What Type of Revenue Cycle Management (RCM) Service or In-House Software your Laboratory Needs for Financials and Management
What Laboratories Need
Whether your laboratory’s specialty is toxicology, pathology, clinical, genetics, esoteric, or any combination of these, if you’re evaluating new revenue cycle solutions services or financial/management systems (or both), either for the first time or for replacing your current platform, you’ll want to make sure the service or system you select can do everything that’s needed.
But, what does “do everything” mean?
Some things are obvious, some aren’t, and some don’t necessarily apply to actual features of the RCM software at all. In fact, our first item is one of those.
While it’s not a system feature per se, it’s an absolute necessity. The RCM software vendor must be tuned into your LIS such that a fluid interface can be established with your LIS.
As a side note, any referring physician’s EHR should also be interoperable with the LIS so that orders and results can flow back and forth. In fact, the laboratory might 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 this, that’s another added layer of connectivity, assuming the referrer is open to considering that EHR.
Genius-Level, Rules-Based, Artificial Intelligence
As an overall software feature, you want intelligence to the point where the RCM’s or in-house software basically operates itself for the laboratory without requiring tons of hands-on input as to what to do next.
For example, certain pre-test alerts as driven by a rules-based engine are critical to laboratories. These include, but aren’t limited to:
- eligibility verifications to ensure the patient’s coverage is active
- out-of-network alerts with tools to help capture those patient payments
- an insurance discovery option for identifying insurance coverage when none exists on the patient’s record
- pre-test access to a patient responsibility estimator; you’d be able to clue the patient into what will be owed
- if applicable, displaying copayments
EOB reconciliations should be intelligent and instantaneous as well. Then as soon as the balance becomes the patient’s responsibility, the system should generate the patient’s statement.
These are only a few examples of intelligent software architecture for laboratories. When exploring systems or RCM companies, be sure to find out about their software’s intelligence; you’ll want genius-level IQ!
Getting Paid Beats Almost Anything
Your laboratory is in place to provide accurate results that lead physicians or clinicians into providing the most appropriate treatments possible. Without question, yours are noble and worthy services.
You also need to be paid for those worthy services. So perhaps above all else, your revenue cycle management services or in-house software shouldn’t just produce revenue but maximized revenue. A rules-based engine for ensuring claims are submitted at maximum value will dramatically increase any laboratory’s revenue.
The software or revenue cycle management rcm services need to have a nearly 100% claim submission success rate on first attempt clearinghouse claims; you’ll want to know the overwhelming majority of your claims pass cleanly on the first submission.
Next, you’ll want a way to track your submitted claims in real-time to ensure they’re being processed. This eliminates the guesswork as to when your claims will be paid. The revenue cycle management service should do this for you although you should have total access to viewing that as well.
An on-the-fly claim denial manager is needed making it easy for you to see any claim denials by health insurance companies and their reasons for being denied and then enabling you to make the needed edits and resubmit, preferably from one window view.
Or, your RCM service should edit and resubmit claim denials to the appropriate health insurance companies within 3 business days of them being denied. And as with claim tracking, you should be able to view how your denied claims are going as well.
Reports, Dashboards, Analytics, and Key Performance Indicators (KPIs)
Your laboratory is also a business, and businesses need financial, management, and operational data and analytics.
An array of user-defined reports, KPIs, analytics, dashboards must be available with an in-house system. With an RCM, you should be able to compile your own reports at any time in addition to the ones they generate and review with you.
Users should be able to save and name their reports without having to constantly recreate them, and schedule them to compile automatically at user-defined times.
Reports should be exportable to Excel, not need expensive, add-on report writing utilities, and not require advanced programming degrees or dozens of hours of report writer training.
Whether your laboratory has one salesperson or a sales team, you’d want to track their activity. Your RCM’s system or your in-house system should have a mechanism for that, saving staff time.
In fact, a sales portal option could be available enabling the sales team and any other authorized users to view the same on their mobile devices.
Laboratories, like almost any other industry, can be very competitive. Marketing, advertising, and outbound campaigns aren’t unusual for laboratories.
If you’re engaged in marketing or plan to be, the system should have a built-in way to track your campaigns without requiring 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 you’d want that.
How We Can Help
MedicsRCM is ideal for laboratories that favor comprehensive revenue cycle management services.
We feature full, on-demand transparent access to your data. You see what we see!
MedicsRCM also uses the MedicsPremier system with our team of laboratory billing experts completing the circle.
If in-house automation is preferred, MedicsPremier is a wide-ranging 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 mentioned above for laboratories and a lot more.
They operate with an unlimited number of tax IDs or a single tax ID depending on your laboratory’s requirements.
We integrate with virtually any LIS and have performed hundreds and hundreds of data conversions from existing systems.
- The software or RCM company should be able to handle any type of single or multi-specialty laboratory
- LIS integrations aren’t a luxury…they’re an absolute necessity
- You’ll want comprehensive, intelligent, hands-off software that’s smart enough to operate without being told what to do
- The system or RCM needs to produce maximized revenue, have a nearly 100% success rate on first attempt clearinghouse claims, have tools for tracking claims, and for quickly managing denials
- EDI for automated EOB reconciliations, eligibility verifications, patient responsibility estimations, and patient statements are all needed
- If the software vendor or revenue cycle management service also provides a certified EHR that can be integrated with almost any LIS, it not only shows their depth of product offerings but also enables you to suggest your referrers see it, especially if their EHRs can’t be integrated to your LIS
With so much depending on timely 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 further explains the type of lab software we offer.
Then be in touch to schedule a personalized overview of MedicsRCM, MedicsPremier, or both!
About Marc Klar
Marc has years (decades, actually) of experience in medical software sales, marketing, and management.
As Vice President of Marketing, Marc oversees the entire marketing effort for ADS (the MedicsCloud Suite) and ADS RCM (MedicsRCM).
Among other things, Marc enjoys writing (he’s had articles published in a number of healthcare industry newsletters and on websites), reading, cooking, and performing comedy which sometimes isn’t funny for him or his audience.
Marc is an accomplished drummer, has studied with some of the top jazz drummers in NYC, today plays with two jazz big bands, was in the 199th Army Band, and has taught drumming at several music schools.
Marc’s free mental acuity exercises:
Pick up a pair of drumsticks (not from a turkey), chopsticks, or knitting needles if you can still find those. You could also tap with your index fingers just to get the feel of it: Right Left Right Right / Left Right Left Left. Get to the point where you can keep repeating that at your fastest speed for five minutes without a mishap. The secret is in allowing the sticks to bounce vs. hard tapping with rigid wrists. This rudiment is called a “paradiddle.”
Next: tap 7 times with the left hand/stick then 7 times right. Without stopping do 6 taps left and right, then 5 each, etc. until you get to 1 each, then up to 2 each, then 3 then 4 up to 7 and back again a little faster. It’ll get interesting when you’re down to 3 each, 2 each, 1 each, 2 each, 3 each.
“Stick” with these and you’ll have accomplished something great for brain/hand/eye.
Next: read our ADS and ADS RCM blogs, ebooks and whitepapers. They’ll stimulate your brain as well.