Blog
LigoLab RCM: An In-Depth Look at the Laboratory Billing Software (Transcript)
August 14, 2024
Thank you for your interest in learning more about LigoLab’s fully integrated LIS laboratory information system (LIS system) and laboratory revenue cycle management (lab RCM) platform.
During this presentation, we’ll take you through our best-in-class pathology lab software and show you first-hand how this powerful encounter-based clinical lab workflow structure combined with over a million rules and automation, and extensive, highly transparent user-friendly features will help you increase clean claim submissions, improve operational efficiency, and increase productivity, revenue, and profit. This helps mitigate compliance risk and avoid future bad debt, differentiating labs to be viewed as true leaders in the increasingly competitive marketplace.
The industry is continuously evolving and effective risk management is critical for success. The LigoLab platform gives you the powerful RCM tools to do exactly that.
These include powerful automation based on rules, unparalleled clean-claim scrubbing and extensive third-party integration, a consolidated single data entity queue-based lab workflow structure with interwoven laboratory billing logic throughout the entire LIS system and lab RCM life cycle, extensive audit recording tools providing transparent workflow and compliance management, accounting insight, powerful reporting and distribution engines that ensure operational integrity, intuitive user visual interface and truly patient-centric laboratory billing solutions and unparalleled customization capabilities, all supported by gifted laboratory billing system developers and a dedicated client support team.
The entire lab billing workflow in the LigoLab platform works with real-time queues. All queues are live ensuring encounters aren’t lost in the laboratory billing process. They allow for strategic distribution of work and include intelligent and convenient filters and template creation capabilities.
With LigoLab’s intelligent RCM cycle module, you gain full transparency and control of lab billing workflow with upfront patient demographic and insurance eligibility checks, insurance discovery, real-time workflow queues/reports, extensive clear audit trail functionality, and automated CPT and ICD coding, all to provide proactive mitigation of denials and rejections which leads to increased revenue and profit.
Our laboratory billing customers using the LigoLab platform know it's in a separate billing software for labs category. We combine your laboratory and billing operations and make your workflow better, faster, and cleaner, all while effectively managing your entire operations compliance risk, enabling exponential profitable growth even during the most volatile and evolving times.
So, let's jump right in and go through the all-in-one medical LIS and laboratory billing system.
We start with the lab billing encounter. As mentioned earlier, the billing encounter is a data entity in LigoLab’s lab RCM module that consolidates all financial and workflow-related information in a well-organized, intuitive, heavily automated, and user-friendly data structure. This data entity consolidates and provides access to lab orders, test results, reports, specimen data, imaging data, all claim statements, invoices, relevant detailed audit information, and remittance and accounting summaries.
The billing encounter consists of several tabs. We start with the main tab which lists all diagnosis and CPT data plus encounter claims, statements, and invoices. In the diagnosis section, we have diagnosis data, add, remove, and make primary user actions. In the encounter details section, CPT and test panel data and add/remove user actions are easily accessible.
The main tab consists of a CPT sub-tab and a test panel sub-tab. The CPT sub-tab lists the following items, CPT codes, units, and DX sequence (and note the order of the DX pointers is based on NCD LCD coverage policies modifiers, the rendering facility, the rendering provider, the primary payer and the place of service, and the test panel sub-tabs tests and panel if any). Also note that the lab billing and encounter data entities provide two financial summaries: basic and advanced.
Here we see the finance summary tab. This represents a financial summary per CPT code for all claims and lists a current responsible party. We have the finances summary advanced tab. This shows expanded financial and processing history for all claims and claim data.
Then we see the claim section that lists all claims, statements, and invoices in a hierarchical structure with corresponding data summary and status. The adjusted column here represents an adjustment activity for all remote responses. The add claim function lists all payers on the encounter and has operational right-click user actions. All claims here are also available for individual review and editing.
The demographics tab includes laboratory billing and LIS system sub-tabs. It acts as a summary of all patient and payer data. The billing sub-tab in the top section contains useful functions including an ordering provider override function, a patient class menu, and an order DX system validation field that lists the current diagnosis on the billing encounter level. The bottom section is split into patient data, lab billing data, and supplemental data sections.
