Velan Assists a Kentucky Laboratory Service in Stabilizing Its Billing Practices, Reducing Denials, and AR Days.

Medical Coding and Billing

A claims clearinghouse was needed by a KY-headquartered laboratory services center to help reduce days in A/R and drive cost savings by streamlining laboratory invoicing processes, as well as efficiently managing the revenue cycle management process to impact cash flow positively.

CHALLENGES

The missing latest annual release codes for the LAB’s invoicing process.

A great majority of the payors were uninformed about claims; 85 or so were for the medical, for which payment was made on the rest of the expenses paid on the claim by the remaining parties and its injury agreements and…

The payer (CPT) reimbursed less than the average.

RESPONSES

Velan submitted the sample claims to the insurance(s) and made concurrent follow-ups to ensure that the claims were processed after identifying the correct lab codes for the year 2025.

Velan discovered that the payer ID was not updated in the clearinghouse, and there is a system error. The sample claims were processed by addressing the identified issues and conducting concurrent follow-ups with the clearinghouse and the payer.

The reimbursement for the CPT was not processed as a result of an internal error in the payer system. Velan sent all claims that were less than reimbursed for reprocessing, and he also followed up with the payor.

RESULTS

A 30% reduction in coding-related denials resulted in a month-over-month improvement in cash flow.

The payor submitted all claims for processing in order to receive a singular reimbursement, which led to a 15% increase in cash flow.

Began getting paid for the C.P.T.S. upfront, which increased cash flow by 10%.