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

What follows is a case study that documents the problems Avero Diagnostics was experiencing by using two disparate laboratory software systems, one for laboratory information system (LIS) workflow, and the other for laboratory revenue cycle management (RCM). It also highlights the positive results the organization has experienced since becoming fully integrated with LigoLab’s all-in-one LIS & RCM software solution. 

Avero Diagnostics is a national physician-operated laboratory operation with facilities in Bellingham, WA, Irving, TX, and Lubbock, TX. Formerly known as Northwest Pathology and Northwest Laboratory, it specializes in women’s health, anatomic and clinical pathology, molecular pathology, and clinical diagnostics. 

Tina Quevedo had two clear mandates to oversee and manage upon returning to Avero Diagnostics after a nearly two-year absence while working for a non-profit. 

• Replace the well-known but underperforming legacy revenue cycle management (RCM) software solution currently in place with an advanced laboratory billing system that would drastically improve staff productivity and laboratory cash flow. 

• Quickly retrieve and get payment for 47,000 stuck encounters in the old lab billing system.

Fortunately, Quevedo was up for the challenge. Using both her 30 years of experience in the medical billing space and her familiarity with countless other RCM software solutions, she quickly sized up the problem and recommended a clear path forward for lab leadership to approve. 

Investigating the Problem and Determining the Correct RCM Cycle Solution 

Quevedo thrives on puzzles and getting to the root of an issue. She loves the investigative piece of solving problems. When things go wrong, she has to know why.

“What happened? Where did it start? Let’s go backward, identify the problem, and then fix it,” she said, recalling those early days after she returned as Avero’s Senior Director of the Business Office in December of 2022 after two years of working outside of the lab industry. 

“Sometimes the fix is a bandaid, and sometimes the fix is by improving the whole process,” she continued. 

Curiosity and a problem-solving acumen have served Quevedo well throughout her professional career, and it was just what Avero needed to dig out of a massive claim backlog problem created by its partnership with a well-established RCM software company that wasn’t able to deliver as promised. 

After a brief investigation into the lab’s current state, Quevedo quickly realized that much more than a bandaid fix would be needed. 

“We literally couldn’t get claims out of the old system,” she said. “Fields were missing and scrubbers weren’t functioning appropriately. Even on claims where that particular field wasn’t necessary, the old system would do a sweep and find some issue with the claim. We couldn’t get the claims out the door and what was going out the door often didn’t contain the information required for that claim to be adjudicated. We were getting way too many front-end rejections.”

Making matters worse, the Avero Diagnostics lab located in Irving (TX) was operating without the ability to check for insurance eligibility and had no way to scrub claims with an AF modifier (used to indicate a specialty physician). Without the modifier, the billing team could not know if it was billing the right payer. 

Additionally, the old lab billing system also lacked automation and transparency between departments, causing staffers to complain about how restrictive the system was, especially at current volumes. 

The old system required too many manual steps and too many clicks on the front end of the RCM cycle. It also didn’t account for the need for clear communication between the demographics and coding departments. As an example, the coding team had no way of knowing if the demographics team had put a hold on a claim, causing claims to bounce back due to a lack of demographics. 

In an attempt to rectify this nightmarish situation, 44 people were hired and added to the billing department. Despite this, the problems remained.  

Quevedo took all of this into account before wrapping up her evaluation and recommending what to do next. 

“It was very clear to me that we had to move to another laboratory billing solution if we had any hope of getting the 47,000 stuck encounters out of the old RCM system with the required information,” said Quevedo, who had already spent weeks with IT and leadership creating unsuccessful workarounds. 

“From that experience, I knew right away,” she said.

Quevedo advised lab leadership about the situation and recommended an immediate move to LigoLab’s laboratory billing system. Leadership agreed with her recommendation and by February, the move to LigoLab’s RCM solution had already been initiated. 

Implementation of the New Lab RCM Solution and Early Results 

Quevedo described the implementation of LigoLab’s laboratory billing solution as easy and seamless. She already had familiarity with LigoLab’s software and had previously worked with its RCM support team. Additionally, Avero Diagnostics was already using LigoLab’s informatics platform for all of its LIS data management. These factors helped pave the way for a very smooth transition. 

The move was first initiated in February, and by April 2023 all but surgical claims had been moved to LigoLab’s RCM module. By August 2023, the move was complete.

“I don't know what was required on LigoLab’s side, but as far as I'm concerned, LigoLab flipped a switch and we in the billing department went to work,” said Quevedo. “Kenny Moreno (LigoLab’s lead RCM Product Manager) did an amazing job. He ran an automation that recreated that whole list of 47,000 encounters. Over just two days, those stuck encounters were moved from the old lab billing system and into LigoLab’s RCM module.”

From there, the billing department’s demographics team started working on the now accessible encounters, and in less than six weeks they resolved the backlog and moved all the claims from demographics to coding before submitting them to the various payers.

The 47,000 previously stuck claims resulted in payments totaling just over $4.75 million. 

Quevedo further described the implementation process. 

“We had a handful of meetings and worked together to update some client rules, bring over master lists into the Irving system, and build a master table. It was all very smooth,” she said.  

According to Quevedo, Avero Diagnostics started to enjoy positive metrics within the first 20 to 30 days of actively using LigoLab Informatics Platform as its all-in-one LIS system and lab billing software solution. 

