setstats Genesis Pathology Billing

Thank you for visiting our site. As you may be searching for a new pathology billing service, please consider the unique attributes that Genesis offers. There are a variety of choices when it comes to billing services and Genesis, with an exclusive focus on pathology, provides a powerful software solution focused on delivering outstanding financial results for pathologists by utilizing advanced algorithms and other proprietary automation techniques to make the billing process as efficient and error-free as possible.

Over the years, Genesis has prospered because of loyal and satisfied clients. Those clients know that Genesis has an advantage…a better software design that yields substantial and meaningful benefits. Those benefits come in two forms….first, system-based techniques that relentlessly work the process resulting in higher collection rates. Secondly, the advanced software developed by Genesis allows more work to be processed faster by fewer people, resulting in lower cost of operations for Genesis and ultimately lower service rates for you.

While Genesis is exclusively focused on pathology billing, we know it is the significant knowledge of the major issues that pathologists face in their practice that allow us to tune our software development and daily operations in a way that separates Genesis from other billing services. Additionally, we have amassed a very strong knowledge of the reimbursement practices of the insurance companies that supply the majority of the pathologist's revenue stream. When converting new clients to the Genesis system it is always apparent that the prior billing service was overlooking opportunities for maximum reimbursement from the insurance companies.

As all physicians face the impact of declining revenues due to managed health care and other forces in the marketplace, Genesis provides a means for your pathology group to offset profit erosion by providing a pathology billing service that contributes by both being less costly (service fees) and by driving higher collection rates through better systems execution.

Advantages of Genesis Pathology Billing Services

When considering which pathology billing service offers the best value, Genesis offers many advantages. Each billing service is unique and the attributes that distinguish Genesis provide real value for the pathology group that consigns their billing to Genesis. The following Genesis advantages are some of the keys to delivering outstanding service as we manage the billing function for our pathology clients:

A very important advantage is derived from the major reduction in the billing labor component that we achieve through our sophisticated use of our proprietary software. By needing fewer service people we are allowed to employ personnel with higher average salaries (and therefore we believe, higher skill levels). This dimension has significant impact when that person has to make a billing choice to pursue the collection further or write it off. Since the easy way out in any billing situation is to “just write it off”, our focus is to do it the right way, not the easy way. This is not software, but our software sophistication allows us to use less labor and pay those whom we do employ a much higher wage, resulting in better decision-making on behalf of our pathology billing clients.

It is common practice in many billing operations to accept write-offs ‘requested’ by insurance carriers when they should not be accepted. Since the patient will almost certainly refuse to pay since the explanation of benefits sent to them clearly indicates they do not owe the amount of the write-off, the billing person is left with two alternatives:

  • Contact the insurance company and get them to reprocess the claim (frequently more difficult than one might expect)
  • Write it off
We have numerous lines of defense against this ‘enemy’ of your income:
  • Our first line of defense (and we believe the most important one) is our highly automated insurance claims appeal system that reduces the effort required to get an incorrect write off request (and/or payment amount) to near equal the effort it takes to accept the write off. The elimination of the extra work required to “do it right” has enormous impact on the decision process of most people.
  • Our second line of defense is the fact that our system is now designed to disallow write offs that do not match a contract profile loaded into the pathology billing system.
  • Finally, should one of our employees write off a charge in error, we are continually enhancing our billing system to automatically find those mistakes. We use after the fact scanning to find suspect write offs and check them manually. While it is our intention to have the billing system do “all of the work”, the way we push forward to that goal is by having top personnel finding mistakes which are in turn analyzed to attempt to have the pathology billing software find them the next time. The fact that our personnel know that we do this essentially eliminates any chance of an “intentional error” designed to make their job easier.

Analytical tools available with Genesis

Maximizing revenue in any pathology practice hinges on having the most complete, concise billing information possible about where revenue comes from, and how the billing pattern is changing over time. Sometimes changes in billing patterns reflect changes in reimbursement rates, sometimes it’s the timing of payment from various payers (cash is tight….they hold claims for a few days longer), and sometimes it informs us that some change in our billing process has either positively or negatively impacted the final result. The key is having the change slap you in the face, instead of having it hide behind the massive amount of data involved in pathology billing. We believe there is no pathology billing service that compares to Genesis in this regard. Here are some of the features that allow us to maintain or increase revenue more easily than any other pathology billing service.

