Revenue Cycle Management Systems: Your New Best Friend in the Emerging Regulatory Environment

This article, Expanding role of RCM, ICD-10, MDx, was recent published in MLO highlighting that laboratory stakeholders are in the midst of a perfect storm of healthcare legislation, technology innovation, and government regulation, ranging from the ICD-10 transition to comparative effectiveness research (CER) to exciting advancements in molecular diagnostic testing.

I would like to add that financial survival for labs will be increasingly dependent on exerting a stronger influence to help strengthen and support patient therapies, spur innovation, and solidify the laboratory bottom line. RCM systems will be a fundamental tool to help ensure effectiveness of patient care as well as aggregation and analysis of actionable information. The ability to derive billing information and analytics such as frequency data, ordering patterns, and cost will be essential in the emerging regulatory environment.

Labs will need to move beyond simple aggregation of data to the measurement of clinical and financial outcomes via the use of high end analytics that definitively support proven therapies and outcomes, and help ensure value-added reimbursement for clinical tests. RCM systems that integrate with other information systems, networks, payors, and electronic health record systems are poised to become an essential, automated technology through which data can be shared and analyzed and used proactively to determine clinical effectiveness and control costs. To respond to ongoing data demands and reform possibilities, labs must stay active in both the debate and the emerging opportunities.

-Lâle White