Laboratory and Pathology
Prior Authorization and RCM Solutions
Capture more revenue with solutions for prior authorization, medical coding and accounts receivable.
Managing pathology and lab revenue is a complicated business. With numerous diagnostic tests per patient, charges split between multiple payers, and increasingly elaborate payment models, maximizing reimbursement can be complex and labor-intensive. To be successful, your revenue management team must have a solid understanding of the prior authorization process, ICD-10 coding, billing, and denial management procedures, not to mention managing contracts and fee schedules for multiple payers.
We help pathology practices, and clinical laboratories manage their entire payment lifecycle with our Prior Authorization and Denial Management solutions, helping you preserve and capture more revenue through your entire payment lifecycle.
We help you preserve and collect more revenue by reducing the friction that exists in your pathology and laboratory revenue cycle workflow.
Laboratory and Pathology RCM Solutions Include:
The healthcare payment lifecycle for pathology and laboratories begins with prior authorization. Is there a prior authorization in place, and can you get it in time to schedule your patient effectively? Receiving prior authorization approval after performing a lab test is becoming a less viable option; as is fighting denials for lack of prior authorization approval during the appeal process. A full 90% of doctors state that the process directly affects patient outcomes through delayed care and abandoned follow-up.
As a provider you can’t complete the test until you’ve received the approval, which often requires navigating proprietary and nonstandard workflows. With our Prior Authorization Software, driven by Artificial Intelligence (AI) and automation, and supported by our certified specialists to handle exceptions, we can help you automate your prior authorization workflow process from claim initiation through follow up. Getting approval is critical to preserving revenue through your entire process.
The second step in the pathology and lab payment lifecycle is managing the complex and ever-changing process of medical coding. With over 144,000 ICD-10 codes and 8,800 CPT/HCPCS codes, you need a team that can consistently and accurately code with pin-point accuracy and proven expertise.
We offer coding services to ensure your payment is handled on time with industry-leading accuracy. Our certified and trained coders and innovative technology enable a workflow that reduces errors, accelerates the billing process, and helps you capture more revenue. Our customers consistently experience a <1% denial rate.
The third step in the pathology and lab payment lifecycle is accurate and timely billing. Your billing needs to meet payor guidelines and expectations.
We offer expert services for charge entry, payment posting, credit balance resolution, and contract management. We provide a complete solution that meets your needs and improves your bottom line through successful implementation and timely follow up.
The final step in the pathology and lab payment lifecycle is capturing revenue that is often overlooked or inadequately pursued through the denials management process. What’s needed is a best-in-class accounts receivable and denial management solution that provides an in-depth analytics and predictive insight to assess the right course of action to secure your payments.
We bring intelligent automation to the accounts receivable and denials management process. We leverage AI and machine learning to analyze your existing accounts and forecast how much you can realistically capture. Then we put human ingenuity and intelligence to work to follow up and secure your revenue.
With a seamless and scalable platform, you can intelligently automate many of your patient access and RCM processes.
A Complete Solution
We deliver a complete solution that includes both artificial intelligence and human intelligence across the payment lifecycle.
Certified and Trained
Our certified and trained coders and billers know how to deliver positive outcomes, allowing you to focus on what matters most – patient care.
We stand by our work and guarantee what we do. We believe customer satisfaction is paramount to delivering business success.
*during quality checks