In these times of hyper-tight reimbursement and changing payment systems, laboratories are under increased scrutiny when it comes to their Revenue Cycle Management (RCM). From the information submitted through coding to denied claims, it’s easy to see that insurance payers are looking for ways to slice the pie even thinner.

Add to that, the complexities brought by COVID-19 and the public health emergency and laboratories are trying to navigate the most tangled reimbursement landscape in memory.

Exploring RCM Through a Fresh Lens

What if there were realistic solutions that just required a laboratory to look at their business operations through new eyes? Billing and RCM are often approached using the “tried and true” methods that brought success in past years. However, today’s environment requires seeing business processes from a new and different perspective.

Streamlining Coding and Billing

The age-old problem is how to most efficiently prepare and submit the claims that request payment from insurance payers in the most expeditious way possible. ICD-10-CM, CPT, and HCPCS codes are complex and frequently updated or changed, as evidenced by the new COVID-19 testing and treatment codes. How can your laboratory possibly stay current with the myriad of new, changed, or deleted codes and ensure that your claims are filed on time and accurately?

Consider a third-party partner that offers a team of certified and expert coders who thoroughly understand laboratory coding and the entire billing process. Using a third-party team, your organization no longer has to ensure coding proficiency or accuracy. Instead it can rely on your support team to provide the best coding and billing process on your behalf.

Optimizing the A/Rs

Once your claims are filed, the lion’s share paid and no questions asked. However, there will be a portion that will be returned as denied or rejected. According to the Medical Group Management Association (MGMA), 50-60% of those claims will languish unattended; revenue completely abandoned.

Whether because of a lack of time or understanding, more than half of denied claims industry-wide are written off as bad debt when they could be corrected and resubmitted for payment.

With Infinx’s AR Optimization Solution tool, data can be analyzed, prioritized, and claims recovered for adjudication, improve the laboratory bottom-line and allow business staff to focus on higher-level functions in the RCM workflow.

Discovering Undisclosed Insurance Coverage

Once all your billing processes are complete, you are left with uncollectible accounts that typically have gone to collections where fees can run from 33 to 70%. Often these accounts have undisclosed coverage that even the patient may not know about but could be used to obtain payment.

By using an AI-driven software solution, uncollected aging AR can be researched against insurance payers’ rules in clearinghouses, coverages updated, and claims resubmitted to the payer. This can be particularly effective with Medicare and commercial insurance coverage and can lead to additional collections from otherwise uncollectible bad debt.

Improve Laboratory Revenue and Reduce Overhead

Using advanced automation solutions allows a laboratory to improve its revenue, and reduces overhead and refocuses human intelligence on the patient experience.

With reimbursement becoming more intricate and involved as testing becomes exponentially more complex and insurance payers increase control mechanisms like prior authorization, advanced automation, and AI-driven solutions are necessary to ensure financial viability.

Contact us to learn more about the opportunities through RCM to improve laboratory revenue.