The LigoLab Difference: Demonstrating the Power of Lab RCM Automation in the Clinical Laboratory

The foundation for LigoLab’s integrated laboratory information system (LIS) and laboratory revenue cycle management (RCM) informatics platform superiority centers on the customers’ ability to seamlessly, accurately, and rapidly prepare clean claims within the pathology lab software for laboratory billing services rendered, guaranteeing an increase in the bottom line and net collections. 

This capability is due to the combination of an innovative Rule Engine and the concept of having a lab information system (LIS in healthcare) with lab revenue cycle management (lab RCM) automation aimed at powering the platform to deliver highly customizable laboratory billing solutions as part of its laboratory workflow management. 

LigoLab Informatics Platform was designed to provide independent clinical laboratories and pathology groups with a single source of truth by making the laboratory information system (also known as a LIS system or LIS software) and laboratory revenue cycle management (lab billing) data instantly accessible. Laboratory operations can take advantage of having full transparency by configuring clinical lab workflow to address compliance, productivity, and scalability without sacrificing revenue. Specifically, the laboratory billing process can be successfully transitioned from the previously accepted practice of “back-end” laboratory billing to the new growing standard of “front-end” laboratory billing. 

Unfortunately, a typical legacy or stand-alone laboratory billing system cannot offer such transparency or flexibility to the RCM process due to its siloed and rigid framework. 

Users quickly come to embrace the easy access to LigoLab’s integrated and all-in-one informatics platform (that includes billing software for labs) as a result of its available features and functionalities that we will highlight here.

1. Data Integration 

Integrated Laboratory Information System & Laboratory Billing Informatics Platform: One Source of Truth

• LigoLab’s integrated platform interface gives users simple access and transparent visibility to all of the LIS system and lab billing data entities, all housed in the Billing Encounter.

• This shared functionality allows users to easily modify lab information system and lab RCM data as needed, enabling them to accurately remove/add tests, and validate pertinent LIS system data within lab revenue cycle management processes, all with a single click of a keyboard button. 

• In addition, this shared functionality allows users to make adjustments to various commonly encountered laboratory information such as patient demographic data, CPT codes, diagnoses, and provider credentials.

• These adjustments can be made “on the fly” with ease due to the user-friendly and intuitive nature of the Billing Encounter window featured within the LIS medical platform. 

• Easy access to relevant test order information, specifically: specimens, results, scans, reports, and audit trails are all available throughout the entire lab billing workflow. 

• This readily available and interdependent LIS lab and RCM cycle data confirms the core philosophy of an integrated platform and demonstrates how laboratories can achieve a transparent laboratory billing process. 

Non-Integrated & Rigid Laboratory Billing Solutions: Data Management Turns Wasteful

• Non-integrated and legacy laboratory billing solutions do not provide users instant and easy access to medical LIS data within lab RCM workflow tasks. 

• Non-integrated encounter-based lab billing interfaces force users to treat lab RCM as a “back-end” process, increasing the chances of data discrepancies. 

• Non-integrated laboratory billing solutions typically increase the amount of incomplete, erroneous, and improperly linked lab RCM claims to subsequent edited LIS system data. 

• Multiple laboratory software systems create an increased risk of potential errors and missed laboratory billing opportunities. Specifically, a need to constantly keep both systems’ master files, such as clients, tests, providers, and payers. As a result, further barriers in the form of data integrity and transmission issues arise. 

• Formatting between disparate laboratory software systems (a medical LIS and a laboratory billing system) can quickly become an issue causing data migration to turn into another labor-intensive task, occupying time that could’ve been better spent on other aspects of the lab workflow. 

2. KPI Reporting & Dashboards

Transparency & Reporting: 360° Operational Visibility

The LigoLab platform provides detailed insight into key performance indicators with robust dashboard widgets and reporting tools.

• Round-the-clock access to “real-time” LIS system and lab RCM performance and throughput metrics independent of volume, workflow, and scale. 

• The ability to monitor lab workflow efficiency and productivity using the numerous proprietary lab RCM tools geared to establishing an innovative data organizational hierarchy, such as statistics inquiry, dynamic reports, dashboards, and RCM cycle forecasting. 

