The LigoLab Difference: Demonstrating the Power of RCM Automation in the Clinical Laboratory

The foundation for LigoLab’s integrated LIS & RCM Laboratory Operating Platform superiority centers on the ability to seamlessly, accurately, and rapidly prepare clean claims, guaranteeing an increase in the bottom line and net collections for your business. 

This capability is due to the combination of an innovative Rule Engine and the concept of automation aimed at powering the platform to deliver highly customizable software solutions into any laboratory workflow. 

LigoLab’s platform was designed to provide laboratories with a single source of truth, by making laboratory information system (LIS) and revenue cycle management (RCM) data instantly accessible. Laboratory operations can take advantage of having full transparency by configuring workflows to address compliance, productivity, and scalability without sacrificing revenue. Specifically, lab billing operations can be transitioned from the previously accepted practice of a “back-end” process to the new growing standard of being a “front-end” process. 

Unfortunately, typical legacy and stand-alone RCM systems cannot offer such transparency or flexibility due to their siloed and rigid framework. 

Users quickly come to embrace the easy access to an integrated LIS & RCM system as a result of available functionalities that we will highlight here.

Data Integration 

Integrated LIS & RCM: One Source of Truth

• LigoLab’s integrated system interface gives users simple access and transparent visibility to billing encounter-related data entities.

• This shared functionality allows users to easily modify lab data as needed, accurately remove/add tests, and validate pertinent LIS data within RCM processes, all with a single click of a button. 

• In addition, this shared functionality allows users to make adjustments to various commonly encountered laboratory data such as patient demographic data, CPT codes, diagnoses, and provider credentials 

• These adjustments can be made “on the fly” with ease due to the user-friendly and intuitive nature of the billing encounter window. 

• Easy access to relevant order data, specifically: specimens, results, scans, reports, and audit trails are all available throughout the entire billing workflow. 

• This readily available LIS & RCM data confirms the core philosophy of an integrated platform and demonstrates how laboratories can achieve a transparent workflow. 

Non-integrated & Rigid Platforms: Data Management Turns Wasteful

• Non-integrated and legacy systems do not provide users instant and easy access to LIS data within RCM-related workflow tasks. 

• Non-integrated encounter-based interfaces force users to treat billing workflow as a “back-end” process, increasing the chances of data discrepancies. 

• Non-integrated platforms typically increase the amount of incomplete, erroneous, and improperly linked billing claims to subsequent edited LIS data. 

• Multiple systems create an increased risk of potential errors and missed billing opportunities. Specifically, the need to constantly keep both systems’ master files, such as clients, tests, providers, and payers. As a result, further barriers in the form of data integrity and transmission issues arise. 

• Formatting can quickly become an issue causing data migration to turn into another labor-intensive task occupying time that could’ve been better spent on other aspects of the workflow. 

KPI Reporting & Dashboards

Transparency & Reporting: 360° Operational Visibility

The LigoLab platform provides detailed insight into key performance indicators with robust dashboard widgets and reporting tools. :

• Round-the-clock access to “real-time” performance & throughput metrics independent of volume, workflows, and scale. 

• The ability to monitor workflow efficiency & productivity using the numerous proprietary tools geared to establishing an innovative data organizational hierarchy, such as statistics inquiry, dynamic reports, dashboards, and revenue forecasting. 

• Transparent audit trail visibility that ensures full accountability and user-to-department-specific productivity, validating all corresponding billing data that can be tracked from start to finish.

• Peace of mind is quickly achieved as a result of establishing transparent access to data, leading to an allocation of time toward the more difficult billing processes without sacrificing revenue. 

• Cases no longer slip through the cracks due to the seamless structure between the workflow queues within the platform and the powerful query capability controlled by customizable data filters. 

• The compartmentalization, uniform distribution, and flagging of claims quickly set clear workflow expectations combined with easy accountability. 

• The Rule Engine triggers automated data processing cascades allowing the platform to prioritize workflow tasks based on pre-configured and easily adjustable criteria such as time, amounts, and ability to collect. 

Non-integrated & Rigid Platforms: Conflicting Error-prone Metrics

• Non-integrated platforms lack robust dashboard widgets and reporting functionality because they cannot access the full spectrum of a laboratory’s data. 

• As a result, laboratories do not have visibility into the inner workings of the total workflow, including its efficiency, the metric needed to maximize operations, workflow output, and total net collections.

Coding Configuration 

Robust Coding Tools & Automation: Unlimited Configurability

• LigoLab utilizes a robust and easily configurable custom Rule Engine, giving users the instant ability to define any given scenario while simultaneously meeting any billing or operational need.

• LigoLab’s powerful Rule Engine allows users to create rules aimed at how CPT code(s) are processed within claims, setting the stage for a maximized clean claim first-pass ratio.

• The “claim-scrubbing” process can be pre-configured to validate established payer-specific compliance regulations such as NCD, LCD, and NCCI (PTP & MUE).

• This automation configurability ensures maximum reimbursement is achieved for every claim every time. 

Rigid Rule-based Functionality & Antiquated Coding Process: Limited Configurability

• Legacy billing systems provide limited, clunky, hard-coded and rigid rule-based functionality with antiquated CPT code rules that cannot be grouped or split, creating a cumbersome and sub-par coding process. 

• Additionally, implementation of new payer-directed reimbursement regulatory practices can be difficult and costly due to the time needed along with labor for full integration into this new workflow. 

