Revenue Cycle Management (RCM) Solutions for Laboratories

Laboratory revenue cycle management (lab RCM) software is billing software for labs that integrates and manages various administrative and clinical components around claim processing, payments, and billing. Ultimately, the goal of effective lab RCM (lab billing) software is to help labs increase profit by encouraging the following actions:

• Cost Reductions - From automating much of the laboratory billing process and avoiding errors that lead to re-work.
• Revenue Growth - From minimizing denials with more accurate and compliant claim submissions.
• Cash increases - More cash available to the laboratory and a decrease in working capital needs by cutting the time in accounts receivable.

Learn More: Five Steps to More Profitable and Efficient Laboratory Operations

If you’re interested in learning what lab revenue cycle management software specifically designed for diagnostic testing can do for your medical lab’s net collections, we invite you to schedule an introductory call with a LigoLab RCM software expert to learn more.

Request a Call with a Lab RCM Expert‍

‍What Laboratory Billing Solutions are Available? ‍

Effective use of laboratory billing solutions is crucial to the success of most healthcare businesses, including medical laboratories, because a failure to adapt to the changing times will leave these organizations vulnerable. 

One way to adapt and improve as an organization is to embrace automation over manual labor.

For example, the nonprofit Council for Affordable Quality Healthcare says the healthcare industry saved $122 billion in 2020 administrative expenses through digitalization and automation.

The message on the wall is clear. FTEs are expensive and modern laboratory billing solutions powered by automation are the answer. 

And clinical laboratories and pathology groups have a choice. They can choose lab revenue cycle management software fully integrated into a modern laboratory information system (LIS meaning medical), or they can choose to use a standalone laboratory billing system that interfaces with a lab information system.

Learn More: Six Reasons Why You Should Choose an Integrated Laboratory Billing Solution for Your Medical Lab

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

Revenue Cycle Management and the Laboratory Billing Process

While laboratory revenue cycle management is most associated with effective claim submission and payment collection, the best lab billing systems need to excel at all seven of the following RCM cycle workflow stages:

• Collection: Collection of patient demographics and payer information at test order creation.‍
• Verification: Verification of patient demographics and insurance information before testing. The best RCM software platforms employ direct interfaces with third-party services specializing in patient demographics verification, insurance eligibility, and insurance discovery.‍
• Coding: Coding for diagnoses and procedures. The best lab billing software fully automates the coding process rather than relying on manual coding from a standard list.‍
• Claim Submission: The process in which coded claims are sent to payers (insurance companies, clients, patients) for payment.
• Payment Collection: Payment from insurance payers, patients, and clients for the balance owed. ‍
• Denial Management: This is engaged if payment is not received and the claim requires correction, resubmission, or an appeal.
• Analysis and Reporting: This enables lab owners and executives to use RCM cycle data to lower expenses, maximize profit, and improve health outcomes. 

Learn More: How Billing and Coding Automation Increases Laboratory Revenue

Revenue Cycle Management Software Trends

According to Global Market Insights, the size of the healthcare RCM market is expected to grow by over 12 percent per year from just over $52 billion in 2019 to approximately $115 billion by 2025.

This growth is fueled by increasing demand from medical laboratories and other sectors within the healthcare system. According to CAQH, the same group that estimated that automation and digitalization helped care companies avoid $122 billion in costs in 2020, fully automating just nine commonly performed transactions could yield a further $16 billion in savings.

Another factor contributing to the importance of revenue cycle management software is the trend (especially in the United States) toward a value-based care model instead of fee-for-service. As patients, insurance companies, employers, and other stakeholders expect more data, presented to them in timely and standardized ways, healthcare companies need to be able to rely on their RCM systems and RCM management companies to keep up.

Best Healthcare Revenue Cycle Management Companies

The best healthcare revenue cycle management companies have invested in the seven key RCM workflow stages we listed above. Their laboratory software systems are customizable, user-friendly, reliable, and packaged with high-quality technical support.

Conclusion

Modern laboratories need advanced lab billing software. This need will only grow in the future, as efficient and standardized lab billing processes become the norm, and the healthcare system moves from fee-for-service toward a care-based model.

Learn More: Reduce Denials and Stop Revenue Leakage With Integrated Laboratory Billing Management

LigoLab’s Advanced Billing Software for Labs

LigoLab is a leading provider of innovative end-to-end pathology management software solutions, servicing 250+ lab facilities nationwide. 

As a comprehensive enterprise-grade LIS system and lab billing solution, the LigoLab LIS & RCM Laboratory Informatics Platform™ is an all-in-one integrated platform that supports every role, department, and case, enabling laboratories to deliver better patient outcomes as they differentiate themselves in the marketplace, scale their operations, become more compliant, and more profitable.

LigoLab’s lab RCM module is integrated with the platform’s LIS system. It automates coding for ICDs and CPTs and many other financial tasks while mitigating audit risk and increasing margins. 

With LigoLab’s advanced solution, the laboratory billing process starts at order creation with verification, eligibility, and scrubbing components that increase clean claim submissions and revenue, and decrease claim denials and compliance liability. 

LigoLab thrives on partnerships and takes full responsibility for its client's information system-related needs, enabling these laboratories to focus on diagnostic services that help healthcare providers and patients make informed decisions. 

Learn More: Navigating the Future of Pathology: The LigoLab Advantage

 For more information or a tailored demonstration of our laboratory billing solutions, contact LigoLab today.