Webinars

^{Michael Kalinowski:} Hi there and welcome to this LigoLab webinar, unifying technical and financial operations to minimize denials and prevent revenue leakage. Thanks for joining us.

We're excited to have everybody together for what we hope will be a very insightful discussion on a very important topic, and that’s laboratory billing. 

Let's meet our guest speakers. Tina Quevedo, Senior Director of Business Office Operations at Avero Diagnostics, Aram Avakyan, LigoLab RCM Specialist. 

Both have taken time out of their busy days to join us today, so let's get right to the agenda. Topics that we're going to be discussing today.

• Why traditional lab billing no longer works 
• How integration creates what we like to call one source of truth for all lab data
• The importance of starting the lab RCM cycle as the order comes into the lab
• How automation and transparency enhance revenue capture, especially with a very tough labor market that most laboratories are experiencing these days

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We'll go into detail on how Avero has benefited since switching from a front-end laboratory billing process with a well known RCM system that was standalone and what the difference has been since they've gone into full on integration with LIS and RCM modules integrated every step of the way. And then we'll also have a question and answer session toward the end of this program.

We ask that you hold your questions until that point. Use the question option in this Zoom call at the bottom of your screen at any time. Log a question when it comes up, but we'll look to hold until the question and answer session before we get to that question. 

Aram, I'll toss it to you to kick off the discussion. 

_{Aram Avakyan}: Thank you for that, Michael, and I hope everyone is having a great start to the day so far. Couldn't have said it better myself. A lot of laboratory executives, management, and lab billing people that work in any type of lab billing workflows know the challenges that are associated with in-house lab billing.

Here's probably the most prominent ones that most people will encounter while they're within any type of reimbursement or claim process or anything to do with the recovery of any type of funds that are owed. In essence, you have shrinking reimbursements…the pie gets smaller and smaller by the year.

I don't think I've ever heard of us starting off a fiscal year where people are saying that reimbursements are increasing or substantially increasing. So it's something that we encounter constantly and it's a constant challenge to think about. High denial rates. No surprises or elaboration are needed there.

Again, something that's consistently increasing is the high cost of labor. Again, something that in more recent years has been a bigger challenge. We have these unique and more complicated payer requirements constantly evolving that payers are putting on laboratories and their partner's growing patient responsibility.

That's also a big stressor, increased regulations, and of course, securing the most maximum revenue you can while avoiding revenue leakage. Tina, feel free to chime in here.

^{Tina Quevedo}: Thank you Aram and thank you Michael for having me here as a guest speaker today. I think overall for this year, the reduction in reimbursements was at 2, or 2. 5%, I believe. And with those higher denial rates, those, as he stated, they're always increasing. I don't think that we've realized over the last six years that we've had a decrease in that. It seems to increase on an annual basis. 

I think one of the things that drives it as well is the minimum wage. So as the minimum wage increases, we see that we are having higher labor costs. We need more people when we're using manual systems. We need more staff to cover the work when you have an all-in-one laboratory that tends to decrease as labor increases.

And the other thing I wanted to mention was that people are realizing higher annual deductibles. I think that's probably known across the industry but as those deductibles increase, patient responsibility, you know, is obviously higher.

_{Aram Avakyan}: So something we're going to be outlining, highlighting and just discussing throughout this entire presentation would be the power of integration. Just a little bit of the moving parts, so to speak, that integration entails. The two big ones are automation and customization capabilities. On the left-hand side, as you can see, non-integrated laboratory building systems are often disconnected and highly dependent on manual processes, and that leads to higher rates of errors and delays that are unforeseeable. 

When you have an integrated all-in-one informatics platform you have access to all the important data entities you need at your fingertips, which makes scalability that much easier.

And you're able to get that maximum first pass rate ratio as people know it. Essentially, you prevent that revenue leakage. And that's the holy grail that every laboratory is after, making sure you get that maximum reimbursement rate and prevent any type of unforeseen errors and delays in processing, that way you're able to stay on top and avoid those long business cycles.

Essentially integration, you have a bridge between the LIS system and laboratory revenue cycle management (lab RCM) platforms. So you are always doing your best to ensure that you're getting updated and accurate claim data. You're eliminating those redundant tasks typically associated with traditional non-integrated RCM cycle workflows. You get a huge increase in opportunities to automate numerous aspects that are tied to lab RCM workflows.

