Bringing intelligent automation to the healthcare billing and payment lifecycle will improve laboratory revenue through increased reimbursement, streamlined processes, and reduced denials. With margins shrinking and reimbursement rates falling, artificial intelligence (AI) and machine learning technology stand ready to positively impact the bottom line for both hospital outreach labs and clinical laboratories alike.
Pathology and laboratory reimbursement relies on ordering providers and often their data collection techniques. When billing information arrives that is incomplete or mismanaged; it falls to the laboratories to follow-up and backtrack to obtain viable information or risk rejection once submitted.
Where Intelligent Automation Brings Added Efficiencies
Too often, claims are abandoned due to lack of pertinent insurance information, properly obtained prior authorizations (PAs), or unknown coverage details. When systems are implemented that bring AI-driven solutions to the reimbursement process, the reduction in errors coupled with the savings in time adds up to significant bottom-line improvements.
Streamlining Laboratory Prior Authorizations
As the menu of available genetic and molecular testing applications continues to grow, so do laboratory PA requirements, and the future promises to hold an ever-growing collection of tests. While PA responsibilities may rest with the ordering provider, often they are missing, or patient information is incorrect, creating a cascading follow-up process that wastes time and can impact patient care.
By moving expectations to the point of care delivery, PAs can be processed before accessioning, or testing is even done. With an AI-driven software solution fully integrated with the lab’s own Laboratory Information System (LIS), required PAs can be isolated, approvals initiated and sent, follow-up performed 24/7, and notification of successful resolution returned to the lab in real-time.
Using an intelligent automated system significantly reduces the need for burdensome manual follow-up (i.e., waiting on hold, faxing and refaxing, etc.), saving time and resources. A process that historically has taken anywhere from several hours to days or even weeks can now be accomplished in minutes.
To illustrate even more clearly, the 2019 CAQH Index looked at the average cost per transaction for manual versus fully-electronic PA transactions and found that automating the process would save an average of $9.04 for providers. Couple that with estimated savings for insurance payers of $3.27, and the industry-wide savings per PA would be $12.31. Add that savings to the increased revenue recognized as denials and write-offs decline significantly, and intelligent automation solutions speak for themselves.
Most importantly, not only will this increase and accelerate the reimbursement cycle, but it should greatly improve the patient’s experience and confidence in their care.
What About Emergent or Complex PAs?
When analyzing solutions of this type, remember that while most PAs can be handled in this manner, some may still require a more hands-on remedy. Any solution implemented must be coupled with a team of highly-trained specialists to handle the small percentage of emergent, acute, or complex requests that present as outliers.
Without a doubt, AI and machine learning are opening opportunities throughout healthcare and the patient billing lifecycle. As the healthcare reimbursement structure continues to evolve, high definition solutions that equate into resource savings (from reduced administrative burdens) and revenue capture will pay for themselves and then some, easily bringing swift ROI to any laboratory organization.
Learn more by contacting us about AI solutions to improve laboratory revenue and streamline business operations processes.