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

The foundation for LigoLab’s integrated laboratory information system (LIS software) and laboratory revenue cycle management (lab RCM) informatics platform superiority centers on the customers’ ability to seamlessly, accurately, and rapidly prepare clean claims within the pathology lab software for laboratory billing 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 (LIS in healthcare) with lab revenue cycle management automation aimed at powering the platform to deliver highly customizable laboratory billing solutions as part of its optimized laboratory workflow management. 

The LigoLab Informatics Platform was designed to provide independent clinical laboratories and pathology groups with a single source of truth by making medical LIS and lab revenue cycle management data instantly accessible.

Learn More: Six Reasons Why You Should Choose an Integrated Laboratory Billing Solution for Your Medical Lab

Technical operations can leverage full transparency by configuring clinical lab workflow to address compliance, productivity, and scalability without sacrificing revenue. Specifically, the laboratory billing process can be (successfully) transitioned from the previously accepted “back-end” laboratory billing process to the new, growing “front-end” lab billing standard. 

Unfortunately,  due to its siloed and rigid framework, a typical legacy or stand-alone laboratory billing system cannot offer such transparency or flexibility to the lab RCM process. 

Users quickly embrace the easy access to LigoLab’s integrated and all-in-one informatics platform with lab billing software for labs, thanks to the features and functionalities we will highlight here.

1. Data Integration 

Integrated Laboratory Information System & Laboratory Billing Solutions: One Source of Truth

• LigoLab’s integrated platform interface gives users simple access and transparent visibility to all LIS system and lab billing data entities, all housed in the Billing Encounter.

• This shared functionality allows users to easily modify the lab information system and RCM cycle data as needed, enabling them to accurately remove/add tests and validate pertinent LIS 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 adjust to various commonly encountered laboratory information system data, such as patient demographic data, CPT codes, diagnoses, and provider credentials.

• These adjustments can be made “on the fly” due to the user-friendly and intuitive nature of the Billing Encounter window featured within the all-in-one medical LIS and lab RCM platform. 

• Easy access to relevant test order information, specifically: specimens, results, scans, reports, and audit trails, is available throughout the lab billing workflow. 

• This readily available and interdependent LIS lab and RCM cycle data confirm the core philosophy of an integrated platform and demonstrate how laboratories can achieve a transparent laboratory billing process. 

Non-Integrated & Rigid Laboratory Billing Solutions: Data Management Turns Wasteful

• Non-integrated and legacy laboratory billing solutions do not provide users with instant and easy access to medical LIS data within lab RCM workflow tasks. 

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

• Non-integrated laboratory billing solutions typically increase the amount of incomplete, erroneous, and improperly linked lab RCM claims to subsequent edited LIS system data. 

• Multiple laboratory software systems create an increased risk of potential errors and missed lab billing opportunities. Specifically, these systems must keep master files, such as clients, tests, providers, and payers, updated separately. As a result, barriers to data integrity and transmission issues arise. 

• Formatting between disparate laboratory software systems (a medical LIS and a laboratory billing system) can quickly become an issue, causing data migration to become another labor-intensive task, occupying time that could’ve been better spent on other aspects of the lab workflow. 

On-Demand Webinar: Unifying Technical and Financial Operations to Minimize Denials and Prevent Revenue Leakage

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.

This leads to:

• Round-the-clock access to a “real-time” LIS system and lab RCM performance and throughput metrics, independent of volume, workflow, and scale. 

• The ability to monitor lab workflow efficiency and productivity using the numerous proprietary lab RCM tools to establish an innovative data organizational hierarchy, such as statistics inquiry, dynamic reports, dashboards, and RCM cycle 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 lab 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 lab RCM 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 collectability. 

Non-Integrated & Rigid Laboratory Billing Solutions: Conflicting Error-Prone Metrics

• Non-integrated laboratory billing solutions lack robust dashboard widgets and reporting functionality because they cannot access the full spectrum of a laboratory’s data (LIS system and lab RCM). 

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

Learn More: Understanding the Importance of Real-Time Analytics in the Modern Clinical Laboratory

3. Coding Configuration 

Robust Coding Tools & Laboratory Billing Automation: Unlimited Configurability

• LigoLab utilizes a robust and easily configurable custom Rule Engine that provides 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 for CPT codes processed within claims, setting the stage for a maximized clean claim first-pass ratio.

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

• This high-level lab RCM automation and configurability ensures maximum reimbursement for every claim every time. 

Rigid Rule-Based Lab RCM Functionality & Antiquated Coding Process: Limited Configurability

• Legacy billing software for labs provides limited, clunky, hard-coded, and rigid rule-based lab RCM functionality with antiquated CPT code rules that cannot be grouped or split, creating a cumbersome and subpar coding process. 

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

Learn More: Boosting Laboratory Revenue with Billing & Coding Automation

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 directly embedded within the Order Entry and Billing Encounter window, ensuring “real-time” payer data validation and 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 lab vendors that can be configured within any lab revenue cycle management 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 Lab Billing Workflow: Significantly Increased Claim Denials & Revenue Loss

• Legacy laboratory billing solutions can not provide such integrated eligibility and discovery functionalities, causing staff to dedicate labor hours toward attaining and validating payer data. 

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

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

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

5. Workflow & Case Management

Designated Lab Workflow Queues & RCM Tools: Maximum Organizational Efficiency

• Optimized lab workflow efficiency is achieved by specialized queues and configuration RCM tools, including entity tags, notes, and queue data filters, powered through the configurable Rule Engine.

• All available platform RCM tools are designed to direct laboratory workflow management, 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 RCM Workflow Control

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

Learn More: Streamline Laboratory Workflow Management With Customized Lab Reports & Unmatched Client Support

6. Claim Denial Processing 

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

• Denials have typically been viewed as a tricky and labor-intensive part of the lab RCM workflow, however, this RCM process has been transformed into its most efficient form thanks to the platform’s limitless configurability options.

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

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

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

• Legacy laboratory billing solutions do not provide denial automation, lab RCM rule infrastructure, supplemental case sorting, and sample tracking functionalities. 
• Users are left to manually handle denied claims, leading to increased time demands, workflow inefficiencies, and a higher risk of errors across clinical lab operations.

Industry Insights: Tips for Laboratory Billing Reimbursement Challenges

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 lab workflows, creating an extra advantage to achieve a maximized first-pass ratio.

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

Limited Configurability: Regulatory Compliance & Payer Data Functionalities

• Legacy laboratory revenue cycle management solutions use traditional non-configurable laboratory billing processes and cannot map payer data. They do not provide the necessary integrated medical LIS system and lab RCM data transparency, limiting control over regulatory compliance.

• The lack of flexibility within regulatory compliance significantly increases the risk of laboratory billing errors, claim duplication, and/or improper coding, leading 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. 

Learn More: What You Need to Know About the CMS Plan to Regulate Improper Lab Payments in 2025

8. Laboratory Billing Automation

Implementing Lab RCM 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 lab revenue cycle management features help ensure significant increases in profitability, 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 laboratory revenue cycle management 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 RCM workflow inefficiencies. 

• Laboratory businesses experience reduced profit and face a higher risk of regulatory non-compliance.

Learn More: Automate Complex Processes & Simplify Clinical Lab Operations with LigoLab Informatics Platform

In summary, a much-needed shift in how clinical and reference labs and pathology groups approach laboratory billing is needed to attain new transparency, flexibility, and scalability with the laboratory billing process.

Please contact us to speak with a lab RCM specialist and learn more. We’re excited to demonstrate how medical LIS and laboratory revenue cycle management integration are critical for your business's prosperity. 

Speak with a LigoLab RCM Specialist Today!