Implementation of compartmentalized sequential and custom workflow queues will further get you to that high first-pass ratio. And of course, something that affects every industry is data transparency, and you get that with an integrated LIS system resulting in secure, fast, and accurate claim generation.

As I mentioned in the previous slide, those are the goals and objectives that you'll get to using an integrated platform. But as far as the data that's going to be flowing through an integrated lab information system and lab billing solution. How does it work?

So it's an alternative approach to the standalone systems and back-end lab billing. Essentially, as far as our integration integrated system, you have an event-driven transaction-based system that's linked to a lab billing encounter. So everything for a claim is tied into that single accessible data entity known as a billing encounter.

A combination of the workflow, acute workflow, acute tools, and utilities available to minimize the risk for errors. You have organization compartmentalization and you have the accountability without all the extra steps that are normally tied to a non-integrated system are one-of-a-kind engine rule will replace.

Configuration issues will establish consistency and it'll help you really utilize those front-end RCM tools as far as demographic check, address validation insurance discovery, things that essentially laboratory flows need in real time. And. Of course, as every laboratory executive might know that robust data analytics are extremely important and having an integrated LIS system, you have everything under one roof.

So you're able to access such reporting or custom reporting with a simple click. And that's literally everything that integration can offer a laboratory. 

^{Tina Quevedo}: Okay. So now we'll talk about the front-end workflow and the demographics validation. With the LIS system, we have a white pages lookup. So it will give us current and historical addresses and associated phone numbers. So if we get things that come in at the accessioning level, and it's absent from the work, we use the white pages lookup and it's going to pull that real time data into the LIS software for you. 

There's also a U. S. P. S. A. P. I. And that's address scrubbing. So when the requisition comes in and it's being accessioned it will scrub that address. And if there's something that is more accurate or current with the postal service, it's going to alert you of that correct address and give you the option if you want to go with the one that came in on the system, or if you want to change and use the USPS reported address. 

Then we move into the eligibility its real-time integration. You can run it in batch processes, or you can use it on a case by case basis. You can also set some rules in the system that will allow you to auto-bypass.

Once the eligibility is recognized by the lab information system, you can set the rule to say if it comes in and it's eligible, let's just bypass demographics and move right over to the next cue, which is the coding cue. We also have an insurance discovery function. It's fast and accurate. It's within a matter of seconds.

You click the button for insurance discovery. It's going to go out in real time and it's going to pull back insurance information if you didn't have it or if the one that came in was actually terminated or ineligible. And then it gives you the option once it populates that coverage on a screen for you to pull it in and auto-apply it to the account and be able to move forward and complete the demographics. 

And then we have patient profile management, historical demographic lookups and profile linking. So if we get a patient that maybe hasn't been seen in a couple years and we get info that maybe they had a last name change or an address change. 

The LIS system's going to recognize that and it's going to run certain parameters and it's going to pull it up on a screen and let you know that there's something similar in the LIS system and give you the opportunity to either link those accounts or if you just determine that it's actually a new patient, you can create a new account.

And so those are some really great benefits of having that front-end workflow. 

Okay, and then we're with the back-end workflow coding to claim generation. We have scrubbing validation, procedure to procedure, which most of us recognize as code bundling or unbundling.

We have the MUEs, the NCDs, LCDs, and custom rules. We come over to the flexible workflows. You have auto-bill scenarios, custom queues and filters, and detailed auditing. We will get into this a little bit later, but one of the great things about the lab information system with this backend workflow is you're able to build in custom auto-bill rules.

So if you have many different clients that have different client bill rules, or if you have payers, which most of us do have payer specific rules, you can actually set in auto bill scenarios and you can build those to where it will auto code them for you and you can make changes to them or you can build them to where it will auto code them.

It will apply to a specific diagnosis that you give them the formula that says if the CPT comes in and it has this diagnosis, then match this diagnosis to that CPT and it will allow you to actually batch all those auto bill claims together, review them, and release them all at one time. 

Under the auto coding engine we also have the bundling and unbundling so the LIS system will recognize codes that bundle together and alert you so you can append modifiers or specifically based on rules that you may build into the LIS system, you might need to unbundle something and build individual CPT codes separately for specific payers.

