US toxicology and genomic laboratories operating in the healthcare industry face many persistent threats to their existence. Two major threats are increased operational costs due to revenue cycle labor requirements and reduced payments per test from insurance and patients. The main factor for this is that laboratories have implemented disjointed software solutions. Each handle a different component of operational needs individually. Unfortunately, this solution amplifies these threats. Many times, a key factor is an LIS that cannot automatically generate accurate charges, thus requiring manual labor processes. Similarly, using an LIS without built-in revenue cycle management functionality leads to the use of multiple systems where manual data entry errors or interfaced data errors lead to missed charge capture, missed claim filings, unworked claim denials, and subpar analytic reporting. Having a solution where all the components are designed to work seamlessly together will increase productivity and maximize revenue.
Making the move to the right all-inclusive LIS will eliminate these problems. The most important features to look for in a robust system are the digitalization of the requisition process, automation of critical processes, analytics to drive decision making, and a strong foundation built around client communication and result delivery.
Digitize
Removing manual processes from your requisition and accessioning with a secure web-based patient and client portal will result in significant labor savings. Requisitions entered digitally utilize required fields and actions to reduce missed entries that paper introduces, such as missed physician signatures, diagnosis entries that do not meet medical necessity, and missing selection of tests. All of these increase labor cost and can cause reduced revenues down the line due to claim adjudication issues.
Automate
LIS software with built-in revenue cycle tools can reduce coding costs by automatically assigning appropriate individual and panel test code charges. In addition to charge capture, the LIS software should be able to automatically transfer diagnosis code entries from requisitions to claims. Transmitting results via multiple mediums (fax, email, SMS text, web portal) is also essential to keep both patients and clients satisfied.
Monitor
Utilization of anything other than an effective revenue cycle software will lead to massive reductions in average per test payments, along with significant increases in costs to collect.1,2 LIS software can alleviate this through capabilities such as dynamic bulk generation of appeals, automated capture and management of claim adjustment segment (CAS) and remark denial codes, and presentation of key performance indicators. Without effective analytic tools, many labs find themselves making ineffective business decisions such as investing in specific sales pipelines that could yield low margin per test payments, investing in additional revenue cycle management labor only to find the actions billers have performed are ineffective, or failing to deliver on contracted turnaround times simply due to a lack of accurate reporting on the metric. All of these can reduce testing volume and profitability.
Engage
Maintaining both client and patient satisfaction is the key to laboratory success as both are drivers of continued loyalty. LIS software can assist with client satisfaction by maintaining competitive turnaround times and provide clients with modern abilities to access and manage results. Keeping patients engaged results in increased patient revenue. An LIS system with the ability to text patients' progress updates and provide patients with a secure web-based portal to access results leads to significantly improved patient engagement.
Unfortunately, many labs find themselves using antiquated software barely capable of half of these essential functions. The right LIS solution should be simple, effective, and constantly innovating.
Migrating to a new system is always an involved process, but the correct system should be able to make the pain of moving more than worth it in the end. The good news is the right LIS should not take more than a month to implement. Increased revenue and improved client satisfaction are critical to any laboratory’s success. This fuels growth and overall productivity in your laboratory. Talk with a GoRev associate today and schedule a demo. At a minimum, you will walk away with new ideas and new processes you can implement in your current environment.
Sources
2. Nichols D (June 2018) The Pathway to Driving Valuation for your Laboratory, webinar.
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