The laboratory billing process and its applications to molecular microbiology testing: guidance for laboratorians.

IF 5.4 2区 医学 Q1 MICROBIOLOGY
Meghan W Starolis, Hema Kapoor, Kristen L Jurcic Smith, Rachael M Liesman, Dawn R Zenefski
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引用次数: 0

Abstract

The processes used by laboratories to seek reimbursement for services performed are complex and often unclear to laboratorians, a key group that has the clinical and technical knowledge to influence reimbursement. In this review, we provide a comprehensive overview of laboratory billing processes for insurance billing and hospital inpatient services, as well as the various procedure codes used in these processes. Understanding the health plan landscape is also of critical importance, as health plan policies and coverage decisions have downstream effects on accessibility of testing for patients. A detailed overview of health plans and how coverage determinations are made and communicated is discussed in this review. Lastly, we present actionable areas of opportunity in clinical microbiology where laboratorians, as well as test manufacturers, can focus on improving reimbursement (syndromic panels, antimicrobial resistance, and next-generation sequencing) to expand access to these evolving technologies and encourage adoption in clinical laboratories.

实验室计费流程及其在分子微生物学检测中的应用:实验室人员指南。
实验室为寻求所提供服务的报销而采用的程序很复杂,而且往往对实验室人员不清楚,而实验室人员是具有影响报销的临床和技术知识的关键群体。在这篇综述中,我们提供了一个全面的概述实验室计费流程的保险账单和医院住院服务,以及在这些过程中使用的各种程序代码。了解健康计划状况也至关重要,因为健康计划政策和覆盖范围决定对患者获得检测的可及性有下游影响。本综述详细概述了健康计划以及如何制定和沟通保险范围决定。最后,我们提出了临床微生物学中可行的机会领域,实验室人员和测试制造商可以专注于改善报销(综合征面板,抗菌素耐药性和下一代测序),以扩大这些不断发展的技术的可及性,并鼓励临床实验室采用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Clinical Microbiology
Journal of Clinical Microbiology 医学-微生物学
CiteScore
17.10
自引率
4.30%
发文量
347
审稿时长
3 months
期刊介绍: The Journal of Clinical Microbiology® disseminates the latest research concerning the laboratory diagnosis of human and animal infections, along with the laboratory's role in epidemiology and the management of infectious diseases.
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