It also has a very robust TC/PC splitting feature. So when you have clients that require that you're billing the technical component back to that client automatically the professional component, even in the reverse mode, we actually have some clients that we bill them the full amount globally and we build the rules. 

And so when these charges come in, it's going to automatically split them on the encounter screen. And we're just verifying that it's correct. And it automatically pushes it over to the client invoice and sends the professional component claim out to the insurance. 

Along with that, there's a diagnosis pointer assignment, which was something I made reference to under the custom queue. You can build the rules into the lab information system so that you tell it if the CPT comes in, And these diagnosis codes are on that encounter. We want you to match these diagnoses to these particular CPTs. You hit auto code and it auto assigns them for you. You're just going to visualize it, make sure everything looks correct, and complete your claim.

The pricing policies, we use those pretty robustly in the LIS system as well. We have many different pricing policies for many different clients, and we also have different pricing policies for our commercial payers versus our regulatory or federal payers. 

Custom rules, so that is something that I've been referring to in both the flexible workflow and the auto code engine, you can set many different custom rules. You can set it by client, you can set it by payer, you can set it by client and payer. And you can set it by CPT, so there could be system-driven rules that you need specifically for one payer, but only for a set of CPT codes that you could separate that from the rest of the normal standard laboratory billing process.

And then again, payer specific. So with the auto coding, you can set your auto coding rules specifically for one payer, for several payers, or you can actually list out how many different payer plans you want to follow a certain specified set of auto billing rules. And you can also have it split and separate the line items for you. 

So, for instance, if you have an insurance plan that requires you need a CPT code with the first unit on the first line, and then if you have multiple units, all the other units go on the second line and you want a modifier, you can actually set custom rules in the LIS system software that say when this insurance comes in and it's this CPT code, this is how I want you to split it on the claim, but yet allow it to go out in a unbundled singular CPT for all the other insurance payers. 

_{Aram Avakyan}: I know you're very hands on as far as claim generation, working the different workflow cues and you’re just running everything as a well-oiled machine, in your opinion how much manual, redundant, kind of the stuff I mentioned earlier, would this, everything you went over, the auto coding, scrubbing, validation, how much manual and redundant tasking does that eliminate, in your opinion, just based on your experience, you know?

^{Tina Quevedo}: Yeah, quite a bit. So coming off the other laboratory billing system, we had a very large staff. And we had many, many manual processes where we had to touch each case multiple times. 

Coming back onto the LigoLab LIS system we have actually reduced our staff by 56% which is a huge amount. There are some other factors that play into that, but primarily by utilizing the bundling, the TC splitting rules, the payer rules, auto assigning those diagnosis pointers, using the pricing policies, and we are not having to touch every single encounter that comes through.

We do batch them. So they can come through, they'll hit the rules, they go into another queue, and we go into that queue, we validate, we go through, we spot check, we look for any issues or anything that might be discrepant with any of the encounters that went through that process. And once we've determined that everything looks good, we go ahead and release the batch.

But that means we're spot-checking 250 claims, you know, for a few minutes a day where prior we had to have somebody manually touching every single one of those encounters. So it's a huge benefit to have it all in one LIS system with lab billing and to have all of the automation in place. 

_{Aram Avakyan}: And just to give everyone an idea average, you know, ballpark, what's the volume, what volume were you guys having to go in and like you said, touch every claim and adjust.

^{Tina Quevedo}: So historically under the old split system where we had the coding and the billing in one place and the accessioning the LIS component on another and working with an interface, we were touching a hundred percent.I would say now we are probably touching about 45%.

It could be even less. It might be closer to 40, but a huge amount of what we do, like I said, we're able to actually append the rules. We don't touch anything that's client, so if we have a strictly client bill that auto bypasses, we've got rules in place. It goes directly to invoice. We do have somebody that manages the client invoicing. They go through, they give it a look over, they make sure everything looks you know, appropriate, that the pricing tables are working and they release the invoice, but we don't have to touch that at all. 

And a lot of our DERM cases are smaller. Surge path that comes in, that's not involving a lot of IHCs and a lot of flow and a lot of the different things that we do.

