Lab Billing Readiness Scorecard

SECTION 1 — Compliance & Documentation Readiness

1. Do you have a standardized medical necessity workflow across ALL ordering providers?

Yes Partially No

Centralize provider documentation expectations early.

ADSRCM Example: Provider-facing checklist reducing errors by 20–30%.

2. Are you prepared for expanded 2026 payer audits?

Yes Partially No

3. Do you maintain a payer-specific rules library updated quarterly?

Yes Partially No

SECTION 2 — Revenue Cycle Health & Clean Claims

4. Is your clean claim rate consistently above 96%?

Yes Partially No

5. Is your denial rate below 8%?

Yes Partially No

6. Do you automatically scrub claims with 2026 CPT/LOINC updates?

Yes Partially No

SECTION 3 — Workflow, Automation & Efficiency

7. Does your LIS/EHR send complete documentation with each order?

Yes Partially No

8. Do you have real-time dashboards for aging and claim status?

Yes Partially No

9. Is at least 50% of your RCM workflow automated?

Yes Partially No

SECTION 4 — Pre-Authorization, Eligibility & Patient Responsibility

10. Do you have a documented 2026 pre-auth workflow for top tests?

Yes Partially No

11. Are pre-test patient responsibility estimates provided?

Yes Partially No

SECTION 5 — Training, Updates & Preparedness

12. Is your staff trained on upcoming 2026 updates?

Yes Partially No

13. Do you review quarterly payer performance?

Yes Partially No

SECTION 6 — Leadership Visibility & Reporting

14. Do leaders have visibility into key KPIs?

Yes Partially No

15. Do you hold monthly billing/operations sync meetings?

Yes Partially No