All patient data, USPS, and white pages address parsing and validation RCM tools are here. So, as you can see, our third-party integrations are also featured. In the laboratory billing insurance data, a payment source menu lists payer options and payer data available for review. The user may add, remove, or alter the payer or payer sequence here. In the supplemental data section, we have fields such as date of injury, comment box, etc. This section is customizable so custom fields may be deleted and or added.
The sub-tab in the top section lists various laboratory information system data such as collected date, case priority, and patient info as collected during creation. The bottom section contains all payer information collected at order creation with the eligibility button here. Specimen tab. This is where all the specimen information can be accessed. Specimen data is organized in a tree format and may be expanded and collapsed. Primary and derivative specimens with details relevant to the coding lab workflow are listed here. Right-clicking on the specimen ID and name opens a very elaborate user action menu.
Order data. This tab provides access to lab information system data. We have all sessions in a tree format that you may expand, collapse, and search data. Plus, you can open the order data entity directly from here. Note the tree format levels down to the session report results and CPT levels.
Right-clicking on either level here accommodates many useful user functions. The audit tab stores clinical lab workflow-related encounter data summaries and automation information. In this tab, users will find workflow and review stages audit information and history such as information about current encounter location. In the additional fields section, we have external ID, encounter ID, and lab billing pattern data. Additional fields here are customizable and may be deleted or added per client request.
Report tab. This provides users with a floating capability for lab workflow and visual convenience. Here we list all reports for the encounter with each having its tab and each tab title will show an accession number and the report name.
The top of the tab allows for visual flexibility so the user can enlarge and zoom in or out. Scans tab. This tab also provides a floating capability for workflow and visual convenience. Attachments listed here are available for visual flexibility. Here too, you can enlarge and zoom in or out, and they too can be reprinted right out of LigoLab, saved locally, and then sent to imaging processing.
In addition to laboratory billing encounter data, we also have an event tab that lists all billing review-related and claims submission-related events. It also displays scrubbing and validation laboratory billing system messages and error notifications after the encounter creation.
The special actions menu. This allows for many important user actions, such as insurance and discovery. We have tags that enable users to tag as many cases as required, providing improved organization and a clean delegation of work. Then we have workflow actions, labels that assign specific tasks and are handled in their respective workflow action queue. And last, we see data panels. Here we provide custom data expansion of the lab billing encounter data entity workflow queues.
Now we delve into the lab workflow queues. The entire laboratory billing workflow of the LigoLab lab RCM module is handled in workflow queues.
All queues are live so no encounter gets lost in the cracks and they allow for the strategic distribution of work. They have intelligent and convenient queue filters, template creation capabilities, and queue-specific data validations. There's a maximum row to display regulations, tags, and notes to promote quality workflow.
We start with the demographics queue. The demographics queue is the first stage in the workflow where patient and payer demographic verification is performed. In this queue, we have multiple filters that allow for extensive case navigation, such as in the main tab we have maximum row limitation, payer, and template filters. The extra tab has tags, result types, and test filters. In the advanced tab, we have workflow-related filters. The system in this queue also performs many types of demographics cue-specific validations that reduce user errors, such as missing patient, gender, patient class, or payment source.
We offer third-party integration to locate and verify patient and payer data. This address lookup is through white pages. The white pages tool locates all known addresses for the patient, references them with age and gender, and provides a phone number, and data gets auto-populated once a selection is made.
We have address format verification through USPS. They are all real-time, and fast and accurate. The USPS tool validates all components of the address listed including street name, street numbers, etc. They’ll locate the last four digits of the zip code if the user did not include them. Here as well, data gets auto-populated once a selection is made.
You can locate insurance coverage through insurance discovery. Insurance discovery is a highly effective real-time interface RCM tool. This tool locates active insurance coverages for a given patient.
