What do laboratories need?
Whether your laboratory’s specialty is toxicology, pathology, clinical, genetics, esoteric, or any combination of these, if you are evaluating new revenue cycle solutions services or financial/management systems (or both), either the first To replace the bar or your current platform, you will want to make sure that the service or system you choose can do everything that is needed.
But, what does “do everything” mean?
Some things are obvious, some are not, and some do not necessarily apply to the actual features of RCM software at all. In fact, our first item is one of them.
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LIS Integration
Although it is not a system feature, it is an absolute necessity. The RCM software vendor must be tuned to your LIS in such a way that a fluid interface can be established with your LIS.
As a side note, the EHR of any referring physician should also be interoperable with the LIS so that orders and results can be passed back and forth. In fact, the lab may even be selectable as a button or drop-down in the EHR, making it easy for the referrer to click into it. If the RCM software vendor has its own EHR supporting it, that’s another additional layer of connectivity, assuming the referrer is open to considering that EHR.
Getting Paid Almost Anything Goes
Your laboratory exists to provide accurate results that guide physicians or physicians to provide the most appropriate treatment. Undoubtedly your service is excellent and deserving.
You also need to pay for those eligible services. So perhaps above all, your revenue cycle management services or in-house medical billing software should not only generate revenue but maximize revenue. A rules-based engine to ensure claims are presented at maximum value will dramatically increase any lab’s revenue.
The software or revenue cycle management (RCM) services must have a claim submission success rate of approximately 100% on the first attempt clearinghouse claims; You’ll want to know that most of your claims clearly pass on first submission.
Next, you’ll want a way to track your submitted claims in real time to ensure they are being processed. This eliminates the guesswork about when your claims will be paid. The Revenue Cycle Management service should do this for you, although you should have full access to view it.
Requires an on-the-fly claim denial manager to make it easy for you to view the reasons for any claim rejection and rejection by health insurance companies and then enable you to make the necessary edits and resubmit Creates, preferably from a windowed view.
Or, your RCM service must edit and resubmit the claim rejection to the appropriate health insurance companies within 3 business days of the rejection. And as is the case with claim tracking, you should be able to see how your rejected claims are doing as well.
Talent-Level, Rule-Based, Artificial Intelligence
As an overall software feature, you want intelligence to the point where the RCM or in-house software basically operates itself for the lab, without needing a ton of on-the-go input on what to do next.
For example, some pre-test alerts powered by rules-based engines are important to laboratories. These include, but are not limited to.
- Eligibility verification to ensure patient coverage is active
- Out-of-network alerts with tools to help capture those patient payments
- An insurance search option to identify insurance coverage when none is present in patient records
- Pre-test access to the Patient Responsibility Estimator; You will be able to tell the patient what will be due
- Display reimbursement, if applicable
EOB solution should also be intelligent and instantaneous. Then as soon as the balance becomes the responsibility of the patient, the system should generate the patient statement.
These are some examples of intelligent software architectures for laboratories. When searching for systems or RCM companies, be sure to find out about the intelligence of their software; You want genius-level IQ.
Reports, Dashboards, Analytics and Key Performance Indicators
Your laboratory is also a business, and businesses require financial, management and operational data and analysis.
Reports
An array of user-defined reports, KPIs, analytics, dashboards should be available with the in-house system. With an RCM, you should be able to compile your own reports at any time, plus they can generate and review with you.
Users should be able to save and name their reports without having to constantly maintain them, and schedule them to be compiled automatically at user-defined times.
Reports should be exportable to Excel, don’t require expensive, add-on report writing utilities, and don’t require an advanced programming degree or dozens of hours of report writer training.
Marketing
Laboratories, like almost any other industry, can be very competitive. Marketing, advertising, and outbound campaigns aren’t unusual for laboratories.
If you’re into marketing or plan to become one, the system should have a built-in way to track your campaigns without the need for a six-figure, stand-alone CRM system.
That said, even if you prefer to use a stand-alone CRM, the RCM or in-house system should be open to doing an interface, assuming that’s what you want.
Sales
Whether you have a salesperson in your lab or a sales team, you’ll want to track their activity. Your RCM’s system or your in-house system should have a mechanism for that, which saves the time of the employees.
In fact, there may be a sales portal option available to enable the sales team and any other authorized user to view it on their mobile devices.
How Can We Help
MedisRCM is ideal for laboratories that support comprehensive revenue cycle management services.
We facilitate full, on-demand transparent access to your data. You see what we see.
MedicsRCM also utilizes the MedicsPremier system with our team of laboratory medical billing specialists who complete the circle.
If in-house automation is preferred, MedixPremier is a comprehensive financial and management system for laboratories of every size, specialty and configuration.
It can be deployed in the cloud or on your own servers if you prefer a customer-hosted configuration.
Both MedicsRCM and MedicsPremier support everything described above for labs and more.
They work with an unlimited number of Tax IDs or a single Tax ID, depending on the needs of your lab.
We integrate with virtually any LIS and have done hundreds and hundreds of data conversions from existing systems.
Key Takeaways
Software or RCM company should be able to handle any type of single or multi-specialty laboratory
LIS integrations are not a luxury…they are an absolute necessity
You want comprehensive, intelligent, hands-on software that’s smart enough to operate without being told what to do
The system or RCM needs to produce maximum revenue, have a nearly 100% success rate on clearinghouse claims on the first attempt, have the tools to track claims, and manage denials quickly.
EDI, eligibility verification, patient responsibility estimation, and patient details are all required for an automated EOB solution
If the software vendor or revenue cycle management service also offers a certified EHR that can be integrated with almost any LIS, this not only reflects the depth of their product offerings but also enables you to suggest that your referrers see it, especially if their EHR can’t be integrated into their LIS
Being dependent on timely medical billing for laboratory services, you need access to actionable information. Take advantage of our expertise by reading our eBook, The Complete Guide to Laboratory Billing Software, which is a short guide that goes over the types of lab software we offer.
Then get in touch to schedule a personal visit to MedicsRCM, MedicsPremier, or both.
