Clinical Lab Optimization Specialists

For Billing Teams

The Problem

As a billing team, you play a pivotal role in collecting revenue for your organization. However, you face several challenges that make it difficult to do so. You don’t have a direct relationship with the patients, and you don’t have control over what the providers order or the information that they provide. Additionally, there is a lot of pressure on you to collect more revenue despite cuts in reimbursements and increasing challenges with prior authorizations and other payer-implemented rules. It is a struggle to keep up with the ever-changing billing landscape.

The solution

Sphere shifts the billing process to the front end at order entry, where there is direct interaction with the patient. We ensure that demographics, eligibility, and benefits have been checked, medical necessity is met, and that there are no additional requirements like prior authorization required before the order is even submitted. If any additional information is needed when the sample has been processed and is ready to bill, we have a direct communication queue to which billing, the provider, and the staff have access. This approach to billing prioritizes transparency and clear communication. This process not only expedites the timeline to get clean claims billed, but also increases the likelihood of reimbursement for the claims and allows your team to focus on the complex problems where they are most needed.

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