If your lab does drug testing, you will get audited. Do you have a plan for this?
We all know that drug testing is an essential part of good clinical practice.
Medical providers need confirmatory/definitive drug testing results to track medication adherence (i.e. opioid therapy), prevent dangerous drug-drug interactions, and identify the presence of a substance use disorder (SUD) or relapse into active addiction.
However, the OIG recently reported that due to Fraud and Abuse from a period between Jan 2016 - Dec 2020, “Medicare paid $704.2 million for definitive drug testing services that were at risk for noncompliance with Medicare requirements”.
Moreover, Medicare (W-00-22-35876, 2024) and the OIG (A-09-21-03006, 2023) have announced their plans to audit more drug testing labs for documentation and compliance, while commercial payers are escalating their prior auth and claim denials for “lack of medical necessity,” which is really a lack of DOCUMENTATION of medical necessity.
IF IT’S NOT DOCUMENTED, IT DIDN’T HAPPEN.
The reality is that no matter how many times you ask, busy providers aren’t going to document medical necessity well enough for your lab’s compliance or reimbursement needs.
“Cellarian solves your problem by creating compliant, patient-specific medical necessity documentation, which protects you and your provider without extra work.”
-Dr. Michael Sprintz
Cellarian Delivers:
Patient-specific medical necessity compliance documentation for every analyte.
Automated patient-specific prior authorization and claim denial appeal letters.
Proprietary technology creates unique documentation that eliminates templated notes.
Seamless integration with LIS, billing, and provider systems
Compliance and revenue up front, while lowering back-end operational costs
Stop leaving your lab vulnerable to audits, clawbacks, or pre-payment reviews. Do better.
Reach out to Cellarian at 866-776-3610 or info@cellarian.com to schedule a Demo and find out how we can keep your lab compliant, safe, and profitable.
Cellarian is here to help you get denied claims PAID.
MAXIMIZE REVENUE.
MINIMIZE RISK.
ENSURE COMPLIANCE.
LOWER OVERHEAD.
Don’t let lack of medical necessity documentation cost your practice or lab thousands per month. Cellarian captures medical necessity-related denied claims, boosts monthly collections, and decreases operational risks and costs.
You don’t have time to document medical necessity well enough. Cellarian’s smart automation does. Compliantly. Your lab collects what’s due and keeps it.
MAXIMIZE REVENUE
Cellarian helps labs capture previously unreachable revenue by compliantly automating medical necessity documentation to support denied claim appeals, audits, and prior authorizations.
REDUCE RISK & ENSURE COMPLIANCE
Cellarian helps you breeze through audits, avoid penalties, and recover everything you're owed by ensuring compliance with insurance medical necessity requirements and CMS regs for medical necessity.
LOWER OVERHEAD COSTS
Cellarian automation streamlines your revenue capture and denials management so your lab can focus on gaining new customers rather than trying to get current ones to document better. Make more money with less payroll.
Lack of Medical Necessity Documentation is the Most Preventable Cause of Revenue Loss
Labs write off millions of dollars annually.
Drug testing is now a high-volume, low-dollar service. Providers are too overwhelmed to adequately document a patient’s medical necessity reasons for every test ordered. Yet, without this documentation, the revenue is unreachable.
Our Service: Automated Clinical Documentation to maximize revenue
Don’t throw more people at the problem. Automate.
Cellarian provides intelligent process automation to clinical documentation, prior authorizations, and denials management to help our clients maximize available revenue capture and decrease the administrative burden for diagnostic labs and their physician customers.
The Challenges
A solution is needed to intelligently automate clinical documentation processes, stay up to date on changes in payer medical necessity and reimbursement guidelines, and accelerate the time from claim denial to successful payment.
Insurance payers overload doctors with excessive medical necessity documentation requirements as a strategy to deny payment for services.
Laboratory Benefit Management process automation by payers uses denials to drive lab behavior towards low-reimbursement codes, since Labs need doctors to provide proper clinical documentation to get paid.
Doctors don’t perceive benefit from the cost of adding clinical documentation, so they rarely do it, resulting in denied payments and significant revenue loss that labs cannot recover without documentation.
Denied claims are expensive to appeal, so labs are forced to either write off on average 20% of monthly accounts receivable or spend more money/staff resources trying to fight the denials which are often never paid due to lack of documentation. These additional expenses further decrease monthly net profits.
The Cellarian Solution
Using data sources such as Laboratory Information Systems and Electronic Health Records, Cellarian automates patient-specific clinical documentation, claim appeals, and prior authorizations to help labs reduce denial management costs, streamline operational efficiency, and collect more revenue so they can focus on growth, without adding any work on doctors and remaining in compliance with HIPAA regulations.
By automatically searching and integrating updated payer medical necessity policies Cellarian ensures maximum revenue capture and compliance with payer guidelines, matching the payers’ Laboratory Benefit Management and ensuring the maximum reimbursement compliantly allowed.
Our scalable technology platform is rapidly adaptable to any diagnostic lab service line with clinical documentation requirements, increasing claim denials, or time-consuming prior authorizations, with the greatest ROI delivered at scale.
Benefits
Higher Monthly Cash Collection
OUr solution delivers the necessary documentation to reverse denied claims and prevent rejection of prior authorizations.
Higher Average Reimbursement per Claim
There’s no reason to down-code with Cellarian’s medical necessity documentation. Labs collect more per claim, decrease risk, and stay compliant.
Faster Claim Appeal Process
Cellarian Automation shrinks the appeal process from weeks to minutes, which means improved cash flow and operational efficiency.
Cellarian delivers the medical necessity documentation you need to support claims
Cellarian is the first-to-market SaaS-model software solution that creates patient-specific, compliant medical necessity and appeals documentation along with intelligent process automation to increase revenue, improve efficiency, and decrease risk.
Other companies only tell you what’s missing.
Cellarian actually creates it. Compliantly.
Cellarian is Transformative.
Cellarian is the only Company that compliantly creates clinical documentation needed for payment, without adding more work on doctors.
Cellarian is Smart.
Designed by physician and drug testing specialists, along with revenue cycle and compliance experts. AI-driven processes automatically update payer medical necessity policies to ensure maximum revenue capture and compliance with payer guidelines.
Cellarian is Expandable.
Modular software design is rapidly adaptable to any diagnostic lab service line with clinical documentation requirements, increasing claim denials, or time-consuming prior authorizations, with the greatest ROI delivered at scale.
Cellarian plays well with others.
Our automated solution integrates with EHR's and Lab Information Systems and can even be integrated into other RCM products to improve their suite of services.
