Too often, hospital outreach and outpatient lab leaders have enterprise revenue cycle management (RCM) systems pushed on them in a misguided attempt to save money or increase the ROI of the health system’s hefty EMR or EHR technology investments. However, a purpose-built laboratory RCM more than pays for itself while improving enterprise system ROI by increasing cash collections while reducing labor costs, write-offs, and compliance risk.
Average Improvement in Cash Collection Realized by XIFN hospital Lab Clients
In addition to the monetary benefits, a purpose-built lab RCM will help your lab develop better data quality through bidirectional data exchange, provide patient and client visibility, and better utilize business intelligence. Beyond these benefits, we have identified six main areas where purpose-built lab RCMs provide more value. Take a look at the following questions for each of the six key areas and decide for yourself if your RCM is up to par:
PAMA
In the first PAMA reporting period, few hospital labs were required to report. The definition of an applicable lab has since changed, and hospital lab leaders should now know if they are required to collect and report data.
- Do you meet the criteria for an applicable Lab?
- Can your RCM distinguish between outreach and outpatient data?
- Can your RCM system capture all of the data that is required?
- Can your RCM system provide access to source documents?
Compliance
Hospital outreach lab claims are particularly impacted by compliance requirements, including the 72-hour and 14-day rules and anti-mark-up legislations. These rules are complex and difficult for many enterprise systems to automate.
- Can your RCM handle claims with respect to the 72-hour rule and the 14-day rule?
- Is it fully automated or does it require manual intervention?
- Does your RCM have logic that adheres to mark-up regulations?
- How does your RCM handle date of service?
- Can your RCM ensure proper reporting of performing location for both institutional and professional claims?
Write-offs
It is a challenge for labs to get paid quickly if they lack accurate patient data. Too often labs write-off balances if they don’t have all of the information needed to get the claim paid, especially if it is a low value claim.
- Does your RCM system automate the correction and completion of patient demographic data?
- Does your RCM system have automated insurance discovery that corrects and completes insurance information?
- How does your RCM system maximize automation and collections?
Visibility
Typical enterprise RCM systems do not provide the data visibility required to effectively operate a lab. Purpose-built RCM systems use web services to deliver information bi-directional making it available where and when it is needed.
- Does your RCM system provide two-way data exchanges, and if so, do they operate in real time?
- Does your RCM system provide a client portal that facilitates invoicing, the ability to correct or confirm data, the ability to receive and respond to price inquiries, upload documents, etc.?
- Does your RCM system seamlessly interoperate with external systems?
Analytics
Analytics help organizations leverage data assets to understand how the lab is operating, e.g., by payor, by specialty, by test, by territory, as well as understanding earnings by referring physician.
- Does your RCM system use analytics and machine learning to improve business process automation?
- Does your RCM system use analytics to improve forecasting accuracy?
- Does your RCM system use analytics to automate expect pricing analysis?
Business Intelligence
Hospital outreach labs have specific business intelligence (BI) needs that cannot be met by most enterprise RCM systems. Can your RCM system provide the most important BI capabilities for outreach labs, including:
- Dashboards to view information summaries?
- Benchmarking to enable tracking and comparing financial and operational performance to industry peer groups?
- Key performance indicators (KPIs) to understand trends?
- Drill-through data to view details?
- Ad hoc reporting to easily build unique reports?
Want more information on how purpose-built lab RCM can help your lab today? Discover the capabilities of XiFin RPM and contact us today:
