Dollars and Cents: How to Ensure Your Dermatopathology Lab Is Billing Appropriately 

Aug 13, 2020 | Digital Dermatopathology

Dermatology clinics who send out to labs rely on accurate pathologic diagnoses to provide optimal patient care. With 44 percent of patient specimens being billed out of network in the United States, it’s also essential to ensure your dermatopathology lab is billing appropriately and in-network.

Your patients trust you to deliver a precise diagnosis and to ward off any surprise billing. By evaluating insurance coverage, looking at common overbilling issues, and defining necessary tests, you can be sure your lab is practicing proper and ethical billing.

Insurance Coverage

Aligning your dermatology practice with a lab contracted with a wide variety of insurance providers is paramount to serving your patients. With more than 900 health insurance companies offering coverage in the United States, it’s crucial to affiliate with a lab that meets the most common demands of the population in your area. 

While clinics can access diverse insurance relationships by working with multiple labs, breaking up samples can be inefficient and lead to confusion. Labs will accept all incoming samples regardless of whether their insurance network covers them. This results in some patients receiving surprise bills from out-of-network labs that could use up their entire deductible. Even though patients can contact their insurance companies or the laboratories directly to negotiate lower invoices, these frustrations impact patient satisfaction and reflect poorly on your clinic.

Overbilling

Safeguard your reputation by partnering with a dermatopathology lab that avoids overbilling or performing unnecessary tests. The costs of excessive medical testing and treatment in the United States is estimated to reach $200 billion annually. Different dermatopathologists and dermatopathology laboratories have different policies on ordering special stains and immunostains. Sometimes increased staining is unnecessary and results in increased bills to your patients. Laboratories that focus exclusively on dermatopathology typically optimize H&E staining for skin diseases, which decrease the utilization and need for immunostains and special stains. Hospital-based dermatopathology or laboratories that do not focus exclusively on dermatopathology sometimes do not optimize for this use case, which can result in increased staining and higher bills to your patients. 

Testing Criteria

In 2014, many Medicare providers responded to growing overbilling concerns by issuing the local coverage determinations (LCD). The rule was designed to boost transparency and raise accountability, indicating that providers can no longer order reflex testing. Labs that violate these standards can be subject to Medicare audits and expensive fines. 

It is up to the laboratory to determine which tests qualify as LCD-approved medical necessities. Dermatopathologists are expected to hold off on billing for costly stains unless documented and necessary. Because most diagnoses can be rendered without a special/immunostain, labs should no longer automatically order stains on cases, also known as reflex testing. 

“Most skin lesions are diagnosed with routine H&E slides,” Medicare reports. “That is the case for most melanomas and other pigmented lesions as well. A minority of skin lesions require immunostains (e.g., atypical fibroxanthomas, Merkel cell lesions, lymphomas). Most common skin lesions (e.g., seborrheic keratosis) do not require IHC stains.”

The LCD provides clear guidelines when it comes to pathologists ordering additional tests: 

  • Tests must be medically necessary to reach a complete and accurate diagnosis. 
  • Results must be shared with—and used by—the treating physician/practitioner.
  • Justification for tests must be documented in the pathologist’s report.

Partnering with a full-service dermpath lab like PathologyWatch that has a broad network of insurance coverage and doesn’t send surprise bills is a smart way to maintain your patients’ confidence and loyalty. Knowing what to look for when it comes to insurance coverage, understanding overbilling practices, and being aware of the LCD testing criteria can help you ensure your dermatopathology lab is billing appropriately.

Identifying Delays in Dermatopathology Lab Turnaround Time

Aug 11, 2020 | Digital Dermatopathology

When patients bring their business to your dermatology clinic, they trust you will provide optimal diagnoses and treatment decisions promptly. You share the same expectations regarding dermatopathology lab turnaround time, which the College of American Pathologists (CAP) suggests should require no more than 48 hours in standard cases.

