Documenting the Avero Diagnostics Move From a Legacy Lab RCM System to LigoLab’s All-in-One Lab Informatics Platform

Editor’s Note: This case study outlines the challenges Avero Diagnostics faced while operating on two disconnected laboratory software systems, one managing laboratory information system (LIS) workflow and the other handling laboratory billing and lab revenue cycle management. It also demonstrates the measurable gains the organization has achieved since transitioning to LigoLab's all-in-one LIS system with advanced laboratory billing solutions.

About Avero Diagnostics

Avero Diagnostics, formerly known as Northwest Pathology and Northwest Laboratory, is a physician-led national laboratory that specializes in women's health, anatomic and clinical pathology, molecular pathology, and clinical diagnostics.

The Challenge: Two Critical Mandates and a Massive Billing Backlog

Tina Quevedo had two clear mandates to oversee and manage upon returning to Avero Diagnostics after a nearly two-year absence while working for a non-profit group.

Mandate 1: Replace a well-known but underperforming legacy laboratory revenue cycle management (lab billing) software with an advanced laboratory billing system that would drastically improve staff productivity and cash flow.

Mandate 2: Quickly retrieve and secure payment for 47,000 stuck encounters in the outdated laboratory billing software.

Fortunately, Quevedo was ready for the challenge. With 30 years of experience and familiarity with several leading laboratory billing solutions, she quickly sized up the problem and recommended a clear path forward for lab leadership to approve.

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Investigating the Problem and Determining the Correct Laboratory Revenue Cycle Management Solution 

A Problem-Solver's Approach to a Broken System

Quevedo has always thrived on puzzles and finding the root cause of problems. When she rejoined Avero in December 2022 as Senior Director of the Business Office, she brought that same investigative mindset to a lab billing operation in crisis.

"What happened? Where did it start? Let's work backward, identify the issue, and fix it," she recalled. "Sometimes the fix is just a Band-Aid, and sometimes it means rethinking the entire process."

What Quevedo Found

After a quick assessment of the lab's financial operation, Quevedo realized the challenges went far beyond quick fixes.

"We literally couldn't get claims out of the old laboratory billing system," she explained. "Fields were missing, scrubbers weren't functioning, and even when fields weren't required, the system would sweep and flag errors anyway. We couldn't get claims out the door, and the ones that did go out often lacked the information needed for adjudication. The volume of front-end rejections was overwhelming."

The problems didn't stop there. Avero's Irving, TX, lab facility was unable to verify insurance eligibility or scrub claims with the AF modifier (which flags a specialty physician). Without this modifier, the laboratory billing team had no way of knowing whether claims were being submitted to the correct payer.

Automation and transparency were also missing. Staff complained that the old system was too restrictive and couldn't handle the lab's growing volume, resulting in excessive manual steps and ineffective communication between departments. Coders had no way of knowing whether the demographics team had placed a hold on a claim, resulting in bounce-back claims with missing information.

In a desperate attempt to keep up, the lab added 44 staffers to the billing department. Still, the issues persisted.

The Decision to Switch

Quevedo factored all of this into her evaluation and quickly concluded that a complete system change was the only path forward.

"It was obvious to me that we needed to move to another lab billing solution if we were going to clear the 47,000 encounters stuck in the old RCM system," she said.

Quevedo recommended that Avero's leadership immediately transition to LigoLab's advanced laboratory billing module, which seamlessly integrated with the organization's existing LigoLab LIS system already supporting its laboratory operations. Leadership agreed, and by February, implementation of the unified medical LIS and laboratory billing solution was underway. 

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Implementation of the New Lab Billing Solution and Early Results 

A Smooth and Seamless Transition

Quevedo described the implementation of LigoLab's advanced laboratory billing solution as easy and seamless. She was already familiar with LigoLab's LIS system and lab billing platform, having previously worked with its RCM support team. Additionally, since Avero Diagnostics was already using LigoLab for its laboratory information system workflows and data management, a smooth transition was more than just a concept.

The move was first initiated in February 2023. By April, all claims except surgical had been moved to LigoLab's lab revenue cycle management module. By August 2023, the move was complete.

47,000 Stuck Claims Recovered in Two Days

"I don't know what was required on LigoLab's side, but as far as I'm concerned, LigoLab flipped a switch, and we in the billing department went to work," said Quevedo. "Kenny Moreno, LigoLab's Senior Software Engineer, did an amazing job. He ran an automation that recreated that whole list of 47,000 encounters. Over just two days, those stuck encounters were moved from the old lab billing system and into LigoLab's RCM module."

