Clinical Laboratory Management Solutions
November 20, 2023
Healthcare systems rely on the right clinical lab workflow software to efficiently manage resources and deliver diagnoses without encountering obstacles resulting from ineffective documentation, delays, or denied bills. Thus, advanced laboratory information systems support laboratory billing and laboratory revenue cycle management (RCM) to automate functions related to the different stages of generation and remittance of medical bills.
Problems and Solutions: Laboratory Billing Software
Laboratory billing and laboratory revenue cycle management involves financial services that automate the process of identifying and generating medical bills, processing claims and payments, and collecting revenue for testing services rendered.
The RCM process thus begins with a patient’s first encounter with a healthcare system and a healthcare LIS, and ends at the point where the hospital or clinical lab is paid fully for their services. The RCM process includes seven important steps:
- charge capture
- claim submission
- remittance processing
- insurance follow-up
- patient collections
Each of these steps in the RCM process identifies and uses patient data for making an insurance claim, and then following up with the claim until the final payments are made.
However, clinical labs and other providers face some common problems with clinical laboratory management. without the right RCM tools. Medical laboratories handle large volumes of patient data that are managed by a laboratory information system (sometimes also referred to as a laboratory information management system) to process samples and deliver timely results. A medical lab requires a laboratory information system software solution in place to process sensitive patient data as well as a lab revenue cycle management solution to handle the RCM process. Traditionally, two separate laboratory software systems were used: LIS software for handling patient information and lab data; and lab revenue cycle management software for lab billing purposes. Thus, in most cases, the lab billing process would start only after the test results had been prepared. It would often lead to a denied claim due to wrong or missing patient information. An effective laboratory billing process reduces denied claims by getting clean claims information upstream, which translates into more clean claims and more revenue downstream.
Inadequate staff or equipment failures can add to the costs of running a lab. A clinical lab LIS software solution that includes billing software for labs is thus ideally tailored to meet a lab’s billing requirements and risk estimation.
Uncollected revenues due to the absence of automated LIS software with laboratory billing solutions lead to reduced annual revenues generated for a lab. This could be due to delays in presenting claims, insufficient documentation, errors in calculating basic costs, overheads and margins, and erroneous implementation of a clinical lab’s coding system (where a clinical sample is incorrectly matched with a test’s code). These errors can be mitigated through advanced lab information systems with laboratory billing solutions.
The Role of Laboratory Billing Solutions
A laboratory billing solution ensures the smooth running of a lab by helping the staff work quickly through the digitization of the RCM process. Medical laboratory billing solutions leverage patient information captured during the patient pre-registration and registration processes to initiate and eventually file an insurance claim.
Billing software for labs automates the RCM process and aids lab billing managers in follow-up on insurance claims. Most importantly, a lab billing solution eliminates discrepancies during claims processing, when a testing service may be mismatched to a medical code due to human error. Laboratory billing solutions validate insurance claims and ensure a patient’s insurance status. Lab managers need to bear in mind the different steps of processing patient samples, as well as track insurance claims, to ensure a smooth RCM process.
Transparent lab billing policies and laboratory billing solutions help both patients and laboratories to manage their resources effectively. Lab billing policies need to be displayed on the testing service’s website, and should be communicated to the patient during their pre-registration. The patient should also be informed of the various accepted payment modes so that they’re prepared during the registration process to provide their insurance details.
Co-payments may be collected at patient registration, and referrals are required when a patient needs a specialist’s medical attention. The registration process must also include steps to assign benefits and record patient signatures on the requisite forms. These ensure the smooth running of insurance claims. Claims are ‘scrubbed’ prior to submission, where advanced clinical laboratory billing solutions are enforced by a dedicated lab revenue cycle management team that assesses the test charges, ensures there are no code mismatches and structures the claim by providing test results to motivate the recommended procedure.
Integrating Laboratory Billing with LIS Software
An efficient LIS software solution that includes laboratory billing services addresses various challenges during the insurance capture, claims, and collections process.
When a patient enters the healthcare system, the medical staff captures their data on the laboratory information system, which verifies the patient’s scheduling and eligibility. The integrated LIS system with lab billing functionality can also estimate charges so that a transparent RCM process is maintained.
Efficient laboratory information system and lab billing solutions also helps lab managers to resubmit denied claims through real-time monitoring of the claims’ status. These solutions also generate reports that need to be presented every three years to the Centers for Medicare & Medicaid Services (CMS), in compliance with financial regulation policies.
The laboratory information system with a billing solution improves the staff’s ability to manage and track various processes from a single interface. It can also integrate with a patient’s electronic health records (EHR), improving the accessibility and tracking of patient information within the organization.
Laboratory information systems with laboratory billing solutions should capture, at an early stage, various details about a patient’s eligibility for making an insurance claim so that questions regarding payments do not crop up in later stages. LIS system claim management solutions should also be able to track the progress of an insurance claim, and the laboratory software system should generate timely reminders to help manage multiple payment schedules.
A health institution that has a strong infrastructure for Information Technology (IT) can easily set up and maintain a LIS software with laboratory billing capabilities.
Alternative Laboratory Billing Solutions
Some labs might find it simpler to outsource their billing to a third-party service that will be up-to-date with the latest industry practices and can thus accelerate insurance claims. Pathology lab solutions for billing can be integrated with a lab’s LIS system so that staff can access the data from a single informatics platform. The data will be stored in the cloud or on server, ensuring reliable access to it within institutions.
Labs can also increase their outreach to improve their RCM process. This is applicable to labs built to scale, which find that their testing capacity exceeds demands. Especially during the COVID-19 crisis, many labs maximized their margins by providing testing services for the virus. Advanced laboratory information system solutions thus should be scalable to meet high demands during a time of crisis.
Some labs require specific LIS software that addresses their unique demands, such as highly specialized procedures and diagnoses, or lab billing dynamics. Pathology lab management solutions should account for the large influx of patient data and samples, and could thus benefit from a third-party vendor.
Implementation of advanced LIS & RCM informatics solutions helps clinical labs ensure a patient is eligible for an insurance claim, even before their samples are processed. This saves time and prioritizes claims for swift approval and reimbursement, ultimately improving patient care.
A third-party billing service can provide application programming interfaces (API) that connect their lab billing service solution with the lab’s existing LIS or LIMS software solutions. It can also be interfaced with Electronic Health Record (EHR) and Electronic Medical Record (EMR) systems.
Finally, financial solutions rendered by third-party experts ensure efficient processes such as claims scrubbing, follow-up on insurance claims, and generating financial reports that meet compliance requirements as well as generate revenue for labs to scale.