Is your laboratory ready for Direct Primary Care?
November 15, 2023
A recent article at Darkdaily.com put the spotlight on Direct Primary Care as a new and emerging healthcare model in the United States. DPC is an arrangement that enables primary care providers to bill patients directly for the services they provide, rather than utilizing a traditional insurance healthcare plan.
The new model is gaining momentum because of its potential to lower healthcare costs overall while freeing up physicians to spend less time on insurance paperwork and administrative costs and more time with their patients. The new model is also attractive to patients who want a healthcare arrangement that’s more cost-effective, convenient, and easy to understand.
The DPC model puts the financial responsibility for services received on the patient rather than on the payer. This shift in responsibility can be viewed as an opportunity for pathology groups and clinical laboratories that invest in laboratory information systems (LIS) and revenue cycle management (RCM) solutions seamlessly built to work with both payers and patients.
The LigoLab LIS & RCM operating platform is uniquely configured with embedded modules to handle both the traditional fee-for-service model for payers and the emerging DPC model for patients. That’s because all LIS & RCM functions share one common and connected database. There is no need for an interface. The platform leverages integration and automation that allows the billing cycle to start at order origination and then advance throughout the entire testing process. The end result is an increase in revenue and margins for the laboratory and greater satisfaction for the patient and the payer.
The all-in-one LIS & RCM captures valuable and accurate information needed for clean claims on the front-end of the billing cycle and fully integrates RCM throughout a lab’s workflow. This gives labs full control and visibility of their financial operations.
For payers, the LigoLab operating platform automates eligibility checks, insurance discovery, address validation, prior-authorization, and CPT and ICD-10 coding. All of these processes are completed in real-time and on the front-end to guard against missing and inaccurate information, the leading causes for claim denials. By utilizing these processes and more, the platform enhances the lab’s relationship with payers, leveraging this newfound efficiency to drastically improve KPI like clean claim percentage and first-pass resolution rate while also minimizing the need for human intervention.
For patients, the platform harnesses automation to flexibly schedule and distribute statements at any time, and the statement templates are fully customizable. The all-in-one platform also features enhanced patient payment functionality, allowing patients to quickly receive and review their statements much faster than before and pay their bills via an online portal that automatically posts payments. Labs can also engage patients throughout the cycle with both email and SMS notifications and set up payment plans. All of these functions cater to today’s healthcare consumers while also providing labs with the tools to adapt to the changing times.
Not all labs are set-up to bill patients directly, but as the article states those that have or acquire this ability to directly engage patients will gain an edge.
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Is your pathology, clinical, or reference laboratory able to directly bill patients? Does your system automatically begin the billing cycle at order origination rather than after the case is finalized?
At LigoLab, we help labs grow and thrive. If you’d like to learn more about us and how our LIS & RCM operating platform can drive revenue growth of 30 percent or more, please fill out this form: https://ligolab.typeform.com/to/MGrZgl
At LigoLab, we’ve provided flexible all-in-one solutions for laboratories since 2006. Our LIS & RCM laboratory operating platform is currently driving efficiency, performance, and growth in over 100 facilities nationwide.
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Related Reading: See how Northwest Pathology used the LigoLab all-in-one operating platform to unlock lost revenue and grow.