology at preferred pricing, and exchanging knowledge with peers across the US, while avoiding compliance pitfalls. For more information, visit www.PSAPath.com or contact Diana Brooks at 1.800.832.5270 x2988 or dbrooks@psapath.com.

Physicians Independent Management Services (PIMS). PIMS is the nation's leading provider of pathology practice and medical billing services. Headquartered in a state-of-the-art 23,000 square-foot facility located in Tampa, Florida, Physicians Independent Management Services, (PIMS) is a full-service medical billing and practice management services company. Led by a highly experienced team of senior healthcare professionals specializing in anatomic and clinical pathology, PIMS developed PathX - a highly customizable and robust laboratory information system designed specifically for anatomic pathology labs. Healthcare providers and pathology labs across the country are leveraging the power and innovation of PIMS' products to increase productivity, efficiency and profitability. Visit our website or call today and find out what PIMS can do for you. For more information, visit www.pims-inc.com or contact Chris Hazelwood at (813) 490-7206 or hazelwoodc@pims-inc.com.

Vachette Pathology. Are you content with your current income? Can you afford to lose more money? Do not settle for less. More than 600 individual pathologists nationwide trust us with their financial oversight and practice management. Imagine: someone who has a successful track record negotiating with managed care, someone that solves your billing and payment problems and guarantees to help you put more money back into your pocket. Vachette Pathology is a pathology practice management firm that specializes in revenue enhancement. WE ARE NOT A BILLING COMPANY. You do not have to change billing agents to increase your income. You simply have to manage the process. Pick up the phone and call me and let’s start increasing your income today, contact Mick Raich toll free at 866-407-0763 or at mraich@vachettepathology.com.


Past / Future Feature Pages:

September 2013: Antibodies / Biomarkers
October 2013: Laboratories
November 2013: Consumable Lab Products / Clinical Lab Analyzers
December 2013: Grossing Equipment / Workstations
January 2014: Billing / Consulting / Management

February 2014: Microscopes / Microscopy Products
March 2014: Tissue Processors / Other Histology
April 2014: Laboratory Accreditation / Education / CME
May 2014: Computer Software and Systems
June 2014: Diagnostic Testing / Reagents
July 2014: Imaging / Digital / Photography
August 2014: Books & Journals
September 2014: Antibodies / Biomarkers
October 2014: Laboratories
November 2014: Consumable Lab Products / Clinical Lab Analyzers
December 2014: Grossing Equipment / Workstations
January 2015: Billing / Consulting / Management

Contact Sara Halladay-Klakulak, 248/646-0325, pathoutsales@gmail.com to advertise at PathologyOutlines.com, the world's most popular pathology website.

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