By sending a query ‘directly’ to the payer, it details the data and auto-populates it within the payer source fields. With this feature, you get a tremendous time saver for your lab billing staff. It works with all major payers, and due to its direct real-time connection, parsed data can be trusted to be accurate and updated. It also provides automated sequence designation. The insurance discovery tool is also an effective coverage verification tool, verifying data such as subscriber ID, payer address, patient name, etc. as it interfaces with the primary source, the payer, and interesting to know for some encounters, we can facilitate a rule-regulated demographics queue bypass. For some cases we can implement a cool-off feature, holding encounters in a limbo state if they are pending information or report release.
Finally, we can arrange automated eligibility checks and cases in this queue.
Insurance eligibility. This is real-time and is performed through a clearinghouse with a real-time interface with an insurance payer community.
The eligibility response format is designed to display in an accessible and strategic way all relevant and important insurance coverage data, including coverage disqualifiers, limitations, deductibles, or coinsurance.
The rule engine in most cases will label the ER as eligible or ineligible and update the status accordingly on the encounter level. Users can see the status without having to open the eligibility response. For instance, it will indicate if it needs a manual review. The status can also be overwritten manually.
The rule engine parses a Medicare secondary reason required for claim submissions from the ER. The eligibility response may provide the user secondary or tertiary payer info, if any, and provide payer sequence verification, preventing payer sequence conflict denials. The eligibility response also provides a vehicle for verifying vital claim data, including patient name, subscriber ID, current address, etc., and users may expand or collapse and search.
Coding queue. The coding cue has extensive convenient and powerful tools. Among primary operational functions here, we have a manual selection of diagnosis, CPT test panels, manual claim creation, automatic coding, and automatic claim generation. At the core of the complex functionalities in LigoLab’s RCM is change line item modification, performed through elaborate coding automation.
Here we see the automatic assignment of modifiers for diagnosis sequence, diagnosis pointers, and units as well as both rendering facility and rendering provider data. Our coding automation performs unit aggregation, TC/PC splitting, and diagnosis sequence assignment.
In addition, here we accommodate panel test and hybrid client lab billing formats. We have clean claim scrubbing based on CPT, MUE, and NCD/LCD regulations. The medical LIS and laboratory billing system can also perform payer-specific scrubbing based on individual insurance requirements. There are also extensive coding cues and specific data validations that pick up any missing field criteria, such as gender or diagnosis to prevent users from completing coding reviews.
Here we see in this example a scrubbing event and an invalid DX notification represented by the highlighting of the panels.
In this example, we have TC/PC splitting. Here a coding queue-specific validation that indicates an auto-billing issue is shown.
Billing review queue. The billing review queue is the conditional queue in LigoLab where conflict resolution between the LIS medical system and lab revenue cycle management modules is handled. Whenever there is a billing-related change on the LIS system side, the laboratory billing system detects it in the corresponding encounter in the billing review queue for user verification.
Examples of issues are CPT added/removed on the LIS system software side, test added, order sync issue, inability to auto-bill, and no bill generated.
The filter ‘encounter flags’ is the operating filter here. The relevant issue is recorded in an encounter event with a timestamp and corresponding detail. Issues in the queue are easily resolved with a simple right-click. Examples include lab billing events, insurance pre-authorization, billing event issues, and no bill generated.
So as you can see, the billing review queue is a useful tool that allows monitoring and the management of the LIS laboratory information system to lab RCM dynamics.
Payments queue. The payments queue stores posted payments received electronically or entered manually for user review and finalization. In this queue, we have filters that allow users to view data by user date created, issue date, or payment mode. Users here can review and edit an individual payment and consolidate payments into manifests (equivalent to batches in the LigoLab platform).
Lastly, you can preview and print any manifest collection queue.
Our collections queue has a very compact and simplified workflow. Certain claims that are qualified for collection are updated automatically with status late and populate automatically into the collections queue.
Inside this queue, users may filter line items with a status filter to organize the workflow and approve or reject cases individually or in batches. Special rules may be configured to automatically adjust collection accounts based on the outstanding balance amount, associated client date of services, or any other specified criteria.
