Revenue Cycle Management (RCM) Management Solutions for Laboratories
November 17, 2023
What is RCM Software?
Revenue cycle management (RCM) software integrates and manages various administrative and clinical components around claim processing, payments, and billing. Ultimately, the goal of effective RCM lab software is to help labs increase profit by:
- Reducing costs by automating much of the billing process and avoiding errors that lead to re-work.
- Growing revenue by minimizing denials with more accurate and compliant claim submissions.
- Increasing cash available to the laboratory and decreasing working capital needs by decreasing accounts receivable turnaround time.
The Future of Laboratory RCM
Effective use of the RCM platform is crucial to the success of most healthcare businesses, including laboratories. According to the nonprofit Council for Affordable Quality Healthcare, the healthcare industry saved $122 billion in 2020 administrative expenses through digitalization and automation.
For laboratories, RCM software can be integrated into the Laboratory Information System (LIS) or it can exist as a standalone module that interacts with LIS software.
How does Healthcare Revenue Cycle Management Software Work?
While laboratory RCM software is most associated with effective claim submission and payment collection, the best revenue cycle management systems need to excel at all seven of the following RCM workflow stages:
Collection of patient demographics and payer information at test order creation.
Verification of patient demographics and insurance information before testing. The best RCM software platforms employ direct interfaces with third-party services that specialize in patient demographics verification, insurance eligibility, and insurance discovery.
Coding with diagnoses and procedure codes. The best RCMs fully automate the coding process rather than relying on manual coding from a standard list.
Claim submission, the process by which properly-coded claims are sent to payers (insurance companies, clients, patients) for payment.
Payment collection from insurance payers or patients and clients for any remaining balance owed after insurance reimbursement.
Denial management is engaged if payment is not received and the claim requires correction, resubmission, and/or an appeal.
Analysis and reporting enable lab owners and executives to use RCM data in efforts to lower expenses, maximize profit, and improve health outcomes.
Healthcare Revenue Cycle Software Trends
According to Global Market Insights, the size of the healthcare RCM market is expected to grow by over 12 percent per year from just over $52 billion in 2019 to approximately $115 billion by 2025.
This growth is fueled by increasing demand from within laboratories and other components of the healthcare system. According to CAQH, the same group that estimated that automation and digitalization helped care companies avoid $122 billion in costs in 2020, fully automating just nine commonly performed transactions could yield a further $16 billion in savings.
Another factor contributing to the importance of revenue cycle management software is the trend, especially in the United States, toward a value-based care model as opposed to fee-for-service. As patients, insurance companies, employers, and other stakeholders expect more data, presented to them in timely and standardized ways, healthcare companies need to be able to rely on their RCM systems to keep up.
Best Healthcare Revenue Cycle Management Companies
The best healthcare revenue cycle management companies have invested in the seven key RCM workflow stages listed above. Their systems are customizable, user-friendly, reliable, and packaged with high-quality technical support.
Modern laboratories need to be supported by modern software, including up-to-date revenue cycle software solutions. This need will only grow in the future, as efficient and standardized billing processes become the norm, and the healthcare system moves from fee-for-service toward a care-based model.
LigoLab is a leading provider of innovative end-to-end healthcare software for laboratories, servicing 100+ facilities nationwide. As a comprehensive enterprise-grade solution, the LigoLab LIS & RCM Laboratory Operating Platform™ includes modules for AP, CP, MDx, RCM, and Direct-to-Consumer, all-in-one integrated platform that supports every role, department, and the entire lifecycle of all cases, enabling laboratories to better serve patients, differentiate themselves in the marketplace, scale their operations, become more compliant, and more profitable.
LigoLab’s RCM module is deeply integrated with the LIS. It automates ICD and CPT coding and many other financial tasks while also mitigating audit risk and increasing margins. Billing processes start at order creation with verification, eligibility, and scrubbing components that increase clean claim submissions and revenue, and decrease claim denials and compliance liability.
LigoLab thrives on partnerships and takes full responsibility for all of its clients’ information system-related needs, enabling these laboratories to focus on diagnostic services that help healthcare providers and patients make informed decisions.
For more information, please visit RCM.LigoLab.com.