• Transparent audit trail visibility that ensures full accountability and user-to-department-specific productivity, validating all corresponding laboratory billing data that can be tracked from start to finish.

• Peace of mind is quickly achieved as a result of establishing transparent access to data, leading to an allocation of personnel time toward the more difficult laboratory billing processes without sacrificing revenue. 

• Cases no longer slip through the cracks due to the seamless structure between the lab workflow queues within the platform and the powerful query capability controlled by customizable data filters. 

• The compartmentalization, uniform distribution, and flagging of claims quickly set clear workflow expectations combined with easy lab RCM accountability. 

• The Rule Engine triggers automated data processing cascades allowing the platform to prioritize lab workflow tasks based on pre-configured and easily adjustable criteria such as time, amounts, and ability to collect. 

Non-Integrated & Rigid Laboratory Billing Solutions: Conflicting Error-Prone Metrics

• Non-integrated laboratory billing solutions lack robust dashboard widgets and reporting functionality because they cannot access the full spectrum of a laboratory’s data (LIS system and lab RCM). 

• As a result, laboratories do not have visibility into the inner workings of the total lab workflow, including its efficiency, the metrics needed to maximize operations, workflow output, and total net collections.

3. Coding Configuration 

Robust Coding Tools & Laboratory Billing Automation: Unlimited Configurability

• LigoLab utilizes a robust and easily configurable custom Rule Engine, giving users the instant ability to define any given scenario while simultaneously meeting any laboratory billing or operational need.

• LigoLab’s powerful Rule Engine allows users to create rules aimed at how CPT codes are processed within claims, setting the stage for a maximized clean claim first-pass ratio.

• The “claim-scrubbing” RCM process can be pre-configured to validate established payer-specific compliance regulations such as NCD, LCD, and NCCI (PTP & MUE).

• This level of lab RCM automation and configurability ensures maximum reimbursement is achieved for every claim every time. 

Rigid Rule-Based Lab RCM Functionality & Antiquated Coding Process: Limited Configurability

• Legacy billing software for labs provides limited, clunky, hard-coded, and rigid rule-based lab RCM functionality with antiquated CPT code rules that cannot be grouped or split, creating a cumbersome and sub-par coding process. 

• Additionally, implementation of new payer-directed reimbursement regulatory practices can be difficult and costly due to the time needed along with labor for full integration into this new lab RCM workflow. 

4. Data Validation 

Insurance Eligibility, Discovery & Overall Data Validation: Time is Money 

• Redundant tasks used for data validation quickly become obsolete and the time previously spent on performing data validation can now be directed toward the more challenging lab workflow tasks.

• LigoLab provides a fully integrated, “single-click” batch Insurance Eligibility/Discovery tool that’s directly embedded within the Order Entry and Billing Encounter window, ensuring “real-time” payer data validation resulting in maximized efficiency within any laboratory billing workflow.

• In addition, LigoLab provides integrated demographic data validation RCM tools powered by White Pages, USPS, and other third-party lab vendors that can be configured within any lab billing workflow. 

• The White Pages and USPS validation tools are also directly embedded in the Billing Encounter window, allowing users to confirm the accuracy of patient/payer addresses, patient names, and phone numbers within seconds.

Back-End Lab Billing Workflow: Significantly Increased Claim Denials & Revenue Loss

• Legacy laboratory billing solutions can not provide such integrated eligibility and discovery functionalities, creating the need for staff to dedicate labor hours toward attaining and validating payer data. 

• Additionally, competitor lab RCM systems force laboratories to treat lab billing as a “back-end” process, delaying or even causing unnecessary denials, missed reimbursement from payers, and revenue loss. 

• Legacy laboratory billing solutions lack the availability of quick, accurate, and user-friendly data validation RCM tools that allow laboratories to transform lab billing into a “front-end” RCM process.

5. Workflow & Case Management

Designated Lab Workflow Queues & RCM Tools: Maximum Organizational Efficiency

• Lab workflow efficiency is dictated by specialized queues and configuration RCM tools including entity tags, notes, and queue data filters powered through the configurable Rule Engine.