Approved cases will advance to the collections log, accessible to a respective collection agency via interface setup. An alternative workflow is also available in LigoLab by exporting and printing a customized report of course collections cases and providing it to your collections partner. A right-click user action inside the queue allows many options, including an assignment payment plan. For the collections workflow, one or multiple collection agencies may be accommodated.
The LigoLab application can accommodate two types of workflows, one that ends when an account is placed in collections and passed along to the collections agency, and the other when the entire RCM cycle from ‘status-update’ to ‘account resolution’ is entirely covered in the LigoLab platform.
Refunds to patient claims automatically populate in the refund queue if there is a negative balance. A single operating filter refund status here has a few options, confirmation needed, refund completed, refund rejected, or refund requested, which allows for clarity and easy dissemination of work.
The workflow consists of a few stages. First, the refund has to be confirmed. Here you view claims under a confirmation needed status. This is a manual laboratory billing process review, after which the user designates either request a refund, or, if this is not a true refund, balance the claim, the adjustment, and get the balance to zero and the claim will vacate the queue.
Second, if a refund is confirmed, an accounting professional can issue a refund through an applicable payment format, and utilize a template for a credit letter, which is a customized document with a reason for the refund. The status for the patient claim will then change accordingly to refund requested and this case will be found under refund requested.
Lastly, for refund request cases, we allow issuing refunds via an issue refund manager operating window. After a refund is issued, it is recorded on the patient claim level accordingly with refund complete status and the claim balance is set to zero.
Rejection queue. Rejection events populate automatically in LigoLab and rejected claims are routed here accordingly per their status. Rejected claims with rejection events from clearinghouses and insurance payers are presented here. Rejections are handled in this queue and when users complete the rejection review, the claims are resubmitted to the clearinghouse automatically.
Inside the queue filter, rejection type, and rejection code, each with a case count, one can organize and manage all rejection cases. He or she can also design and implement any client-requested method of rejection profiling. Rejection events are available on the encounter level in the remit activity tab of the insurance claim.
Rejection events archive or rejections in detail with a timestamp source, entire internal rejection code message, and rejection type.
Remittance queue. The remittance queue in LigoLab is where denials are managed and resolved. Claims are routed here automatically according to the remit codes listed and their respective remit strategies. Claims that do not require manual review do not populate here and are archived in the laboratory billing system.
This queue is broken down into sub-queues, most of which are titled after respective remit codes and some after the issue they represent. Additional sub-queues might also be created and named after an individual monitoring them and cases can be easily relocated from one sub-queue to another.
The remittance queue has intelligent filters such as payer and client filters. Plus time-saving template creation options. Here a count for each sub-queue is shown in the remit filter. Users can identify the work volume for each sub-queue and we have the ‘sort-by’ option for populated results and then the reprocess function. This is utilized when you alter a permanent remit resolution strategy and is retroactively applied to all applicable claims in the remittance queue.
We have added a strategy that permanently alters the remit strategy for the relevant codes. We also have a one-time option that alters the remit strategy for that specific case. Established strategies for remit codes are assigned automatically and are visible on the claim level. Labels like adjustment, patient responsibility, and need review are utilized in LigoLab.
Many user actions relevant to denial handling are available on the encounter level from within the remit queue such as assigning the remaining queue. Lastly, claims currently residing in the remote queue are highlighted in red in the encounter.
Remittance strategies. The most important aspect of denial handling in LigoLab is the remittance strategy engine which allows users to establish a remittance handling course of action for each remit code based on detected insurance payer processing patterns and trends. This involves what sub-queue within the remittance queue the case will be allocated to, what strategy label such as ‘needs review’, ‘adjustments’, etc., will be assigned, and finally, what rules if any, will be involved in handling that specific scenario. An unlimited number of remit strategies can be created for a single remittance code, and each may be as basic or as complex as the user requires.
