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Labs Worry About Covid-19 Test Payment And Potential Audits Challenges on the Front End

Article published by Laboratory Economics, December 2020

Article features comments from John (JD) Donnelly, FrontRunnerHC CEO

The average daily volume of Covid-19 PCR testing performed in the United States is now averaging nearly two million tests per day, according to the Covid Tracking Project. Hospitals and independent labs are currently performing 73% of volume, while ACLA member labs account for 27%. The tremendous volume of Covid-19 testing, now equivalent to an annualized rate of 700+ million tests, is stressing the front-end capabilities of labs. Most private insurance payers have been uncharacteristically cooperative in paying Covid-19 test claims, but billing experts expect that to change once the pandemic ends.

The tremendous volume of Covid-19 PCR testing combined with the emergency use of non-traditional specimen collection sites have made it more difficult to obtain complete and accurate test orders, notes John Donnelly, President and CEO of FrontRunnerHC (Plymouth, MA), which provides automated software systems that verify and fix patient insurance and demographic information on lab test orders. For example, Donnelly says that nurses, phlebotomists and volunteers at drive-through locations at hospitals, stadiums and malls are often understaffed and under extreme pressure to speed the patient registration and sample collection process, leading to missing patient information and errors on test orders. Regular non-Covid-19 clinical lab test orders are estimated to have first-time submission rejection rates that average roughly 9% for eligibility, while rejection rates for Covid-19 test orders can be over four time higher, according to Donnelly. Determining insurance eligibility is especially important because it’s a necessary first step before labs can bill a patient’s insurance plan or the HRSA Covid-19

Uninsured Program, he adds.


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