We can set those rules to recognize that it's a single CPT or a single CPT with maybe one IHC stain. We can set those rules to say, if it's this client and it's got this, put these codes on it with these two diagnosis, it's something we see over and over, like specifically with GI cases. You know, a lot of what we have coming through for GI, it's pretty similar in the codes that we do if there's no findings on the case.

So we can set those rules to apply those diagnosis codes and even a modifier if necessary in certain scenarios, and it'll apply it and send it through. We don't even have to look at them. 

_{Aram Avakyan}: So, that's kind of the power of our rule engine that I was alluding to earlier. It just, as Tina mentioned, makes your workflow that much smoother.

You don't have to go in there and nitpick through claim after claim, especially if you're a high-volume operation like a Avero is. I'm sure there were probably thousands and thousands of claims as a result of implementing these rules and just going through and validating, that you didn't have to touch and that's just the power again that integration can offer a laboratory, and the beauty of it is it's configurable and adaptable to any type of volume and scaling is that much easier.

You have all of this at your fingertips and essentially, that's how laboratories can utilize an integrated LIS system with laboratory billing solutions. 

^{Michael Kalinowski}: Really good questions and info. Just a reminder of the Q and A button at the bottom of your screen. Feel free to hit us up with your questions. 

Once we get done with this presentation, we'll have a chance for both Tina and Aram to answer any questions that you guys have. 

_{Aram Avakyan}: Absolutely. Thank you, Michael. So one source of truth. That's essentially the first bullet point that I mentioned when we began.

And that's the bridge that supports constant communication between the LIS system and RCM cycle solution. You have the visibility and the accuracy of your data. Essentially, you're able to fully control the movement of a claim and claim generation, and you're making that seamless transition between front-end and back-end.

And you, most of the time, won't even realize that you're doing it because everything is all in one. So, to you, it's one system, but it doesn't seem like you're going from LIS system to RCM system. It feels like everything is just right there at your fingertips and the use of the real-time workflow cues when it comes to just the accountability portion and everybody's roles that are assigned.

Everybody knows what their task is, following up. If there's an issue, you can easily track it using the audit trail. You can link it to a workflow cue. You just have that transparency that's so vital in establishing that maximal reimbursement rate, you don't have cases falling through the cracks where you're digging through the different systems.

Let's say you were using a non-integrated system, you'd have to really track down a case to see what, and where went wrong, essentially. Here everything is just one click away. You're able to follow a claim from start to finish with ease and no problems.

A huge bonus is having that access to real time performance and throughput metrics. Having the ability for custom data analytics and executive-level reporting. It's no secret, that's how you're able to comp on your business and improve and just reach those milestones that will allow you to scale up and grow as a company.

But to do that, you have to have accurate real-time performance and data analytics with easy access. And kind of what I touched on earlier, having a transparent audit trail that you're able to refer to in case there is a question about a certain claim or data entity, anything of that nature, you can easily do so with right click access through virtually throughout the entire platform.

That is the power of integration. Everything is linked. So accessing where it came from and where it's going, it’s that easy. You right click and the audit trail pulls up user information, daytime stamp, everything that you need in order to track either a claim or data entity that you may have to look into or question, et cetera.

So essentially you're, you're having that peace of mind and the opportunity to scale up and grow as a result of using that one source of truth. 

^{Tina Quevedo}: Correct. I'd like to hop in here for just a moment. One of the things that I wanted to talk about is that under the old lab billing system that we had that was two components and with an interface, we would lose that tracking from one system to the other, and it became a manual process of having to run reports from one system, pull the reports from the second system, and try to match up what happened to to find your gaps, right?

So things would fall through the cracks, or if there were something that was going on within the interface, we might not be able to locate a case where it was in the workflow. One of the things that we use daily are the audit trails, whether it be looking at a user specifically to find out what cases they worked on and what changes they made to a specific case, for staff management, or using it to to determine what happened to a case in the workflow or to find out what the status is, right?

So if you have a case that comes in and you have a client that's on pins and needles and waiting for the results to come back they may call in and want to know what is the status is and and where's the report, and you're able to track it and to see who touched it. Where it is in the process. Is it completed? When will the report be released? 