For example, you may choose a specific payer remark code, CPT code, or payment rate to outline a scenario and be handled accordingly in the background with our automation mechanisms. An example of a written strategy you see here is one that was configured for remit code co-45. It covers two scenarios, one with co-45 on the remittance response and another co-45 with zero payment as a single condition.
Supplemental queues in LigoLab include three supplemental queues. The first is the demographics request queue. This queue accommodates a resolution of demographic issues, such as patient or payer issues discovered mid-workflow and manually requested for demographics review.
Then we have the payment queue incomplete. This queue is intended for payments that are entered but pending clarification or in need of additional data. Cases here will be preserved for later review. Last we have the EOB review queue. This queue is meant for insurance claims that received conflicting or erroneous remittance responses that the laboratory billing system cannot reconcile.
Our reporting module supports statistical and linear reports with extensive customization capabilities, and all reports that are produced by the system can be exported as an excel sheet or a PDF document.
We start with dynamic reports, which are customizable high-complexity reports. Here we see the workflow action report with multiple columns such as status, created, time created user, etc. Any report of any structure can be designed for specific client needs. Reports may be expanded, collapsed, or filtered by dynamic format filters, and reports may be printed, previewed, and saved as excel files or PDFs.
Then we have dashboards. Dashboards in LigoLab allow users to easily view all types of data such as lab billing, workflow, productivity, accounting, and revenue. Widgets in LigoLab take group data and represent it in any desired format. The dashboards are then loaded in real time. We have many dashboard widgets, including daily coding, daily remittance, auto-billed today, total count, and payer aging just to name a few. Other dashboards can be configured upon request. Examples of dashboards include billing queue throughput, client delinquent 60 days, patient delinquent 60 days, and queue count.
Learn More: Mastering Real-Time Analytics in the Clinical Laboratory: A Comprehensive Guide
Finally, we see the financial stats section. This section provides executives with three major reports: A/R reports, KPIs, and the posting activity report. Each may be organized in any format by utilizing multiple filters located here. Users may view data in flat or tree format and expand and collapse.
Here we see all AR posting activity for a time interval of the last 60 days. These powerful reports are structured to produce pivot table-like functionality, providing in-depth analysis of your business operations, productivity, and financial efficiency.
The AR report provides detailed accounting insight in a time-based format. This enables users to see all receivables within any given timeframe. Multiple filters and sorting options are also available.
The KPI report is a helpful financial tool LigoLab provides. It enables users to review a multitude of KPI indicator-based commonly used report structures. Here we have a variety of filters that support different presentation models and combinations of data.
The posting activity reports allow users to view a reliable representation of immutable posting data within a specific time or date range. The comprehensive summary by filter includes CPT ordering clients, date of service, posted month, etc., enabling users to model data representations that are highly transparent, and tailored to accommodate specific and data-intense reports. Additionally, strategic manipulation and grouping of other filters produce distinct reports to serve user’s needs. Finally, any combination of filters can be saved as distinct templates to be used at any time.
Distribution engine. Our distribution engine supports all LIS laboratory information system distribution channels and includes the following features.
Patient statements or client invoices are created automatically on the fly. Flexible distribution allows remote and local printing of patient statements and client invoices. The distribution is facilitated through fax, email, mail, and client and patient portal capabilities, and integration with a third-party mailing company to mail out patient statements is also possible.
With LigoLab you can be set up for automated recurring notifications if desired. As you can see, both client invoices and patient statements can be highly customized operations modules.
In LigoLab we have three posting utilities. Post payment is intended for client patient and collection payments, post EOB, is meant for insurance and EOB posting exclusively, and the reconcile payment function is used for financial reconciliation procedures.
For posting we have a direct interface connection with a payment gateway. The reconcile payment function in LigoLab is intended to reconcile payments against a client's banking activity and is conducted in the reconcile payment window. This assures the linking of the system payments with the bank deposits.
One option is to upload a file received from the bank and conduct the reconciliation process automatically. Another option is to individually reconcile payments with bank deposits already reported in the lab RCM system.
