The LigoLab Difference: Demonstrating the Power of RCM Automation in the Clinical Laboratory
November 21, 2023
The foundation for LigoLab’s integrated laboratory information system (LIS) and laboratory revenue cycle management (RCM) informatics platform superiority centers on the customers’ ability to seamlessly, accurately, and rapidly prepare clean claims for services rendered, guaranteeing an increase in the bottom line and net collections.
This capability is due to the combination of an innovative Rule Engine and the concept of having a lab information system with laboratory billing automation aimed at powering the platform to deliver highly customizable medical LIS solutions into any lab workflow.
LigoLab Informatics Platform was designed to provide laboratories with a single source of truth by making the laboratory information system and laboratory revenue cycle management data instantly accessible. Laboratory operations can take advantage of having full transparency by configuring lab workflow to address compliance, productivity, and scalability without sacrificing revenue. Specifically, laboratory billing can be successfully transitioned from the previously accepted practice of a “back-end” laboratory billing process to the new growing standard of being a “front-end” laboratory billing process.
Unfortunately, a typical legacy or stand-alone laboratory billing system cannot offer such transparency or flexibility due to its siloed and rigid framework.
Users quickly come to embrace the easy access to LigoLab’s integrated and all-in-one informatics platform as a result of its available features and functionalities that we will highlight here.
1. Data Integration
Integrated LIS & RCM Informatics Platform: One Source of Truth
- LigoLab’s integrated platform interface gives users simple access and transparent visibility to all the LIS system and Billing Encounter-related data entities.
- This shared functionality allows users to easily modify lab data as needed, accurately remove/add tests, and validate pertinent lab information system data within lab revenue cycle management processes, all with a single click of a keyboard button.
- In addition, this shared functionality allows users to make adjustments to various commonly encountered laboratory information 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 featured within the platform.
- Easy access to relevant test order information, specifically: specimens, results, scans, reports, and audit trails are all available throughout the entire lab billing workflow.
- This readily available and interdependent LIS & RCM data confirms the core philosophy of an integrated platform and demonstrates how laboratories can achieve a transparent workflow.
Non-Integrated & Rigid Laboratory Billing Systems: Data Management Turns Wasteful
- Non-integrated and legacy laboratory billing 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 laboratory billing workflow as a “back-end” process, increasing the chances of data discrepancies.
- Non-integrated lab RCM systems typically increase the amount of incomplete, erroneous, and improperly linked lab billing claims to subsequent edited LIS data.
- Multiple laboratory software systems create an increased risk of potential errors and missed billing opportunities. Specifically, a 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 between disparate laboratory information systems and lab RCM systems 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 lab workflow.
2. 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, workflow, and scale.
- The ability to monitor workflow efficiency & productivity using the numerous proprietary RCM 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 laboratory 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 personnel time toward the more difficult laboratory 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 lab workflow tasks based on pre-configured and easily adjustable criteria such as time, amounts, and ability to collect.
Non-Integrated & Rigid Laboratory Billing Systems: Conflicting Error-Prone Metrics
- Non-integrated laboratory billing systems 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 lab workflow, including its efficiency, the metrics needed to maximize operations, workflow output, and total net collections.
3. 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 laboratory 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” RCM process can be pre-configured to validate established payer-specific compliance regulations such as NCD, LCD, and NCCI (PTP & MUE).
- This level of automation configurability ensures maximum reimbursement is achieved for every claim every time.
Rigid Rule-Based Functionality & Antiquated Coding Process: Limited Configurability
- Legacy laboratory 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 lab workflow.
4. 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 lab 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 RCM tools powered by White Pages, USPS, and other third-party vendors that can be configured within any lab 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 laboratory billing systems can 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 lab RCM 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 laboratory billing systems lack the availability of quick, accurate, and user-friendly data validation RCM tools that allow laboratories to transform billing into a “front-end” RCM process.
5. Workflow & Case Management
Designated Workflow Queues & Tools: Maximum Organizational Efficiency
- Lab 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 workflow, streamline lab billing operations, and easily scale business regardless of volume.
- Claims can be tracked manually and/or automatically (via the Rule Engine), ensuring accurate claim resolution.
Limited Rule Engine Capabilities: Ineffective Lab Workflow Control
- Legacy laboratory billing systems have limited and obsolete rule engine capabilities, providing users with fewer and/or ineffective lab workflow control, case exception management, and case routing capacity.
6. 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 lab workflow, but LigoLab has transformed this RCM 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 toward 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 rule infrastructure with supplemental case sorting and tracking functionalities.
- Users are forced to manually process denied claims with the results being increased time consumption, lab workflow inefficiency, and higher risk for overall errors.
7. Regulatory Compliance
Single-Click and Up-to-Date: Regulatory Compliance Functionality
- Laboratory billing workflow functionality setups such as payer mapping, coverage plans, and lab billing patterns are easily configured within the LigoLab platform.
- The flexibility of configuration options for regulatory compliance is customizable to match all laboratory workflow, 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 laboratory billing 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.
8. Billing Automation
Implementing Automation via the Rule Engine: Increases Total Net Collections
- The LigoLab platform eliminates the need for manual intervention within lab billing workflow tasks, creating timely and accurately coded claims and increasing throughput across the board.
- The platform’s many features help 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 laboratory billing systems without these powerful features rely on manual processes, become inherently labor-intensive, and are prone to user errors combined with untimely and non-trackable delays.
- The byproducts as mentioned above collectively decrease operational throughput, increase denial rates, and cloud lab 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 and reference labs and pathology groups 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 and contact us today to speak with an RCM Product Specialist. We’re excited to show you just how important laboratory information system and laboratory revenue cycle management integration is for your business's prosperity.