Several factors can increase or cut down the time between receipt in the lab to a verified report. By carefully considering transportation, laboratory workflow, diagnostic hurdles, report delivery, clinical findings, slide requests, and processes in your dermatology clinic, you can improve turnaround time and your patients’ satisfaction and care.

Transportation

While The College of American Pathologists in the above-mentioned recommendation measures turnaround time from the moment a specimen reaches the lab until the result is signed out to the ordering dermatology provider, we at PathologyWatch measure turnaround time from the moment a specimen is picked up until the result is signed out. Regardless, reliable transportation is required to ensure tissue samples are delivered safely and on time. 

Delays in transportation are not uncommon, as couriers may have to battle traffic or mechanical issues as they carry specimens from the dermatology clinic to a local lab. Meanwhile, overnight providers such as FedEx and UPS may face weather challenges as they move samples greater distances to labs in other parts of the country. Dermatology clinics should expect their partnering labs to provide a reliable and secure system to transport specimens on time in a consistent fashion.

Laboratory Workflow

Running a productive dermatopathology lab requires cooperation from many vital team members. While dermatopathologists read their slides, lab technicians maintain the equipment, and office managers oversee incoming and outgoing reports, they all share in the responsibility of providing acceptable turnaround times.

National holidays, vacation days, and the 2.5 sick days American professionals take every year add up to many missing hours for smaller labs to work around. However, locum tenens provide a reliable source of dermatopathology talent to keep labs working at capacity. While some labs are open 24 hours a day, seven days a week, it’s important to note the majority hold traditional weekday hours when calculating turnaround time.

Diagnostic Dilemmas

After a dermatology clinic sends out a batch of specimens, they can reasonably expect to receive results from the lab within a few days. However, since complex cases can increase turnaround time by 100 percent, it’s essential to be aware of the tissue samples that could require possible delays.

For instance, a dermatopathologist may order additional studies, like special stains, to determine if a specimen contains an infection. And if an immunohistochemical stain is needed, it can require up to two additional days, depending on the availability of the particular stain.

Intradepartmental consultations cause delays in obtaining a second colleague’s opinion on complicated specimens. However, labs using digital slides can collaborate with experts around the world in real time and avoid longer turnaround times. 

Reporting

After the lab completes a diagnostic report, the priority shifts to returning the report to the dermatology clinic as efficiently as possible. Delays can occur for providers working with paper, as this requires fax, mail, or overnight couriers. Once the paper reports are received, they need to be collated in the patient files.

The majority of providers utilize electronic medical/health (EMR/EHR) systems to enhance patient care. This makes integration with digital pathology reporting the next step and a dependable time-saver offered by full-service dermpath labs like PathologyWatch. Instead of waiting for deliveries, diagnostic results and digital pathology images are transferred instantaneously from the lab to each patient’s EMR. The digital results are easy to search and convenient to share with patients on tablets and laptops. 

Clinical Findings

Experienced dermatologists can quicken the turnaround time by providing detailed clinical information, impressions, and differential diagnoses on their pathology request forms before they are sent to the lab. 

Because labs don’t always have access to the patient’s clinical history, providing a clinical impression on the request form is always helpful. This is particularly true for inflammatory lesions, which can be subtle and nonspecific under a microscope. Without a clinical impression, the dermatopathologist can struggle to diagnose the findings with confidence, sometimes leading to a descriptive diagnosis, which should include differential considerations, as well. 

One factor that can impede clinical interpretation is the lack of access to the interpreting dermatopathologist for any questions about the interpretation. You should be able to contact your dermatopathologist directly. At PathologyWatch, for example, our dermatopathologists are directly available by cell phone or text message for consultations, which significantly speeds up the turnaround time.

Slide Requests

Many dermatologists feel that reviewing their own biopsy slides improves the quality of care they can render to their patients. Requesting traditional glass slides to be mailed can sometimes take up to two weeks for clinics to receive. Digital pathology providers such as PathologyWatch provide 24/7 access to digital slides from anywhere globally, which dramatically improves turnaround time on slide requests.