You have all of this information right at your fingertips, even though the RCM cycle side, I call it the LIS side and the RCM side because there are certain clinical functions that go on that front end and we don't necessarily see everything happening there until it comes into the lab RCM module as an encounter, but I can still get to it from many different areas, whether it be at the claim level, at the patient demographic level, you can run those audit trails that will take you backward in the process.

There are also audit tabs on every level so you can click onto that tab and you can see just by the audit tab where that claim is sitting or where that specimen is in the lab workflow laboratory billing process. So it's really an amazing thing to have everything integrated into one lab information system and have that transparency.

^{Michael Kalinowski}: I think that's a pretty good place to segue into a case study that we did recently with Tina. Avero Diagnostics making front-end lab billing a priority, and so can you.

That's the topic we're going to discuss now. In fact, there is a URL on our website at LigoLab.com that I will share with everybody that registered for this webinar later today. 

Basically, it's documenting what Averro Diagnostics experienced when it moved from a legacy lab RCM system to an all in one lab informatics platform.

Tina, I know you've already touched upon it a little bit, but here's an opportunity to go into a little bit more detail about what things were like when you came back to Avero Diagnostics. You had taken a bit of a career change, as I recall, you ended up coming back to Avero Diagnostics.

They were using two different systems, one for LIS, one for RCM. Just describe a little bit about what issues you guys were dealing with at that time. 

^{Tina Quevedo}: Yeah, so I've actually been through this twice. As you mentioned, I was working here under Northwest Pathology, started back in 2018. I came in and they had a two part system and it just wasn't working.

So no automation, lack of transparency, claims were being locked in the module, lots of reporting and lots of manual mining of the data to try to find out where the gaps were and to try to find solutions for those problems. That is when we came on to LigoLab’s laboratory billing solutions for the first time.

It was amazing. The implementation was seamless. We were one of the first onto the laboratory billing module and huge difference. So shortly after COVID everybody went remote and yes, my career went in another direction. And then, they grew and got bigger had made all kinds of changes.

So at the end of 2022 they contacted me and told me what had happened and what was going on and asked if I would come back as a consultant. Right away, I recognized the problem.

They had, for whatever reason, decided to go into another two part system in their growth changes so they were back on that RCM system with an interface, and then still with LigoLab’s LIS system and just, some systems are meant to talk to each other and be together, hand in hand, and sometimes they're just not meant to be together and to talk to each other seamlessly.

So when I came back, they were back on that two part system and lots of problems. So immediately we started having the conversation. We've got to go back to an all in one. I knew that coming back to LigoLab was going to be the only thing that would right set us and get us where we needed to be, get the claims out the door, have clean claims and be able to drive that revenue back up.

I feel like it was like they pushed a button and we were back on. It was really that easy. All of the rules were still there, all of the detailed automation, there were a few things that we changed and added, but it was just from an RCM perspective, it was seamless.

We started with one set of cases and then transferred over a couple of more and things were just running and working. It was a beautiful thing. I can't say enough about how seamless it was to come back onto the all-in-one LIS system and lab RCM platform. I was so appreciative and I know that the doctors and the owners were equally impressed that we got things back onto the all in one system and just working efficiently. 

As far as the training, this system, I hate to date myself or to age myself, but this system, I have been on many in my 33 years of working the RCM process, and I can tell you that I have two favorite systems and LigoLab is at the top.

The training is just, it's so easy. It's quick. I can bring people in with very minimal experience and get them started on the demographics piece. And before you know it, they're working in the remittance queues and helping out in the rejection queue. It's a very intuitive and user friendly, so where in other systems, you've got to train them in increments and you've got to get them through one process and then spend a couple of days on another process before you know it , you're looking at 2, 3, 4 weeks to get somebody really up and running.

I brought people into the demographics department and I've had them up and running in two days, so the training and the ease of the system, it's just incredible. I can't say enough about it. And yes, as, as it's showing there on the screen we have a very high clean claim percentage, 97, 98%. It could even be higher now.

This was the percentage that we pulled when we first transitioned back. So after the transition and cleaning things up and implementing payer rules, client rules and just really going through from top to bottom to make sure that everything was back in place and working, I believe that that percentage is probably closer to 99%.

We have a very small amount of claims that come back into our rejection queue. It's very small. They do go straight to the clearinghouse. So when we generate a claim in the laboratory information system from the encounter, once you generate that claim, it's a matter of minutes and within an hour, you can actually go into the clearinghouse and see what the status is.