From there, the demographics team worked through the now-accessible encounters, and in less than six weeks, resolved the entire backlog, moving all claims from demographics to coding before submitting them to the various payers.

The 47,000 previously stuck claims resulted in payments totaling just over $4.75 million.

Positive Metrics Within the First 30 Days

"We had a handful of meetings and worked together to update some client rules, bring over master lists into the Irving system, and build a master table. It was all very smooth," said Quevedo.

According to Quevedo, Avero Diagnostics began to see positive metrics within the first 20 to 30 days of using LigoLab for both its LIS and lab billing operations. The data silos, sync problems, and interface issues they once struggled with were eliminated, replaced by a single unified lab organization software platform where the laboratory information system and lab billing modules run on the same database and infrastructure.

Three Key Features That Made the Biggest Early Difference

Quevedo highlighted three critical features embedded within the LigoLab platform that drove the most immediate improvement:

Real-time insurance eligibility verification: Provides accurate payer information before claims are submitted, preventing avoidable rejections at the source.

Synchronized third-party connection with the clearinghouse: Enables seamless, real-time claim transmission and status tracking without manual follow-up.

Real-time rejection queue: Notifies the billing team immediately when a rejection occurs, eliminating delays caused by waiting for a 277 file from the clearinghouse.

"Without eligibility and that third-party connection, we were struggling," she said. "But now when we use the eligibility function within the LigoLab platform, 95 percent of the time it comes back with accurate information that enables us to get the claims out the door, and if there's a rejection, it goes into the rejection queue, and we're notified immediately."

RCM Cycle Performance Metrics: November 2023 to January 2024

Performance metrics from November 2023 to January 2024 highlight how LigoLab’s front-end RCM cycle improvements enhanced Avero’s laboratory billing performance while reducing the number of claim rejections requiring manual follow-up. 

4 to 8 hours: The time it takes for the lab billing department to complete demographics and coding, submit a claim, and receive same-day claim acknowledgment.

98.1 percent: The percentage of claims processed and paid on the first submission without rework or resubmission.

99 percent: The percentage of claims processed and paid with claim scrubbing support for the clearinghouse.

All three metrics significantly exceed accepted national benchmarks, contributing to a more efficient laboratory billing process, faster reimbursement, lower accounts receivable (A/R) days, and stronger cash flow. 

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One Source of Truth and Additional Platform Features That Improve the Laboratory Billing Process

Flagging, Automation, and TC/PC Splits

Since partnering with LigoLab for both its LIS system and laboratory billing operations, Avero Diagnostics has enjoyed steady improvement across the board. Quevedo first pointed to LigoLab's flagging system as the feature that had the greatest impact.

"We're all under Avero Diagnostics, but our Irving location has separate contracts and payers from our Bellingham lab, and we often co-mix them," she said. "With LigoLab, we're able to flag our encounters automatically, and we have the flexibility to add or change footnotes on the actual reports. That aids both our coding and rejection teams."

Quevedo also highlighted the automation built into the Avero laboratory billing process. With LigoLab, her team can set up hospital clients with their own automated rules, mapping out various scenarios involving split bills and payers, without requiring the billing team to handle every case manually.

The Advantage of a Single Lab Database Software for LIS and Lab RCM

Quevedo emphasized the value of working within a single system for both LIS and laboratory billing workflows. Beyond ensuring end-to-end data integrity, this integration enables her team to immediately confirm where a service was performed, verify that the correct rendering provider is on the claim, and access all supporting documentation associated with a specimen or case.

"Every day, every department is moving between LigoLab's RCM and LIS modules to either fix claims or get them out the door. Having both on the same database is a huge advantage," she said.

She also noted a key difference from the legacy system: her team no longer needs to manage client billing separately from other RCM cycle processes. All billing information is centralized, linked to the patient account, and always accessible.

"There simply aren't many lab revenue cycle management systems that provide direct client invoicing and daily notifications within the same platform," she added.

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System Usability and Software Support

User-Friendly by Design

According to Quevedo, another way LigoLab sets itself apart from the competition is usability.

"You cannot ask for a more user-friendly system than LigoLab’s," she said. "I've been at this for 30 years, and I've probably encountered 20 to 25 other lab revenue cycle management systems. There's just no comparison. LigoLab is intuitive. It just makes sense."

To illustrate this, Quevedo described a recent new hire who was trained on demographics within two days, quickly matching or surpassing the productivity of staffers with years of experience.