Users may search payments by payment amount, deposit date, or payer name, and the system searches for unreconciled or reconciled payments with the single or multi-criteria you provide. The lab revenue cycle management system will locate individual payments or manifests that fit selected search criteria.
Search section. The search section in the lab RCM module allows for locating any data entities with sets of strategically placed filters.
Right-clicking on any located record can offer the option to review or edit the sections displayed. We have multiple search sections. These include finances. Users can view global financial data and filter extensively with or without posting details.
Insurance claims. Searching insurance claims plus the aging option and the aging tab allows your user to monitor claims that did not receive a response to patient statements. Here users can view native and legacy patient statements of any status, including those currently in collections.
Client invoices. Users can view client invoices by status, client account, or created and build date.
Adjustments. Users can view adjustments of any kind, regardless of the associated data entity, and create a search template payment. Users may search and edit any payment and use the filter selection of the reconcile tab to show reconciliation-related criteria.
Lastly, bank deposits. This is a vehicle to search for bank deposit items with an option to import directly from the bank database.
Our special payment projections feature is also accessible in this third section. The payment projections feature shows payments anticipated from insurance payers up to seven days from the current date. An example would be specifying the current date as a “from issue date” and not specifying the to date. By sorting your results by issue date and noting the electronic method of payment delivery, you will see what will be deposited electronically from specific payers on any given day.
By reviewing the total amount of deposits in the lower right corner of the section display, you will know what will be deposited for the time interval. Notably, the data that can be viewed the next day or the day after may include even more payment items. So daily check is very effective here, and because all our financial cues are updated every few seconds, this information is accessible and is renewed constantly.
Statistics. The stats section gives the ability to run extensive statistics on primary and secondary data entities in the LigoLab laboratory billing solutions application.
Encounters. This section addresses a primary data entity in LigoLab, the billing encounter. Users here can run workflow-related statistics with extensive queue input-output visibility, and are user-centric but may also involve the responsible payer or automation aspect of the encounter processing. This section allows the user to closely monitor all aspects of workflow efficiency within the LigoLab lab billing application.
Finances. This component of the statistics section is an extremely versatile RCM tool that may be utilized for extensive financial analysis. We will address this section later in further detail.
Insurance claims. The insurance claims section here is focused mostly on the insurance lab billing workflow and remittance processing. Filters such as status, in remit queue, or resubmitted allow users to monitor various stages of claim submission and post-remittance dynamics.
Patient statements. The patient statements section allows users to monitor billing-related workflow and payment status with filters such as build date, date of service, status, payment exists, etc.
Client invoices. The client invoices section of financial status gives users views of client invoice statistics by created date, status, etc. The summary by filter expands users’ options to design the format of the statistic structure they may prefer. This ensures full transparency of laboratory client billing adjustments.
The adjustments sections of stats address user-initiated and insurance-applied adjustments recorded in the laboratory billing system.
Importantly, this tool analyzes the entire adjustment culture for your business and allows company executives to gauge the integrity of manually discounting write-offs and related logistics. Additionally, with the insurance payer filter, billing professionals can determine and monitor the adjustment trends of specific payers to model respective lab billing practices accordingly.
Payments. The payments section here is very accommodating and comprehensive. A summary by filter allows for many format manipulations and extensive filter options also allow for increased flexibility and details in viewing payment statistics.
Financial activity report. Finally, the financial activity report in this section is a uniquely powerful RCM tool that provides a fully inclusive financial summary for the current year's month-long time interval.
Here we see indicators such as bad debt, refunds, etc. We see references for the same month of the previous year. This PDF-configured report template can be altered to the client's needs and may be viewed and printed on the fly using the preview function.
Pricing policies. We have many diverse pricing policies. Users can assign pricing policies to individual insurance payers, clients, or patients. They may be assigned manually or configured to follow a rule and can be assigned per CPT test or panel. An example of an insurance pricing policy is Medicare physician.