The multi-system data silos, synchronization, and interface issues they had been dealing with were now a thing of the past, replaced by one united system with LIS and RCM modules sharing the same software database and infrastructure. Data integrity was now assured from the moment a test order came into the lab through the completion of the laboratory billing process. 

For Quevedo, the biggest performance improvements resulted from being able to work all the denied claims and being able to attack those denied claims in bulk.

“That was a big savior for us,” she said.

She also referenced the importance of three key features embedded within the LigoLab platform. 

• Real-time insurance eligibility verification
• Synchronized third-party connection with the clearinghouse
• Real-time rejection queue

“Without eligibility and that third-party connection, we were struggling,” she said. “But now when we use the eligibility function within the LigoLab platform, 95 percent of the time it comes back with accurate information that allows us to get the claims out the door, and if there’s a rejection it goes into the queue and we’re notified immediately rather than having to wait for the clearinghouse to send a 277 file.” 

RCM cycle metrics captured from November of 2023 through January of 2024 highlight the positive impact that the front-end improvements have had on the billing department and the number of rejections that have required further attention. 

• 4-to-8 hours: The time it takes for the billing department to complete demographics and coding, submit a claim, and receive claim acknowledgment, all on the same day. 
• 98.1 percent: The percentage of claims that were processed and paid on the first submission without a rework or resubmission. 
• 99 percent: The percentage of claims that were processed and paid with claim scrubbing support for the clearinghouse. 

All three metrics are well above accepted national benchmarks and contribute to a more streamlined and effective billing process resulting in faster payments, less time in A/R, and improved cash flow. 

One Source of Truth and Additional Platform Features That Improve the Lab Billing Process

Since switching from the legacy laboratory billing system it was using and partnering with LigoLab for its LIS and laboratory billing operations, Avero Diagnostics has enjoyed steady improvement across the board. 

When asked about specific features or functionality that have made the biggest difference since the switch to fully integrated LIS and RCM modules and one source of truth took place, Quevedo first credited LigoLab’s flagging system. She said flagging has streamlined and simplified lab billing processes such as TC/PC splits between multiple facilities. 

“We’re all under Avero Diagnostics, but our Irving location has separate contracts and payers from our Bellingham lab, and we often co-mix them,” she said. “With LigoLab we’re able to flag our encounters automatically, and we have the flexibility to add or change footnotes on the actual reports. That aids both our coding and rejection teams.”

Quevedo continued by highlighting the automation built into the Avero laboratory billing process. She said with LigoLab, her team is now able to set up several hospital clients with their own set of automated rules. 

“They all have various requirements in terms of split bills and payers, so the automation within the LigoLab platform helps us automatically map out all of the different scenarios,” she said. 

Once the rules have been put in place, the automation takes over. This means the billing team no longer has to touch 100 percent of everything that comes through the door, a welcome change that’s led to a more efficient and productive department. 

Quevedo also noted the importance of her entire department needing only one system to navigate LIS and RCM workflows. Beyond end-to-end data integrity, this level of integration allows the billing team to immediately identify where the service was performed and whether or not the right rendering provider was put on the claim. Additionally, the team can access at any time all of the documentation and attachments that come with a specimen and a case. 

“Every day, every department, in one way or another, is moving between LigoLab’s RCM and LIS modules for the data to either fix claims or to get the initial claims out,” she said. “Using one system where the RCM and LIS share the same database is a huge advantage.” 

Lastly, Quevedo pointed out another functional difference between LigoLab’s billing solution and the replaced legacy billing system. With LigoLab, her billing team no longer needs to handle client billing separately from other RCM processes. All relevant billing information is in one place, linked to the patient account, and accessible. 

“There simply aren’t many RCM systems that offer direct client invoicing and daily notifications from the same system,” she said.

System Usability and Software Support

According to Quevedo, another way LigoLab sets itself apart from the competition is with system usability. 

“You can’t ask for a more user-friendly system than LigoLab,” she said. “I’ve been at this for 30 years and I’ve probably encountered 20 to 25 other RCM systems. There’s just no comparison. LigoLab is intuitive. It just makes sense.”

To further illustrate this point, Quevedo spoke of a recent new hire. She said the new hire was quickly trained on demographics and within two days she was up and running, matching or surpassing the productivity of staffers with years of experience.

In terms of training and software support, Quevedo said if there’s ever a problem, it gets addressed and solved promptly.

“The customer service is impeccable. I never hear them say that it cannot be done. They either give me the solution I’m looking for or provide an alternative workaround that’s comparable. They never leave me hanging,” she said. 

Final Thoughts

In summary, the switch from a legacy and outdated RCM system to LigoLab’s all-in-one LIS & RCM solution has led to widespread measurable improvements and outcomes for Avero Diagnostics. 

Unlike before, Quevedo’s team is now meeting its goals in terms of cases worked daily because they no longer have to deal with two or three sweeps and claims coming back with multiple errors, followed by yet another 24 hours to see if the reworked claim went through. 

“Now, everything is immediate. You let the claim go, it goes into the transmission, and within a couple of hours, you see it in the clearinghouse and know if it was accepted or not,” she said.

Even better than that, Quevedo said bringing on LigoLab’s RCM solution with its fully integrated LIS and RCM modules has also helped with LIS operations and client relations.  

“In the old system, our clients were complaining about slowness in receiving their lab reports, and that’s no longer the case,” said Quevedo, who referenced four-day and six-day turnaround times for hospital clients. “That all went away. We made a lot of clients happy by moving from the old RCM system to LigoLab’s lab billing system.”