If you don't see it bouncing back, if you've got a claim that you're not sure how it's going to process or how it's going to hit those lab billing rules with the scrubbers, you can actually follow it from one place to the other within an hour. It's just it's that quick. Again, percentage of claims paid on the first pass because we have those automated rules, the scrubbing tools, and then of course, the clearinghouse does its own set of scrubbing between the two entities.

 I think that the percentage even though we were pulling 87 I think we're closer to 90, 95 first time around they're paid. And then of course net collections increased by 30 percent and I think it's going to follow with the rest of the items there.

We're probably at an increase closer to 40 or 50 compared to what we were seeing in our collections on that two part system. So it's, it's been a huge benefit for us in our organization.

^{Michael Kalinowski}: Very powerful numbers, the clean claim percentage and obviously the net collections certainly stand out. 

^{Michael Kalinowski}: So I guess we can go back to why we're having this webinar in the first place, right? I mean there are significant RCM challenges out there that all laboratories are facing. How do you overcome these challenges?

Aram, I'll let you discuss challenges and we can go from there. 

_{Aram Avakyan}: That's good, Michael. Thank you. And this is kind of a review or not review, but bringing all of it together, kind of piggybacking off what Michael said earlier. I mentioned high denial rates and said they're always increasing.

We covered that when we were going through the back end workflow RCM cycle where specifically we discussed how much reduction in manual processes there was as a result of the rules and the configurations and all the utilities that are available in terms of auto coding and claim generation and just instilling things like coverage policies, et cetera. The limited visibility and operational transparency that I think anybody that has dealt with the traditional 2 part system has had that problem because you don't have that bridge of communication.

So you're not necessarily having that full transparent view of the data needed to process claims and to ensure that maximum reimbursement rate. And unique and complicated pay requirements year by year, you know, whether it's private or public insurance groups, they're going to continue to make it that much harder to get proper reimbursement and adequate reimbursement based on the services that are provided out there by the laboratories.

The roviders equally are going to become that much more cutthroat and in order to properly be prepared again, something Tina will chime into. And then we all know about those increased regulations consistently asking for, you know, a period here, so to speak, comma there, and things of that nature in order to get that extra nickel out of whatever claim that you're submitting.

Lastly, what we're all here to prevent is the revenue leakage. You want to get that maximum reimbursement each and every time, especially when it comes down to that first pass ratio. You want to capitalize on that because that means that you will not have to invest the time and effort into going back to that claim or claims or anything that has to do with you touching another claim.

^{Tina Quevedo}: I think some of this we've touched on, but primarily in regards to the revenue leakage, the reports that we have in the system, they're very detailed and we have custom filters, right?

We can set our reports up to run with so many different parameters that it really will help us to identify the trends. So it will help us to identify what CPT codes with what ICD 10 codes with what pair. Are we having an issue? Are we seeing denials? We often have claims that go out and they've got, you know, 567 different CPT codes and maybe the claim is paid first time around.

But all of a sudden we're getting one CPT code that they're starting to deny. We can regularly run those reports to identify those trends. Then go back to those automated and custom lab billing rules when we know that this is a specific problem and we need to make a change based on the information that comes in with the specimen and how it's accessioned.

When we talk about the custom payer center centric data scrubbing, we have those rules built into the lab information system. So with those rules being built into the LIS system, it's by place of service, it's by payer, it's by procedural type, it's different for GYN versus surgical.

So all of this is built into the LIS system software. So we are not experiencing revenue leakage. We're not missing our assessions that are lost somewhere because they didn't make it from the LIS system over to the laboratory billing system because we can track it. We have very detailed reports that can show us here are the specimens that came in and here's where they are in the system.

So If we had 1100 specimens come in today, we can see that 900 of those made it into demographics, 600 went automatically over to the coding queue because eligibility pulled them up they were eligible. Nothing else was identified under the benefits to state that it there was an HMO that a change needed to be made and it pushed it through the other 300 might have an issue.

Maybe we're missing a diagnosis because it was pushed through the system and they didn't put a diagnosis or one that was acceptable because of the payer on the case, so those might be sitting in a queue somewhere. But we can identify them where they are in the system and we know that we're not losing that revenue.

