Improving Operational and Financial Performance – Why EHR Revenue Cycle Modules Aren’t Enough for Hospital Labs (Part 3)

As discussed in Part 1 and Part 2 of this 4-part series, hospital outreach and outpatient laboratories are often asked to use the hospital’s enterprise revenue cycle management (RCM) module that is offered as part of the EMR/EHR software in an attempt to save money or accelerate the return on investment on the enterprise software system. While this may seem like a smart, economical decision, it fails to take into account the specific needs of the lab to maximize its revenue contribution and effectively manage compliance risk.

The purpose of this 4-part blog series is to highlight the advantages of investing in RCM solutions purpose-built for laboratories and designed to interoperate with enterprise systems. This post covers the next two considerations for lab administrators when it comes to selecting the most appropriate revenue cycle software for the lab.

Does Your RCM System Automate Patient Demographic and Billing Information to Minimize Write-Offs?

One of the most challenging obstacles to laboratories getting paid quickly for their services is a lack of accurate patient data. Many laboratories struggle with the quality of the demographic and insurance data that they receive because they lack direct access to the patients. It can be an expensive, manual process for lab team members to chase down incomplete, incorrect, or missing data that is required for claim reimbursement.

Filling in missing data or cleaning up erroneous data is not a step that can be skipped in the claims handling process. Automating the correction and completion of patient and insurance data upfront is the key to both unencumbering the downstream reimbursement process and freeing up valuable staff time to focus on more important activities.

Too many laboratories end up writing balances off only when they don’t have all of the information needed to get the claim submitted correctly or if the claim gets denied, especially if it is a relatively low-value claim compared to other claims (i.e., below an internally determined dollar threshold). This is another place where a purpose-built laboratory revenue cycle intelligence can make a difference.

Does Your RCM System Provide the Data Visibility Needed to Improve Operational and Financial Performance?

Another potential impact of running outreach or outpatient laboratory services on an enterprise RCM system is that typical enterprise RCM systems do not provide the data visibility required to operate a laboratory effectively. SaaS-based, purpose-built RCM systems for laboratories use web services to deliver capabilities and information wherever they are needed across the system, including connections with patients and clients through portals as well as interoperating with external systems. The best web services for labs have HIPAA and Internet security protocols built in. It is also essential for labs that these two-way data exchanges operate in real time, removing redundancies and data latency.

The information held within laboratory billing and information systems is useful and powerful. Diagnostic services influence medical and therapeutic decisions, and the data from the patient’s medical record, most relevant for optimizing care, is also diagnostic data. Labs need to leverage these important data assets, but if they are using enterprise RCM systems, they may not be able to fully access, visualize, and thereby benefit from this valuable information.

These hospital outreach programs can benefit from client support tools such as a client portal that includes client invoicing, the ability to correct or confirm data, the ability to receive and respond to price inquiries, to upload documents, etc. They also need the flexibility to update fee schedules freely so they can be competitive in the marketplace. An enterprise RCM system is not typically configured to fully support these needs, often lacking the ability to handle the concept of a “client” at all and certainly lacking comprehensive client support tools.

The bottom line is that enterprise RCM systems may not have the many capabilities required for managing the billing complexities of outreach or outpatient laboratories. Too often, hospital laboratories struggle to use the hospital system, which results in costly and manual workarounds, significant write-offs, or insufficient access to actionable data to improve the lab’s operational and financial performance. Any additional cost for a purpose-built RCM more than pays for itself through increased cash collection and reduced labor expenses and minimizing costly compliance risk. Discover more about why hospital labs need a purpose-built lab revenue cycle solution in part 4 of this blog series.

We invite you to register for the upcoming webinar entitled “How Pairing a Purpose-Built Lab RCM System with Your Enterprise System Improves Health System Economics.” Guest speaker Mutaz Shegewi, Research Director from IDC, will discuss how a purpose-built RCM improves cash collections while enhancing enterprise system investments with bi-directional data exchange.