Managed Care Contract Analysis

Managed care contract analysis is of vital importance. It is difficult to look at two “fee schedules” from two different payers and have a clear idea which is the better deal. We all know the payment rate for a Tissue 4 is the most important, but it’s just not that simple. This is how we address this issue. Every month when we produce your pathology procedure analysis report (all procedures month and year to date production) we have the data available to tell us what percentage of total units of service each cpt code represents. We populate the procedure master file with this information. This allows us to produce a procedure billing list showing your fee and the reimbursement for up to 14 payers on one report. While it prints, it calculates a frequency weighted average charge, and reimbursement for each plan. That’s gives us a single number that not only tells you what percentage of your charge is being allowed over the entire contract, but more importantly allows you to compare with one number the “quality” of every managed care contract you have. We use this information to renegotiate some contracts or as part of the information needed to make a decision to exit a plan. More importantly is gives us the upper hand in negotiations because we can quickly determine the overall impact of changes on a few procedures. We have had success getting increases in important codes while sometimes giving ground in other areas. We have also discovered that simply being willing to go back to the table proactively puts upward pressure on reimbursement rates.

Permanent History Maintenance

We maintain permanent history on all billing reports. In the case of the procedure analysis report that means that we can produce graphical reports indicating the units of service or fee production per month for any or all procedures for any duration of time. This can be in either report or graphical format. This business tool is applicable specifically to the pathology lab where gaining new clients is the source of revenue growth.

Meaningful and Accurate Collection Rates

We believe we are leading the industry in providing a pathology group with an actual handle on true collection rates. In order to give you a collection percentage that has any value at all the system MUST be able to associate all payments to specific claims and it must keep records of the month of charge origination related to every dollar collected each month. Comparing this months charges and this months receipts (and other months in like manner) has value only in a practice whose production is identical every month. A practice that is growing or shrinking significantly will have distortions in collection rates calculated any way other than the Genesis way. We even have the ability to track ongoing collection rates by referring physician, which will undoubtedly show that some clients may be more or less important that you once thought.

Aged Claims by Payer

Our billing service has the ability to produce aged charges (not aged claims) by payer. This allows us to discover very quickly that the insurance company has lost a batch of electronic claims when payment has not been received. Our system can keep statistics on the average time between claim filing and payment for each carrier, and the standard deviation from the mean. This allows us to spend our time not on all claims that are over a certain age, rather on claims that are beyond a certain number of standard deviations from the mean.

Integrated Contract and Charge Matching

One of the most important problems faced by a pathology practice is the fact that you frequently are given insurance information that is either incomplete or inaccurate. As a result, when an EOB claims a contractual relationship exists, even if your (our) records do not show a contracted entity being involved, we cannot be certain that the information is accurate. As a result, most billing services are forced to accept whatever write-off is indicated by the insurance company. Our system is loaded with all contracts that you have signed (including Medicare, Medicaid, BC/BS, etc). When each insurance payment is posted the operator is presented with the system-calculated write-off based on the contract and the exact mix of services on that claim. Because we may have had inaccurate insurance information (wrong contract) at patient registration the operator can enter a different write-off amount that the one suggested. It must however match the write-off indicated by a plan in our system. It’s a widely known fact that some insurance companies claim write-offs that they manufacture from thin air. We catch all of these as they are extremely unlikely to match to the penny the correct amount for any plan in which we actually do participate.

"We have a long-standing relationship with Genesis. I am firmly convinced that we are getting the best possible value from a billing service….the combination of high revenue capture, system-driven pursuit of collections and a low fee structure make me feel very good about the decision I made over 10 years ago. Other billing services have approached me over the years, but I have never seen the combination of value and personal service that I get with Genesis."

Robert B. Kinney, MD
Cabarrus Pathology Associates