The pricing policies in LigoLab are very flexible and are set up by terms that cover a specific time interval with effective dates specified. With our import function, clinical and physician fee schedules may be used as a base for a pricing policy that can be automatically uploaded. The setup works with a hierarchy child-parent policy relationship, where discounts can be accommodated for any scenario using a multiplier feature.
The other category is the client pricing policy. Client accounts may have their own manually configured pricing policies or go off of existing parent policies. All pricing policies globally or per test may be altered at any time and applied retroactively. Client pricing policies can be used at the single client, group, or account levels. The third category is patient policy, such as in default patient.
Client billing. Client billing in LigoLab is set up in a hierarchy for billing to a group or a specific client. We can produce a highly customized client invoice. Any design is achievable, and any template may be implemented.
The client invoices in LigoLab have features like client billing history listed in the invoice document. Data may be grouped by location, physician, or LIS system data components.
Each invoice has a summary page at the end. The combination of data that the client invoice includes may be expanded or reduced. Client billing in LigoLab also involves elaborate notification schedules with a notification format template setup.
Multiple distribution channels like email, fax, EDI, etc., with flexible options of rule-regulated distribution, secure invoice distribution via email with the subject line, email content options, and secure password setup are available, and all client billing can be automated, which will significantly speed up your revenue recovery.
Billing policies and CPT bundling. The LigoLab lab RCM laboratory billing solution fully supports the bundling of sets of CPT codes, assigning an appropriate alternative and consolidating CPT codes automatically as soon as the applicable set of CPT codes has been designated in the order record. Thanks to bundling users can add supplemental conditions such as specific payer-provider or any relevant variable.
Here we have a default bundling policy and a payer-specific policy catered to United Healthcare insurance. So, as you can see, we can create many payers’ specific policies on the fly. In this example, for a renal function panel, the mechanics of bundling are clearly outlined and the consolidating CPT code here is 0076.
Rule Engine. The LigoLab platform has a highly effective rule engine in place that addresses many functions. One of the branches of our rule engine involves auto coding. Our auto coding rules increase coder efficiency by automatically populating CPT codes and assigning diagnosis priorities.
They facilitate 100 percent automation of less complex lab cases and eliminate the need for human intervention. They ensure extensive client billing automation, which can be up to 100 percent. They expand insurance auto-billing with the utilization of the lab billing patterns feature, and they allow for TC/PC splitting rules to be run automatically, which is a tremendous time-saver for coders.
Here you see another example of TC/PC splitting. Here we see a client-requested billing rule. The main condition in regards to the contract with this client indicates that if Kaiser is the primary insurance payer, they are to be billed. If not, then a TC/PC split is to be initiated automatically with clients and insurance. As with remittance strategies, any scenario more or less elaborate can be accommodated through an associated rule.
Another component of our rule engine is our claim scrubbing mechanism. Claim scrubbing rules in LigoLab handle a multitude of issues upfront to mitigate future rejections. When insurance claims or built, default systems checks are run, but also any custom rules that the client needs can be implemented.
Here is an example of a claim scrubbing rule involving lab billing insurance codes. Here this rule established that if any insurance claim besides Medicare lists codes, the system will prevent the claim from being billed out to the payer.
Finally, we have laboratory billing patterns. Lab billing patterns work in conjunction with auto coding rules to automatically build out a case with zero human involvement.
Lab billing patterns compare criteria like when certain tests were ordered, and with a certain result status, such as abnormal and normal, when certain CPT codes were performed on the results, when certain DX codes were used on the results, or any were used, depending on the scenario. So as a result of outline auto coding rules, the CPT codes matching the exact criteria will be generated.
This rule indicates that a COVID case gets automatically billed for six specific insurance payers listed here. Auto-coding assigns a CR modifier and a matching rendering facility provider. Additionally, COVID policy grants that the use 0003 CPT code is covered according to a specific coverage policy. If any condition mentioned, for example, use 0003 is not covered, or see our modifier wasn't assigned, then the cases get sent to the coding queue for manual review.
