Planning for flu season amid the COVID-19 pandemic not only involves procuring reagents, swabs, and personal protective equipment (PPE) but also reengineering processes to remove steps that involve paper.
This is important because some lab managers have concluded that reimbursement rates for SARS-CoV-2 molecular assays do not cover their testing costs. David Nichols, a lab industry expert I spoke to earlier this year, said labs are spending between $40 and $150 per test. In addition to the cost of test kits, PPE, and other supplies, there also are overhead costs, such as rent, utilities, and labor.
Labs at hospitals and health systems, in particular, say they also must cover the cost associated with sending overflow specimens to reference labs for testing.
Then there is billing. Manual processes throughout the revenue cycle, cost healthcare providers overall an average of $29.27 per patient encounter, according to CAQH, a nonprofit alliance focused on streamlining administrative processes in healthcare.
Reacting to concerns about covering testing costs for SARS-CoV-2 specifically, the Centers for Medicare & Medicaid Services (CMS) in April upped the amount it pays for a test performed with a high-throughput analyzer from $51 to $100. However, in October, the agency revised those payment rates to encourage faster turnaround times. Beginning January 1, 2021, CMS will pay $100 per high-throughput test in which a lab completes testing within two calendar days from the time a specimen is collected from a patient. When a lab takes longer than two days to complete testing, CMS will pay $75.
Putting costs aside, patients are anxious to get their test results quickly. They do not want to wait seven days, which has occurred at times this year with COVID-19 testing.
Getting rid of paper will help solve these problems by speeding up turnaround times and reducing costs, allowing labs to maximize reimbursement from CMS and other payers. As we report in Medical Laboratory Observer’s first-annual LIS Product Guide, manual procedures exist in pre-analytical, analytical, and post-analytical phases of testing as well as in billing processes. (The guide also includes an informational product chart.)
In an ideal process, a web-based portal allows healthcare providers or patients to enter test orders and demographic and insurance information into an electronic system, which creates an order and a bar-coded label for the specimen. Once the specimen arrives at the lab, it can be routed to testing quickly. The same portal allows providers and patients to access test results easily, while also allowing information to flow easily to an electronic revenue cycle module.
Paper processes in the pre-analytical phase invite errors, leading to issues in subsequent phases of the process. For example, missing demographic information for patients results in payers rejecting claims and inaccurate reporting to state health agencies.
In the analytical phase, electronic processes include real-time pending work queries, electronic quality control reports, and auto-verification, which applies to up to 80 percent of testing results.
The bottom line: manual processes tend to be inefficient and do not scale well, particularly in the current environment where labs test thousands of symptomatic people daily for SARS-CoV-2, influenza, and RSV. And those testing demands will only increase as surveillance testing of asymptomatic people ramps up across the country.
I welcome your comments, questions, and opinions – please send them to me at [email protected]