Customer Support That Never Leaves You Hanging

"The customer service is impeccable. I never hear them say that it cannot be done. They either provide the solution I need or recommend an effective workaround. I never feel like my issue is left unresolved," she said. 

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Final Thoughts: Widespread Measurable Improvements

In summary, the switch from a legacy and outdated laboratory revenue cycle management system to LigoLab's all-in-one medical LIS and lab billing solution has led to widespread, measurable improvements for Avero Diagnostics.

Quevedo's team now consistently meets its daily case goals, no longer hindered by multiple claim review cycles, recurring errors, or the 24-hour delays associated with reprocessing.

"Now, everything is immediate," she said. "You submit the claim, it goes into transmission, and within a couple of hours you can see it in the clearinghouse and know whether it was accepted."

Beyond accelerating the revenue cycle, LigoLab's modern laboratory billing solution has also streamlined laboratory operations and strengthened client relationships.

"In the old system, our clients often complained about delays in getting their lab reports, with turnaround times stretching to four or even six days for hospital clients. That problem disappeared once we moved from the legacy laboratory billing system to LigoLab's lab RCM solution, and we made a lot of clients happy in the process," she said.

Take Control of Your Lab’s Financial Future

Avero Diagnostics turned a massive backlog and outdated laboratory billing system into a streamlined, profitable operation by switching to LigoLab's advanced laboratory billing software solution. With automation, real-time eligibility checks, and a single source of truth, the lab improved productivity, reduced rejections, accelerated payments, and boosted client satisfaction.

Ready to Eliminate Laboratory Billing Headaches and Maximize Medical Laboratory Profit?

Act Now: Contact a LigoLab Product Specialist!

Frequently Asked Questions About Avero Diagnostics and LigoLab's Laboratory Revenue Cycle Management Integration

What problems was Avero Diagnostics experiencing with its legacy lab revenue cycle management system?

Avero's legacy laboratory billing system had missing fields, non-functioning scrubbers, and excessive false error flags, preventing claims from being issued correctly. The Irving, TX, location was unable to verify insurance eligibility or apply the AF modifier for specialty physicians, resulting in payer routing errors. There was no automation, no inter-departmental communication, and no real-time rejection notifications. Despite adding 44 billing staff to manage the backlog, 47,000 claims remained stuck with no clear path to resolution.

How quickly were the 47,000 stuck claims resolved after switching to LigoLab?

LigoLab's Senior Software Engineer ran an automation that migrated all 47,000 stuck encounters from the legacy system into LigoLab's lab billing module in just two days. The billing team then worked through the backlog, completing demographics, coding, and claim submission all within six weeks. The recovered claims resulted in payments totaling just over $4.75 million.

What RCM performance metrics did Avero achieve after switching to LigoLab?

From November 2023 to January 2024, Avero achieved a claim submission-to-acknowledgement turnaround of four to eight hours, a 98.1 percent first-pass claim payment rate without rework or resubmission, and a 99 percent payment rate with clearinghouse scrubbing support. All metrics were well above accepted national benchmarks.

What three LigoLab features had the most immediate impact on Avero's billing performance?

The three most impactful capabilities were real-time insurance eligibility verification, which accurately identifies payer information before claim submission in approximately 95 percent of cases; a fully synchronized clearinghouse integration that enables real-time claim submission and status tracking; and a real-time rejection queue that alerts the billing team to issues immediately, eliminating the need to wait for a 277 rejection file from the clearinghouse. 

How does having LIS and lab billing modules on the same database benefit Avero's billing team?

With both modules sharing a single lab database software, Avero's billing team can confirm where a service was performed, verify the rendering provider on a claim, and access all supporting documentation for a specimen or case within a single unified system. This eliminates synchronization errors, preserves end-to-end data integrity, and allows every department to move seamlessly between LIS and RCM workflows throughout the day.

How did switching to LigoLab affect Avero's client relationships?

Before adopting LigoLab's unified platform, Avero's hospital clients routinely experienced report delays of four to six days. Those delays disappeared after the transition, as the fully integrated LIS and laboratory billing solution eliminated the workflow bottlenecks caused by disconnected systems. Faster report delivery improved client satisfaction and strengthened Avero's relationships with its hospital partners. 

How user-friendly is LigoLab's lab billing platform compared to other RCM systems?

Tina Quevedo, with 30 years of experience and exposure to 20 to 25 other laboratory billing systems, describes LigoLab as simply incomparable in terms of intuitiveness. A recent new hire at Avero was trained on demographics within two days. It quickly matched the productivity of experienced staff, a testament to how accessible and well-designed the platform is for billing departments of all experience levels.