And this all is happening while we were able to reduce staff. The other thing is that even though we have a very low claim denial rate because of these automated rules, when we do have a denial, even if it's not a full denial, if it's a partial denial, the system has a remittance queue.

Based on the denial type, we can go into this remittance section and we can say, okay, show me everything that was denied because it was sent to a health plan and it really needed to go to the HMO, or show me everything that was denied because they're calling it a duplicate claim.

It will separate them by the type of denial so you can go in and work those immediately and you're working them as a group. So you're not just running an A/R report and looking at every claim to see what's wrong with it, what happened, why it's not paid. You're actually able to work them all together at one time, apply your fix and push them back out the door. So it's very efficient.

^{Michael Kalinowski}: All right. I think we have reached the point where we will open it up to the audience for questions. There is a question and answer tool at the bottom of your screen. Feel free to log your question there. 

A couple of key things that I've heard are reduction in staff and not having to touch every case, and a high first pass acceptance rate. Those are really key metrics that I think will get everybody's attention. 

So from the staffing point of view, you've been able to refine the staff a little bit? Also, does this allow for more opportunity to work the more complicated cases?

^{Tina Quevedo}: Correct, and that's been a big change for us as well, because we have turnaround times with clients and we weren't meeting those turnaround times on the two part system. Now along with staff reduction, our team is able to focus on those bigger cases, and get them handled.

If there's an issue with them, they have that time that they can dedicate to focus and work on those issues, so that when that claim or when that specimen is completed and that report is released, we're immediately sending that charge out the door. That's something that we haven't talked about yet is that with the LIS system most of our charges are out within 24 hours from report. It is that clean.

We're working out any issues, whether it be correct diagnosis, missing date of birth, anything that might be going on with that specimen, we are able to touch it, handle it and get it moved forward so that when that report goes out the door, it's immediately billed, usually within 24 hours. 

^{Michael Kalinowski}: Aram, can comment on this and give us an example of how that works and how the rules, the profiles are created? 

_{Aram Avakyan}: Essentially payers are imported depending on the clearinghouse that we're working with. So the profile is very flexible, highly configurable. Again, it just depends on the workflows and clearinghouse you're working with, but essentially it goes by insurance group and plans. The type of billing or charges or codes that you're looking to charge but as far as how they're set up, typically they're imported and they're mapped using our mapping interface that is involved and essentially it just feeds into the rest of the workflows and anything that's involved with payers.

^{Michael Kalinowski}: One question from the audience here. I'll let either one of you or both of you handle it. Will Z codes be covered during this webinar? Maybe the question should be how are Z codes handled within the LigoLab LIS system and laboratory revenue cycle management platform? 

^{Tina Quevedo}: We are not currently billing codes that require the Z code at this time, but it's certainly something that we have been monitoring and paying attention to. What I would say is if we had a certain CPT code that we were billing out and it was required that we submit that Z code, it would work in the same way that we attach MIPS codes. 

So what we have done with the MIPS codes is we have certain procedures that when they come through the system and with certain payers only specifically medicare they want to see that MIPS code so we can attach whatever MIPS code we want to whatever CPT code and whenever that CPT code comes through it will auto pull that MIPS code at a zero charge on to the encounter. So if that time comes where the services that we're billing would require that Z code, we would just set up the rule in the same way to send it through automatically.

We don't have to manually put that in. We can still use the auto billing engine. And if it's a single CPT, it requires a Z code. We've already got the diagnosis that's in the rule that says if it's a CPT with that diagnosis code, match it up and send it out. It would automatically append the Z code.

^{Michael Kalinowsk}_i: Next question for Tina. Where has Avero witnessed the most improvements since switching to an all in one LIS system and lab revenue cycle management platform? 

^{Tina Quevedo}: I would say transparency and revenue. So the transparency of the system has allowed us to move things through the system and get them out the door to the payer more efficiently than when we were on the two part.

With that having the payer driven rules, which is really important. I've met with people from other labs and I feel like we are really, really detailed and I don't know if everybody experiences the same kind of payer mix, specific rules and client rules that we do, but we have seven major clients that have a huge set of payer rules and they're not the same.