• All of the available platform RCM tools are designed to direct laboratory workflow management, streamline lab billing operations, and easily scale business regardless of volume.

• Claims can be tracked manually and/or automatically (via the Rule Engine), ensuring accurate claim resolution.

Limited Rule Engine Capabilities: Ineffective Lab RCM Workflow Control

• Legacy billing software for labs has limited and obsolete rule engine capabilities, providing users with fewer and/or ineffective lab workflow control, case exception management, and case routing capacity.

6. Claim Denial Processing 

Single-Click Claim Denial Processing: Case Prioritization & Revenue Recovery

• Denials have typically been viewed as a tricky and labor-intensive part of lab RCM workflow, but LigoLab has transformed this RCM process into its most efficient form as a result of the platform’s limitless configurability options.

• Specifically, denial processing is set up to have “single-click” access to denial laboratory workflow management along with denial rates, trends, and pre-configured response protocols.

• The labor hours typically spent addressing the denial workflow tasks are significantly reduced resulting in more time allocation toward other lab workflow aspects and decreased revenue loss. 

Inefficient, Error-Prone & Labor Intensive: Manual Claim-Denial Processing

• Legacy laboratory billing solutions do not provide denial automation lab RCM rule infrastructure and supplemental case sorting and sample tracking functionalities. 

• Users are forced to manually process denied claims with the results being increased time consumption, clinical lab workflow inefficiency, and higher risk for overall errors.

7. Regulatory Compliance

Single-Click and Up-to-Date: Regulatory Compliance Functionality

• Laboratory billing workflow functionality setups such as payer mapping, coverage plans, and lab billing patterns are easily configured within the LigoLab platform.

• The flexibility of configuration options for regulatory compliance is customizable to match all lab workflow, creating an extra advantage to achieve a maximized first-pass ratio.

• The risk for regulatory non-compliance is mitigated via lab RCM automation while reimbursement rates simultaneously rise, creating the perfect environment to maintain revenue growth along with scalability. 

Limited Configurability: Regulatory Compliance & Payer Data Functionalities

• Legacy laboratory revenue cycle management solutions use traditional non-configurable laboratory billing processes and cannot map payer data. They do not provide the necessary integrated LIS system and lab RCM data transparency, limiting control over regulatory compliance.

• The lack of flexibility within regulatory compliance significantly increases the risk of laboratory billing errors, claim duplication, and/or improper coding that leads to revenue loss.

• Collectively, regulatory non-compliance leads to immediate “red flags” and increases the cross-functional risk that triggers in-depth regulatory audits, resulting in business contraction. 

8. Laboratory Billing Automation

Implementing Lab RCM Automation via the Rule Engine: Increases Total Net Collections

• The LigoLab platform eliminates the need for manual intervention within lab billing workflow tasks, creating timely and accurately coded claims and increasing throughput across the board. 

• The platform’s many lab RCM features help ensure significant increases in revenue, consistent operational efficiency, multiple transparent audit-tracking capabilities, and executive-level reporting tools.

Labor Intensive Claim Processing: Reduces Operational Throughput & Increases Error Rates

• Non-integrated laboratory revenue cycle management systems without these powerful features rely on manual processes, become inherently labor-intensive, and are prone to user errors combined with untimely and non-trackable delays. 

• The byproducts as mentioned above collectively decrease operational throughput, increase denial rates, and cloud lab RCM workflow inefficiencies. 

• In the end, laboratory businesses experience reduced profit and simultaneously face a higher risk for regulatory non-compliance.

In summary, a much-needed shift in the way clinical and reference labs and pathology groups approach laboratory billing is needed if they are to attain new levels of transparency, flexibility, and scalability with the RCM process.

To learn more, check out these related links and contact us to speak with a lab RCM specialist. We’re excited to show you just how important LIS laboratory information system and laboratory revenue cycle management integration are for your business's prosperity. 

The Connected Laboratory: A New Approach to Laboratory Billing Services

How Advanced and Highly Integrated Billing Automation Can Help Improve Workflow Efficiency and the Clean Claim Pass-through Rate

How Billing and Coding Automation Increases Laboratory Revenue

Reduce Denials and Increase Your Lab's Revenue and Net Collections