Clinical Laboratory Management Solutions

Healthcare systems rely on the right clinical laboratory management software to efficiently manage resources and deliver diagnoses without encountering obstacles resulting from ineffective documentation, delays, or denied bills. Thus, advanced clinical laboratory solutions adopt the system of revenue cycle management (RCM) to automate functions related to the different stages of generation and remittance of medical bills.

Laboratory Problems and Solutions: Billing

Revenue cycle management (RCM) involves financial services that automate the process of identifying and generating medical bills, processing claims and payments, and collecting revenue for testing services rendered. 

RCM thus begins with a patient’s first encounter with a healthcare system and ends at the point where the hospital or clinical lab is paid fully for their services. RCM’s seven steps include: 

• pre-registration 
• registration
• charge capture 
• claim submission
• remittance processing
• insurance follow-up 
• patient collections 

Each of these steps identifies and processes patient data for making an insurance claim, and follows the claim up until the final payments are made. 

However, hospitals and clinical labs face some common problems with clinical laboratory management. Medical laboratories handle large volumes of patient data that are managed by a laboratory information management system (LIS or LIMS) to process samples and deliver timely results. A medical lab requires laboratory information software solutions in place to process sensitive patient data before installing a billing service. Traditionally, two separate software solutions were used: LIS solutions for handling patient information and lab data; and RCM solutions for billing purposes. Thus, in most cases, the 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 RCM system 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 software solution is thus ideally tailored to a lab’s billing requirements and risk estimation.

Uncollected revenues due to the absence of automated software 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 automated laboratory medical billing solutions.

The Role of Laboratory Billing Solutions 

A lab billing solution ensures the smooth running of a lab by helping the staff work quickly through the digitization of RCM. Medical laboratory solutions leverage patient information captured during the patient pre-registration and registration processes to initiate and eventually file an insurance claim. 

Billing software automates the filing 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. Lab 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.

Transparent billing policies and solutions help both patients and laboratories to manage their resources effectively. 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 solutions are enforced by a dedicated revenue cycle 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 Billing with Laboratory Management Software

An efficient lab software solution for 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 information on the lab’s management software, which verifies the patient’s scheduling and eligibility. The system can also estimate charges so that a transparent billing process is maintained. 

Efficient billing software also helps lab managers to resubmit denied claims through real-time monitoring of the claims’ status. Laboratory RCM solutions in advanced software 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 billing system can also be integrated with the lab’s laboratory management system, thus improving 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 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 claim management solutions should also be able to track the progress of an insurance claim, and the billing software 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 lab management software for billing. 

Advanced Clinical Laboratory Solutions 

High throughput 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 so that staff can access the data from a single 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. 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 solutions thus should be scalable to meet high demands during a time of crisis. 

Some labs require specific software that addresses their unique demands, such as highly specialized procedures and diagnoses, or billing dynamics. Pathology solutions should account for the large influx of patient data and samples, and could thus benefit from a third-party vendor. 

Implementation of advanced solutions helps the 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 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.