Patient billing/ patient payment processing. Patient statements in LigoLab are highly customizable and may be delivered through multiple channels, including email and text. Notifications also may be established for payment reminders via multiple channels such as SMS, email, mail, etc.
Users may manually alter the patient billing lab workflow by prompting the next transition date, forcing the next billing stage, or holding statement distribution.
Patient portal. Importantly a patient statement features a unique pin number that is utilized along with the patient's last name to locate an invoice on the online patient portal. Manual payment processing such as when a patient calls in is conducted in a very secure manner with card or bank data not saved in LigoLab, but rather captured outside of our platform. The payment made via the patient portal is posted within seconds in the LigoLab application.
The patient billing policies in LigoLab are very flexible. Flexible rules may be created to facilitate discounts or fees for statement applications. These discounts and fees can also be removed or reapplied based on any given scenario.
ABN feature. The ABN waiver of liability or advanced beneficiary notice is a unique component of medical lab billing as it applies to Medicare. At LigoLab we have a special rule specifically designed to address this workflow component. This rule fires right at the order entry before any billing-related lab workflow stages commence. When a collection of patient information occurs, and the patient insurance is designated as Medicare, and the CPT and diagnosis data meet the rule-specified criteria, an ABN form generation takes place. This ensures an option to facilitate ABN-specific procedures.
The patient insurance is filled in as Medicare and the diagnosis is not specified. So as soon as the user proceeds to save the order, an ABN form is populated, with an option to preview and print, to be scanned in after the patient signs it, and saved as an attachment for the related order. This ensures that the patient consents that they are legally liable for laboratory charges and will reimburse accordingly. With this feature, the laboratory is guaranteed to properly collect for their services.
Adjustment templates. The adjustment templates function is a unique RCM tool in LigoLab that is designed to assist users in the organization and management of the adjustment-related lab billing workflow. Users can specify an adjustment type and include a prefilled or custom memo. Additionally, users can set a percentage for the adjustment that will be calculated automatically. Finally, the rebill option, if employed, will automatically rebuild associated charges.
The adjustment templates feature may be utilized in insurance billing, as well as patient and client billing. Notes, tags, and attachments may be added for a created adjustment item. The strategic adjustment template application allows for organized management of lab billing, reinforced remittance processing, and efficient archiving of applied manual adjustments.
An example of an adjustment template you see here is titled low balance. This adjustment template is used for low-balance patient statements. It has a default memo and stipulates that 100 percent of the balance is to be adjusted audit trail.
The audit trail function is a special and very helpful feature in LigoLab.
For each data entity in LigoLab, such as a billing encounter, insurance claim, patient statement, etc., users are able to view an audit trail, which is a full archive of manual and automatic events that took place.
The audit trail covers entity modification, entity automation, entity creation, changing status, workflow activities, and reviews, and is intended for mostly workflow analysis and case investigation.
The audit trail not only tracks who touched an entity but also clearly shows what was recorded, at what time, and by whom. All while showing the previous and updated values of each change. So, it's a complete forensic tool that locks in every touchpoint for a future look back at any time. This function is available on the right click of individual line items from inside of the queue, as well as from within the relevant data entity via the special actions menu.
We also have an audit records feature accessible in the administration menu on the top pane of the application. It's equipped with four filters: entity, user, action, and date. This function allows the user to locate any entity in question for review, or to correct as needed. This function is mostly used for scenarios where a user needs to revisit an entity recently worked on for clarification of some kind, or for correction.
As you have seen, the LigoLab medical LIS and lab RCM platform is a powerful pathology lab software product that provides full transparency and control of your lab billing workflow. Our fully integrated real-time queue facilitated workflow design with powerful interwoven lab billing logic and clean claims scrubbing automation gives laboratories the RCM tools to increase productivity, mitigate risk, and improve compliance. This enables you to increase both revenue and profit and efficiently scale your business.
We hope you've enjoyed this presentation and it has provided you with a granular look into the power behind the LigoLab platform. We thank you for your time, and we look forward to discussing how we may assist you in further streamlining your business and achieving your growth initiatives.