Data Validation 

Insurance Eligibility, Discovery & Overall Data Validation: Time is Money 

• Redundant tasks used for data validation quickly become obsolete and the time previously spent on performing data validation can now be directed toward the more challenging workflow tasks.

• LigoLab provides a fully integrated, “single-click” batch Insurance Eligibility/Discovery tool that’s directly embedded within the order entry and billing encounter window, ensuring “real-time” payer data validation resulting in maximized efficiency within any laboratory billing workflow.

• In addition, LigoLab provides integrated demographic data validation tools powered by White Pages, USPS, and other third-party vendors that can be configured within any workflow. 

• The White Pages and USPS validation tools are also directly embedded in the billing encounter window, allowing users to confirm the accuracy of patient/payer addresses, patient names, and phone numbers within seconds.

Back-end Billing Workflow: Significantly Increased Claim Denials & Revenue Loss

• Legacy billing systems do not provide such integrated eligibility and discovery functionalities, creating the need for staff to dedicate labor hours toward attaining and validating payer data. 

• Additionally, competitor systems force laboratories to treat billing as a “back-end” process, delaying or even causing unnecessary claim denials, missed reimbursement from payers, and revenue loss. 

• Legacy systems lack the availability of quick, accurate, and user-friendly data validation tools that allow laboratories to transform billing into a “front-end” process.

Workflow & Case Management

Designated Workflow Queues & Tools: Maximum Organizational Efficiency

• Workflow efficiency is dictated by specialized queues and configuration tools including entity tags, notes, and queue data filters powered through the configurable Rule Engine.

• All of the available platform tools are designed to direct laboratory workflows, streamline billing operations, and easily scale business regardless of volume.

• Claims can be tracked manually and/or automatically (Rule Engine), ensuring accurate claim resolution.

Limited Rule Engine Capabilities: Ineffective Workflow Control

• Legacy billing systems have limited and obsolete rule engine capabilities, providing users with fewer and/or ineffective workflow control, case exception management, and case routing capacity.

Claim Denial Processing 

Single-click Claim Denial Processing: Case Prioritization & Revenue Recovery

• Claim denials have typically been viewed as a tricky and labor-intensive part of workflows, but LigoLab has transformed this process into its most efficient form as a result of the platform’s limitless configurability options.

• Specifically, claim denial processing is set up to have “single-click” access to denial management along with denial rates, trends, and pre-configured response protocols.

• The labor hours typically spent addressing the claim denial workflow tasks are significantly reduced resulting in more time allocation towards other workflow aspects and decreased revenue loss. 

Inefficient, Error-prone & Labor Intensive: Manual Claim-Denial Processing

• Legacy laboratory billing systems do not provide denial automation and rules infrastructure with supplemental case sorting in combination with tracking functionalities. 

• Users are forced to manually process denied claims with the end results being increased time consumption, workflow inefficiency, and higher risk for overall errors.

Regulatory Compliance

Single-click Up-to-Date: Regulatory Compliance Functionality

• Laboratory billing workflow functionality setups such as payer mapping, coverage plans, and billing patterns are easily configured within the LigoLab platform.

• The flexibility of configuration options for regulatory compliance is customizable to match all laboratory workflows, creating an extra advantage to achieve a maximized first-pass ratio.

• The risk for regulatory non-compliance is mitigated via automation while reimbursement rates simultaneously rise, creating the perfect environment to maintain revenue growth along with scalability. 

Limited Configurability: Regulatory Compliance & Payer Data Functionalities

• Legacy laboratory billing systems use traditional non-configurable processes and cannot map payer data; they do not provide the necessary integrated LIS/RCM data transparency, limiting control over regulatory compliance.

• The lack of flexibility within regulatory compliance significantly increases the risk of billing-related errors, claim duplication, and/or improper coding that leads to revenue loss.

• Collectively, regulatory non-compliance leads to immediate “red flags” and increases the cross-functional risk that triggers in-depth regulatory audits, resulting in business contraction. 

Billing Automation

Implementing Automation via the Rule Engine: Increases Total Net Collections

• The LigoLab platform eliminates the need for manual intervention within billing workflow tasks, creating timely and accurately coded claims and increasing throughput across the board. 

• The platform’s features ensure significant increases in revenue, consistent operational efficiency, multiple transparent audit-tracking capabilities, and executive-level reporting tools.

Labor Intensive Claim Processing: Reduces Operational Throughput & Increases Error Rates

• Non-integrated legacy billing systems without these powerful features rely on manual processes, become inherently labor-intensive, and are prone to user errors combined with untimely non-trackable delays. 

• The above-mentioned by-products collectively decrease operational throughput, increase denial rates, and cloud workflow inefficiencies. 

• In the end, laboratory businesses experience reduced profit and simultaneously face a higher risk for regulatory non-compliance.

In summary, a much-needed shift in the way clinical labs approach laboratory billing is needed if they are to attain new levels of transparency, flexibility, and scalability.

To learn more, check out these related links or contact us today to speak with an RCM Product Specialist and learn why LIS/RCM integration is so important for laboratory prosperity. 

The Connected Laboratory: A New Approach to Laboratory Billing Services

How Advanced and Highly Integrated Billing Automation can Help Improve Workflow Efficiency and the Clean Claim Pass-through Rate

How Billing and Coding Automation Increases Laboratory Revenue

Reduce Denials and Incrase Your Lab's Revenue and Net Collections