Making the most of revenue in the laboratory healthcare industry’s complex third-party payment system is always a problem. With ever-expanding payment models and increasing scrutiny of payers for testing with high-tech equipment and diagnostics, it’s more important to keep up with the latest technological advancements within the revenue payment cycle.

To help us, let’s consider the lifecycle as two-fold 1.) access to patients, which includes prior authorization and verification of insurance coupled with two) the management of cpt modifiers complete guideline, coding, and insurance discovery. The advancements in AI-driven software and enhanced automation offer opportunities to dramatically enhance efficiency while making administrative work less burdensome and ultimately growing the revenue that is earned.

Laboratory Billing Services

Automation Makes the Process Much Less Cumbersome.

Begin with Access to Patients

One of the most frustrating issues with the revenue payment process is accessibility to patients. This is the first point at which you receive a specimen , and the accessioning process starts. If you do not have accurate and current data, collecting revenue turns into an intricate rework process in which accurate information about insurance needs to be gathered along with previous authorizations (PAs) needs to be resubmitted and tracked down.

If it’s a hospital-based outreach or a routine lab, using advanced automation , which is integrated into your current LIS software, the above tasks can be performed in real-time, with only the most complex scenarios that require human intervention:

Information about insurance, whether it comes through a third party or directly from the individual, can be confirmed prior to initiating testing and PAs. Using an integrated portal using technology-driven by automation and AI can be identified to be initiated, confirmed, and monitored – decreasing the requirement to deduct denied amounts or appeals through retro-payment requests.

Find Support After Testing is Complete

After a patient has had their tests completed, the process of collecting revenue starts. If you’ve correctly confirmed the insurance information of the patient and have obtained a PA (if needed), then automated technology and the expertise of third parties will allow you to create a winning formula to collect all revenue.

Coding – With more than 144,000 ICD-10 codes available, keeping current with the most recent changes and updates can be daunting. When you work with a trusted third-party support service, Coding can be completed promptly and with the highest accuracy, without the responsibility of providing adequate education and training.

The guidelines for payment and time limits are able to be altered, for example, the entry of charges, posting of payments, and credit balance resolution. In addition, contract management is often an area that is not considered, but it is crucial to ensure you get the maximum amount of reimbursement.

Insurance Discovery

With the help of AI and machine-learning technologies, Additional insurance coverage could be discovered, and claims can be submitted to earn revenues that your lab wasn’t aware of. This is crucial in hospitals where patients who are considered to be charitable may not always have access to their entire insurance coverage. Insurance Discovery is highly successful in reducing bad credit and increasing cash flow.In short, the reimbursement process for laboratory services is in danger from every angle. You must arm yourself with equipment that incorporates advanced automation throughout your entire revenue-related payment for laboratory services process, beginning with patient access to the whole RCM workflow. Contact us for a discussion of the lifecycle of your lab’s revenue payments and how automation and AI-driven software could bring about a positive change.