Take PathologyWatch’s partnership with Allen-Taintor Dermatology. Before collaborating with PathologyWatch, the Utah dermatology clinic waited up to two weeks for slides to return from the lab. PathologyWatch was able to deliver faster results by interfacing directly with the EMR, providing academic-level reads, and providing direct digital access to each patient’s pathology slides. The result was a 75 percent turnaround time improvement in most cases.

Improving Turnaround Time

Dermatology clinics can make an impact on dermatopathology lab turnaround time. Begin by opening the lines of communication with the lab and staying in contact about the status of your cases. Being proactive will allow the lab to identify issues with transportation or particular specimens that require additional information from the clinic to help expedite the diagnosis.

Securing accurate and timely results from the lab is better for your dermatology clinic and your patients. Identifying the cause of delays in transportation, staffing workflow, reports, slide requests, and clinical findings, while being proactive in your dermatology practice, can help you speed up dermatopathology lab turnaround time. 

Managing Pathology Orders and Results

Aug 7, 2020 | Digital Pathology

Dermatology clinics carry the responsibility of providing patients with correct test results from dermatopathology laboratories. With 9,500 Americans diagnosed with skin cancer every day, the weight of managing pathology orders and results is critical to ensure every patient’s diagnosis is received and shared in an organized, accurate, and timely manner.

Experienced dermatologists know there’s more involved in processing pathology results than sending out request forms and waiting for results to return. By being proactive, defining the lab’s responsibilities, evaluating paper and electronic workflows, and exploring the advantages of an EMR interface, you can ensure your dermatology clinic provides optimal quality of care to your patients.

The Clinic’s Responsibility

Patients hold their dermatology clinics accountable for sharing biopsy results, which means it is up to the providers and their staff to receive, organize, and deliver pathology results directly to patients. While it takes an average of 12 years of schooling and training to become a dermatologist, it only takes a few moments to lose a patient’s trust.

Labs return their reports to clinics through various channels, including fax, web portal, courier, and mail. The dermatology practices keep track of these results and share them with their patients. Proactively opening the communication lines between the clinic and the lab is the best way to make sure nothing slips through the cracks. By checking in with the lab frequently to follow up on cases, a dermatologist can stay on top of any delays or missing reports while answering questions that may help to produce more definitive diagnoses. 

According to Tammie Ferringer, MD, open communication between the clinic and the lab is “totally appropriate and should occur.” The dermatopathologist advises, “Calling is absolutely acceptable, and it is usually easier to get ahold of a dermatopathologist than a lot of dermatologists because they’re seeing patients constantly.” 

The Lab’s Responsibility

The dermatopathology lab is obligated to deliver case results and alert the clinic of any unexpected or urgent diagnoses. Labs deliver their diagnoses using documented communications, keeping records of faxes, correspondence, and deliveries. However, the lab’s obligation stops once the clinic receives the results. The dermatology practice coordinates and shares the results with their patients. 

Paper Workflow

Dermatology clinics have the option of sending requests and receiving diagnoses via traditional paper or electronically. Even though 70.2 percent of dermatologists report using an EHR in their practice, many still prefer to use paper when communicating with labs. 

One disadvantage of paper is the task of matching outgoing orders with incoming results. With some dermatology practices seeing 40–50 patients per day, managing a paper workflow can create a bottleneck and impact the time to deliver results to patients. 

Current events also point towards electronic records as a safer solution for clinics to consider. “We’re in the era of social distancing, so it’s time to embrace EMRs and other technologies that make it safer for us to do our jobs,” notes Mark D. Kaufmann, MD, FAAD. “This will help us be responsible in the COVID-19 era, as well as create new efficiencies in terms of billing and coding.”

