Industry Insights
Roundtable Discussion: Laboratory Billing Solutions and the RCM Process
November 28, 2023
For those that may have missed it, the April Issue of CAP Today features a Bob McGonnagle-led roundtable discussion on laboratory billing. As usual, Bob did a great job as moderator as experts in the field discussed various topics including:
- What’s required and where things stand with the No Surprises Act
- Ongoing issues with prior authorizations, denials, and slow payments
- Lab billing processes and digital pathology
In billing, No Surprises and other complexities
LigoLab CEO Suren Avunjian participated in the discussion and was asked if LigoLab customers were having issues matching estimates for service against what is actually billed to patients. He responded by saying that LigoLab Informatics Platform has the infrastructure and rule engine that customers can use to manage such a scenario. He also added that having lab information system (LIS) and lab revenue cycle management (RCM) modules as a fully integrated single source of truth allows customers the opportunity to address this example from multiple angles.
A bit later, Avunjian was asked how LigoLab Informatics Platform helps pathology practices overcome staffing issues. Here’s his full response to that questions (the CAP Today version was edited because of spacing constraints):
“One of our approaches to solving staffing issues is by leveraging a rule and automation engine designed to adapt to any lab operation, whether large or small. Specifically, this approach allows our partners a chance to stay ahead of workflow-related challenges via pre-loaded rule sets,” said Avunjian. “For example, payer mapping combined with local and national coverage determination (LCD & NCD) rules capture potential denials up-front. Transforming the denial aspect of billing workflows into a “front-end” process results in a first-pass pay rate as high as the upper 90th percentile.”
Our primary focus for automation is not the reduction of staff but to increase compliance and revenue acceleration and collection, by severely lowering the rate of claim denials and appeal work, creating unnecessary delays and likely money left on the table,” continued Avunjian. “Driving maximum transparency and attacking the challenge with a large rule set that can capture potential denials before they are submitted is a healthier and more sustainable approach to the RCM process. Whether the laboratory is small or large, full system automation and configurability is the key to addressing the laboratory operators’ challenges. The solution is to comply with payer requirements via maximum streamlined manual operations.
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The conversation next turned toward pathology practice consolidation and whether or not consolidation will help with billing and collection problems. The immediate future of digital pathology was also discussed with McGonnagle asking the roundtable if the new CPT codes for digital pathology would make an immediate impact.
The group agreed that there were many variables to consider, including pathologist burnout. Avunjian then suggested that the right pathology lab software could make a difference in efforts to address the burnout problem.
“Simplifying pathologists’ daily work as much as possible and adding automation to remove the redundant steps and clicks can make a significant impact on productivity and job satisfaction,” he said. “AI and digitalization of the slides and workflow will help relieve the staffing shortages.”
The roundtable ended with all participants afforded one more chance to weigh in with their future thoughts for the industry. For Avunjian, end-to-end solutions are the key to future success in the pathology lab space. That’s a fact he learned after several years of work in a private laboratory IT department.
“The lesson we learned is that the most successful laboratories have to transform into technology companies,” he said. “We took the tough route and tried to build as much as we could in-house (at the private lab), but at some point the cost of development and scope of the implementation got exponentially more complex going from innovation to maintenance mode. These days there are lab information system partners who can help with this transformation. You have to choose your battles and select partners wisely because if you’re going to be a great lab, it will be hard to also be an exceptional software company at the same time.”
The April issue also has a section that lists Billing/Accounts Receivable/RCM Systems and system features. Here’s a link to that listing.
Billing/Accounts Receivable/RCM Systems, 2023
LigoLab’s RCM solution is included in the listing, and for more information, you’re invited to read these related articles.
How Cole Diagnostics Streamlined Client Billing with LigoLab’s LIS & RCM Platform
Leveraging LIS & RCM Integration to Improve the Laboratory Billing Process
The Connected Laboratory: A New Approach to Laboratory Billing Services
