search.noResults

search.searching

dataCollection.invalidEmail
note.createNoteMessage

search.noResults

search.searching

orderForm.title

orderForm.productCode
orderForm.description
orderForm.quantity
orderForm.itemPrice
orderForm.price
orderForm.totalPrice
orderForm.deliveryDetails.billingAddress
orderForm.deliveryDetails.deliveryAddress
orderForm.noItems
LAB MANAGEMENT :: RCM


Data visibility is truly essential, yet just as important are the analytics to help make the data actionable. Analytics help an organization leverage its data assets to understand how the lab is operating, by payor, by specialty, by test, by territory, etc. Analytics also help lab leaders better under- stand the business they earn from each referring physi- cian. This helps identify opportunities for increasing the value of the relationship. There is also tremendous value to this data beyond the billing department. Clinical data is a treasure trove for analyzing and improving popula- tion health.


Business intelligence


Hospital outreach, outpatient, and other diagnostic labs have specific business intelligence (BI) needs that cannot be met by most enterprise RCM systems. Data on the efficiency and effective- ness of lab operations are essen- tial. It is also critical to have fast access to reporting and analytics without impact


to production system performance.


Some of the most important BI components and capabilities for


labs include: t Dashboards: view information summaries with ease, and drill


down for further detail, if necessary. t Auditable: ensure data integrity and GAAP/Sar- banes-Oxley compliance. Easily address PAMA and FASB 606


data needed for a successful appeal is not automated. This results in manual intervention, which is costly and opens the laboratory up to new risks—including compliance risk.


ADDITIONAL CONSIDERATIONS


Can the RCM system: t distinguish between billing on


t identify when the performing location is different than the billing location?


order, billing on result, and manage its ramifications?


t report collected and expected revenues on a per salesperson basis for commission calculation purposes?


t easily handle bifurcated and multiple fee schedules?


t accurately track and report how much volume is being written- off rather than worked?


accounting requirements. t Benchmarking: provide metrics that enable tracking and compare the organization’s financial and operational


performance to your industry peer group. t Key performance indicators: use data to understand


trends and establish and track key performance indicators. t Drill-through data: view contextual details related to the data


elements by drilling up/down in the summary reports. t Ad hoc reporting: enable end users to easily build his/ her own reports.


Precision medicine As the healthcare industry continues to adopt precision medicine approaches, labs need informatics technology to integrate clinical, diagnostic, and financial data to enable care teams to gain better insight into the patient’s medical situation, make better diagnostic and therapeutic decisions, and improve outcomes. Frankly, this is something that most enterprise RCM systems just cannot do. They are not designed to improve the efficiency of patient care coordi- nation, deliver data visibility or quality metrics reporting for reimbursement, nor to effectively discover actionable insights.


The advancement of precision data creates more complex tests and thus more complex billing. It tends to result in more rejected claims, and thus more appeals. The appeal process can be challenging for labs using an enterprise RCM system, since access to and the attachment of the


26 JUNE 2019 MLO-ONLINE.COM


Lab-specific RCM solutions provide more value In short, enterprise RCM systems just don’t have many of the capabilities required for labs. We see hospital outreach labs struggling to use the hospital system. From a compliance per- spective, in today’s environment where new regulatory and payor requirements are being introduced regularly, making a commitment to compliance and obtaining the technology solutions that an orga- nization can rely on to proactively support their compliance needs and programs are imperative. Otherwise the risk is just too great, and it is even harder for hospital outreach labs to succeed. Too often hospital and health system lab administrators have enterprise RCM systems pushed on them in a misguided attempt to save money. They are told the enterprise system will meet the lab’s needs and comes bundled with the cost of the hospital or health system software. Unfortu- nately, what comes with the enter- prise RCM system is the potential for compliance risk, additional labor costs to create the “work- arounds” the lab needs, and sub- par capabilities that fail to maxi-


mize reimbursement for the highly valuable work the lab performs. These labs leave over half their potential profit mar- gin uncollected, because the cost to collect is too high. Only laboratory-specific automation can cost-effectively maxi- mize both AR collections and profitability. Lab leaders need to rationalize data strategies with busi- ness strategies. A lab-specific RCM system can go a long way to making this happen. Value-based pricing is dependent upon the ability to demonstrate financial and economic ben- efit, which is not possible in an enterprise system. Without leaders focused on technology, data, and strategy alignment, it will be challenging to thrive in today’s environment of reimbursement compression and increased regulation.


Lâle White serves as CEO and founder of XIFN, a company dedicated to the vision of optimizing the economics of healthcare. A nationally recognized expert in medical financial management and regulatory compliance, with over 35 years of experience in information systems development and medical billing.


David Nichols, MBA, serves as President and founder of The Nichols Management Group, leading laboratory consulting for a number of healthcare systems, independent laboratory, biotechnology, private equity, and managed care clients. Nichols has a clinical and anatomic lab consulting practice based in York Harbor, Maine.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48