Interfacing the EMR

Working with a lab that interfaces electronically with a dermatology clinic’s EMR introduces a new level of streamlined reliability. In an instant, office staff can see which orders are still outstanding and which diagnoses are ready to be reviewed and shared with patients, with some interfaces using color codes to flag new or urgent results.

In addition to simplifying sorting, searching, and managing requests, an EMR interface, like the one provided by PathologyWatch, includes immediate access to whole-slide images and access to academic-level dermatopathologists. PathologyWatch makes it easy to pull up digital images and review them independently or with the patient.

Your dermatology clinic moves quickly to ensure your patients receive accurate results with an acceptable turnaround time. If you take time to evaluate your practice role, understand the lab’s obligation, compare paper and electronic workflows, and consider an EMR interface, you’ll find ways to improve the management of pending specimen lists and report distribution to serve your patients better.

Improving Pathology Workflow with an EMR Interface

Jul 24, 2020 | Digital Pathology

Precise and punctual communication between dermatology clinics and pathology labs is essential to provide patients with accurate results and swift turnaround times. Because over 90 percent of all tumors are confirmed by pathologists, physicians that utilize an EMR are increasingly interfacing with pathology laboratories to relay case results.

Integrating an EMR interface between your practice EHR and the lab can help increase operational efficiency, streamline staff workloads, and improve the quality of patient care and satisfaction.


Operational Efficiency 

Your patients expect an organized and efficient experience every time they interact with your clinic, and you can hold your laboratory to those same standards. Relying on a laboratory with outdated means of communication can negatively impact the quality of your experience, as well as impact patient care. 

Today, three out of five dermatologists have adopted an EMR into their practices. Interfacing with your laboratory’s information system takes full advantage of this record-keeping technology, creating a communication portal that instantly organizes and shares case data results. Integration into pathology reporting means clinics can use their existing EMR systems to automatically receive, review, search, and sort results on demand without additional clinic support staff involvement.

In Utah, Allen-Taintor Dermatology was used to sometimes waiting up to two weeks to receive results from the lab, which sometimes failed to send slides. Because the clinic wanted to review the slides before calling patients, this consistent issue was a concern. Once they began using PathologyWatch, Allen-Taintor Dermatology saw improved staff workflow efficiency, including a 75 percent reduction in dermatologist review time, which further improved efficiency. Patient satisfaction likewise improved because the physicians could review the results with their patients on digital slides.


System Setup

For those using an EMR in clinic, the advantages of an interface are clear. Building an interface between your EMR and the laboratory in a way that optimizes workflow efficiencies is not always straightforward and requires an experienced IT professional.

By partnering with a trusted full-service dermatopathology laboratory like PathologyWatch, clinics can rely on experienced engineers to architect their interfaces in a way that optimizes their EHR capabilities to maximize internal clinic efficiencies.  


Streamline Workloads

For many clinics, paper continues to be the gold standard for documenting and sharing records. For clinics that have moved to an EHR, however, additional benefits can be realized if your laboratory is fully integrated. For example, a well-designed interface can make handwriting requisition forms and physically making carbon copies a thing of the past. You can also reduce the probability of errors by digitally sending that information to the laboratory, as clinic data must be re-entered into the LIS and attached to the sample when received on paper forms. 


Patient Satisfaction

Delivering reliable and timely results to your patients should be a high priority for every dermatology clinic and dermatopathology laboratory. After patients have a biopsy taken, many experience an uneasy suspense while waiting for their results. This was the case for Allen-Taintor Dermatology. Once they were able to utilize digital biopsy images to show patients their pathology during visits, their high patient satisfaction increased even more. EMR interfaces and optimal laboratory processes can reduce the turnaround time from when a biopsy is taken to when a result is received, resulting in a better quality of care and patient satisfaction.

An additional benefit to patient safety and satisfaction is that interfaces can also improve data integrity and results delivery, decreasing the risk of a data entry error in both the clinic and laboratory.