We have some clients that with all of their services, we're split billing, and then we have some clients that with only certain types of procedures we split bill with the other procedures. We're global billing, and then with those procedures, we're global billing, unless it's this payer, that payer, and all of those payers have different rules.

We also have a place of service override table, so you have certain facilities that depending on, you know, are they a hospital? Are they an independent center? So all of those different scenarios have different places, service rules, and different payers.

They want a specific place of service when you're lab billing for that entity with that certain payer, so we've built those rules into the LIS system. We were able to build some rules in the other system, but not at the level that we have been able build it in our all in one and specifically with LigoLab, we didn't have the ability to drive certain types of customization under that two part system.

It doesn't mean that other two parts might not have the ability, but in the two different systems from the first time I was with Northwest Pathology, and the two different systems we were with, we didn't have that full functionality. When I came back and a different RCM system in the two part, we weren't able to build those custom rules at that level.

So those claims had to be manually touched. Every single time where now we're not having to do that. So that drives revenue, right? The faster you get the claim out the door, the faster you're going to get that payment back from the payer. 

^{Michael Kalinowski}: And a follow up there. You say we're building rules. Is it you and your staff, or LigoLab?

^{Tina Quevedo}: Yeah. So we could, if we wanted. To dive into that functionality, it's been offered that they would train us to build those rules. I'm not quite comfortable there yet. I'm not really a programmer and I'm not ready to step into that area.

But what we do is we sit down, it's usually myself and a provider and maybe somebody from the coding team, and we look at, okay, what's happening here? What are we seeing with this paayer, with this client? Or with this type of procedure? And then we think of the scenarios. Okay, when we get this certain type of specimen in, how does it need to go out and what are the automated rules?

And so we do the workup, we just literally pull up an Excel sheet and we say, This is the CPT code, here's our list of diagnosis and we want it to apply to these three payers. And if it's these three payrs, this is what we want it to do. And we want you to match this CPT with this code and if there's something to unbundle and we need a modifier, we tell them what it is.

Then we send it over to LigoLab customer support and they build the rule and then they put it into our training environment, which is updated a couple of times a year. They'll actually pull our production data over so we're working with real time cases and accounts, but it's in a training environment that doesn't go anywhere.

They'll build that rule and put it into the training environment and say, go test it. So then we go out there and we create several different cases, several different payers, some to the patient, some to the client, some globally to the payer, to make sure that all of those different details that we built into that rule are actually working, functioning, and that we're seeing them move through the process the way that they should.

We approve it, they put it into production and we go. It's that simple. 

^{Michael Kalinowski}: Aram. Would you like to add anything there? 

_{Aram Avakyan}: I think Tina covered everything. I mean, essentially out of the box there are preset rules. That's the only thing that I would comment on. And we do start off with the whole training wheels type of thing, but we can work with you and eventually, once you're comfortable, you could go in there and set up or tweak the rules that you need to without help, in order to fit your workflow.

^{Tina Quevedo}: That's great, thank you Aram. That's a great point though, because with the other systems, whether it be two part or a single system, other systems that I have worked on historically, there are a lot of global settings and you can't deviate, right?

So maybe in our office with a certain payer, we want to split a certain code and append a modifier. Everybody else that's working on the system, that CPT code is only set to be billed a certain way, right? With LigoLab, what we have found is there's very little in global settings that we can't change.

There are going to be some things like maybe columns that are in a certain report that we don't have a specific filter, but even then I have been very fortunate that if I go to the team and I say, you know, gosh, I really love this report, but I really need this data, can you put a column here? 

Most of the time it's going to be a yes. There has probably been a time or two that they've said, no, we really can't do that because we'd have to change the whole functionality of the whole system, but for the most part, working with LigoLab we are able to customize to the level that works for our organization and not based on other organizational needs.

^{Michael Kalinowski}: Well, a powerful discussion. Great insight from both of you. We've reached the end of our presentation. Now, one other question was, will there be a recording of this available? Yes, we will have a recording in a short amount of time. We'll have it up on our website at LigoLab.com/webinars.

So look forward to that. We also have QR codes and email addresses for both Tina and Aram for any follow up questions, let's say something pops up in your head a little bit later, or you're bashful and you're a little shy and you don't want to ask the question now, feel free to reach out to Tina or Aram at your convenience.