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The Two Most Important Documents Produced by a Lab: Results and Claims

  • Vice President of Sales, XIFIN

In today’s complex diagnostics market, it is easy for lab leaders to get distracted by rapid volume changes, new regulations, fee schedule changes, restrictive payor policies, and significant reductions in reimbursements. The diagnostic providers that thrive in this often-unpredictable market are those that focus on the two most important information sources produced by a laboratory ― test results and claims for reimbursement.

I can’t imagine a lab leader who would deny that producing high-quality, efficient, and reliable test results should be a core competence for a diagnostic laboratory. If this is not the case, one might question why that organization is in this business at all. That said, many leaders do not think about revenue cycle management (RCM), including revenue billing, claim submission, and reimbursement as a necessary core competence. My position is that RCM is a critical factor for long-term success. I would argue that transforming the way you manage your lab’s revenue by addressing challenges that undermine the effectiveness and efficiency of your RCM process is just as important as testing and results reporting for prolonged competitive advantage.

The most successful high-volume laboratories in the country have the clinical resources and technology to process tens of thousands of test orders per night and return a quality result to their ordering providers, typically the very next day. 

Expertise in testing and results reporting is a complex process that requires:
  • Speed
  • Quality
  • Consistency
  • Reliability
  • Cost Effectiveness― tests run and results produced economically
  • Simplicity ― easily understood
  • Effective Technology ― e.g., LIS, instrumentation, etc.
  • An ongoing commitment to, and process for, quality improvement
  • Trust

Where is your lab’s expertise? In testing and results reporting as well as RCM, or merely the former? Is there an opportunity for improvement in your organization when it comes to revenue cycle intelligence? For diagnostics providers to succeed in the current laboratory market, they must have access to the technology that will enable them to maximize revenue opportunities and operational efficiencies. The good news is that if your lab has not or doesn’t have any interest in developing expertise in RCM, that competence can be tapped into through a technology vendor partner that offers outsourced services. 

To maximize reimbursements and billing, processes must be:
  • Fast ― meeting payor guidelines for remittance and patient expectations
  • Accurate ― all information is available to get reimbursed by insurance payors
  • Transparent ― easily understood
  • Compliant ― coded correctly, so fraud charges are avoided
  • Correct ― properly taking into account payor rules
  • Part of a quality improvement process
  • Informed by actionable insights from business intelligence and analytics
  • Provide information needed to improve business decision-making

Diagnostic providers that gain efficiency and effectiveness in their RCM processes improve cash collections, which can significantly increase the profitability of the organization. This is especially important as diagnostic organizations are operating at ever-tightening margins. If your organization has competency in billing and RCM, it is crucial to make sure you are using the right tools to maximize both reimbursements and cost effectiveness. If billing and RCM are not one of your organization’s core competencies, outsource it to a company, such as XIFIN, Inc., that is an expert in RCM.

With XIFIN, whether you choose to manage the RCM process in-house or through outsourcing, you will get access to the same cloud-based technology and comprehensive RCM capabilities. As a diagnostic leader, you can be assured that the quality, functionality, maintenance, and support of the technology will be excellent.

Want to understand your lab's true cost of billing as a percent of revenues? Discover how to optimize your revenue and financial performance in this whitepaper titled "The Executive's Guide to Measuring Total Cost of Billing in the Laboratory."

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Published by XIFIN
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