In summary, building and utilizing a well-developed interface between the clinic EMR and laboratory system can help to improve operational efficiency, simplify staff workloads, and improve the quality of patient care and satisfaction.

FAQ Interview with PathologyWatch CEO Dan Lambert

Jul 22, 2020 | Digital Dermatopathology, Digital Pathology

What is the single most innovative technology you are currently delivering to health systems or medical groups?

We deliver digital pathology services and EMR integration solutions to dermatology clinics in many locations. Dermatologists are able to discuss cases with expert pathologists from many different locations in a way that has never been done before. We’re also developing AI tools that are specific to dermatopathology. Ultimately, humans and the AI working together in pathology will mean lives saved, and we’re at the beginning of this process.

How is your product or service innovating the work being done in these organizations to provide care or make systems run more smoothly?

PathologyWatch greatly reduces the amount of time spent on duplicating data between systems—the reports are accurately and automatically entered into the dermatologist systems. We’re eliminating the faxed reports and walled-garden report access. Digital pathology and EMR integration alone have streamlined clinical workflows and improved the quality of care within dermatology clinics.

What is the primary need fulfilled by the product or service?

The primary need is improved quality of care with decreased cost. We are attacking this problem in the narrow field of dermatology/dermatopathology, but the principles and technology can be expanded well outside of that area. We plan to expand from dermatology to other fields of outpatient medicine within the next two years.

What is the ROI of said product or service?

Our clients have seen up to 75 percent decrease in sample turnaround time, as well as up to 75 percent decrease in the time it takes for physicians to review pathology reports (per internal case study reports).

What are some examples of implementation and outcomes use cases?

  • Improved operational efficiency with digital workflows
  • Improved patient satisfaction as the physician and patient review pathology together
  • Improved patient outcomes because of faster turnaround times
  • Improved staff efficiency

(For more information, see the Allen-Taintor and Prairie Lakes Healthcare case studies.)

Who are some of the clients and organizations served by the company?

How has innovation advanced the field of healthcare or the practice of care? 

  • Increased availability to high-quality care in underserved areas: Geography is no longer a limiting factor, providing opportunities for underserved areas to receive academic-level dermatopathology reads.
  • Improved speed and availability of samples for improved patient outcomes: Dermatologists are able to view their slides 24/7 digitally with a web browser (on-demand ability to correlate with pathologic findings).
  • Expanded access: Forty-five percent of the world does not have access to cancer diagnostics. AI has the potential to solve this problem.

How is innovation changing lives specifically?

Through patient education, patients are now able to better understand why they do or do not need surgery, because physicians can display the digital pathology images for them. Patient diagnoses are improved, as dermatologists can more quickly and easily correlate pathologic findings with clinical features. Patients are more satisfied with their care, as they are receiving answers more quickly, especially in difficult cases where consultations would normally take additional days or sometimes weeks.

What is the company’s go-forward strategy? What’s next? Which problem is the organization working on now and in the future?

We’re focused on optimizing workflows and technology specific to dermatology and dermatopathology. We plan to expand into other areas of pathology in the future, as well as work to solve the lack of access to pathology globally through the utilization of AI. Ultimately, our goal is to provide affordable, available, and accurate diagnoses to the world’s population.

What are the most significant lessons learned by delivering the innovation, product, and/or service to health systems and/or medical groups?

  • Healthcare systems are extremely difficult to work with, as they sometimes employ outdated systems with limited ability to quickly and easily adapt to current technological changes.
  • Very few successful healthcare companies are “just software.” You can’t build it and expect they will come. It takes making the right relationships with payers and providers.
  • As the healthcare industry continues its digital transformation, significant opportunities exist to improve patient outcomes and improve the efficiency and effectiveness of the overall healthcare system.
  • There are many ways to build algorithms. Think long and hard about your end-use case when architecting it and deciding whether to take a supervised or unsupervised approach to building out your algorithms.