Laboratory Accounts Receivable (AR) system

The Laboratory Accounts Receivable (AR) system is designed from the ground up by labs for labs bringing efficiencies and scalability which often can be the difference between success and failure. Note radiology billing is also fully supported.

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  • You’ll have full visibility into your business, with a deep level of detail at each stage of the revenue cycle from registration, through the many steps of billing and follow-up, ending with the final posted payment. [Lab VP]
  • The AR system has all the necessary tools in the front-end available at all order generation touchpoints, including referring physician offices and patient service centers ensures a clean registration which significantly reduces back-end clean up and puts those same tools in the hands of the laboratory and billing departments for follow-up. [Lab AR Director]
  • The AR system is not compartmentalized - provides managers insight where they are losing money so they can go solve the issue. [Lab CEO]
  • End-to-end no dark corners - everything is transparent, the ability to pinpoint and correct contributing factors that impact revenue. [Lab CEO]

Innovative Solutions by Industry

  • Radiology

    Challenge: this industry represents hospital-based physician radiology groups and independent imaging centers each requiring specialized radiology coding experience to navigate all the regulatory changes and code sets that impact reimbursement.

    The Solution

    The Radiology Accounts Receivable (AR) system follows regulatory changes and codes sets and provides automated workflows that prioritizes the next steps and reconciles all procedures and services provided have been received, coded, and processed following a guided path until final reimbursement is received.

    Scenario: Demanding and Labor Intensive Radiology Pre-Authorization Process

    Demanding pre-authorization process holds radiology hostage to the unique payer requirements. The electronic preauthorization (ePA) program is the standard for insurance companies to follow however about 20% elect to participate in the program with the remaining 80% maintaining policies and guidelines that vary with each insurance company thereby creating a cumbersome workflow.

    • The software provides a systematic workflow approach to manage pre-authorizations. Eliminates calling payers, faxing, or navigating online portals to submit and track the authorization. The software enables providers to automate several manual steps in the PA process.
    • Dashboard monitoring that lets you know the count and percent that is in Process, Pending, Denied, or Inactive Insurance Coverage.
    Scenario: The need for Extensive Document Imaging Storage at the Performing Location

    The software has extensive document imaging capabilities. The input can be at the performing location with the attachments being accessed at the encounter level for quick retrieval by the billing team.

100% familiarity with the AR system
  • System Implementation Assistance
  • Revenue Cycle Management (RCM) support
    • Supplemental assistance RCM
    • Full outsourced RCM
    • Special projects as needed
    • Startup staffing until operations
    • Legacy AR system work down - familiar with 35+ billing systems
  • Engagement Duration
    • Fulltime
    • Part time
    • Interim
    • AR Reductions Projects

Major Modules

The world of laboratory billing has always struggled with the registration process due to multiple ordering locations (the referring physician office) outside the control of the laboratory and billing departments.

  • The AR system has outreach tools needed to achieve a successful registration, deployable to all ordering locations including the outside referring physician location and patient service center. Insurance eligibility checking, pre-authorization, document capture, and queue routing system for bi-directional communication. Imagine a registration process containing all the highly sought-after billing elements and order generation occurring at the same time.
  • The tool also serves as a communication tool for any follow-up with the referring clients using a message workflow routing system - no more faxing, emailing, calling, or mailing is required.

Billing teams struggle with volume heavy and process heavy work. Management is constantly challenged with identifying and prioritizing the workload. Priority processing will help to alleviate the burden and guesswork of prioritizing the next-best claim to work so your teams can do more

  • Most billing departments have job functions or special projects that would benefit with workflow assignment with priority sorting. Registration, insurance eligibility checking, pre-authorization verification, billing, timely filing, appeals, rejections, denials, aging AR, small dollar balances, and refunds.
  • Intelligent work distribution automatically assigns work based on your organization’s priorities and the skill set of available team members. The transfers the burden of determining the next best claim to file based on priority guidelines.

ABN checking performed at the referring client or draw center, generates, and stores a signed ABN. Based on registration can generate the modifier GA (ABN signed) or GZ (ABN not Signed)

CMS-1500, UB04, Patient Statements, Physician and Nursing Home Client Statements, and Request Letters.

  • Available cloud hosted or on premise.
  • HL7 interface or API connection to your LIS and referring client locations
  • Implementation time frame, quick as one month.
  • A fully functional AR system with dedicated rules engine and automated workflows that can be tailored for optimal results.
  • Configured for the challenging Hospital Laboratory Outreach environment, the system is available as a standalone AR system or as a front-end system for registration capture and ongoing bi-directional communication with referring ordering clients, improves information capture for the HIS.

  • Performed tests sent from the LIS to AR system are mapped to billable tests, with CPT, CDM, and charges assigned.
  • HL7 interface or API connection to your LIS and referring client locations
  • Physician insurance (many) is mapped to your organization’s insurance master (one), staff work with one set of familiar insurance ids.
  • Handles Test updates: add-on tests, cancelled, and reference lab send-outs, eliminates late charges and the associated labor component of running the payer gauntlet of steps to void, resubmit, cancel, or refund the claim.
  • Original order level review - ability to see the order from LIS before billing rules are applied.
  • Reconcile order/accession and test counts sent from the lab to the AR system, monitor for dropped tests, missing, incomplete, or files not sent.

  • Ability to define ad-hoc pricing and billing rules for outside testing.
  • If the test has no billing rules or price, will error out, place on a hold and route to the appropriate person for intervention.
  • Automated Test Bundling and Unbundling (explode to components) provides the ability, through user-defined rules, to automatically combine tests into Groups/Panels or unbundle tests to the appropriate components.
  • Handles Test updates: add-on tests, cancelled, and reference lab send-outs, eliminates late charges and the associated labor component of running the payer gauntlet of steps to void, resubmit, cancel, or refund the claim.
  • Modifier assignment - based on payer defined criteria, system can automatically append modifiers to tests reducing manual intervention during charge generation, example repeat modifiers, technical/professional procedures.

  • Available on demand or in batch eligibility for end-of-day business processing.
  • Workflow queues grouped by multiple sort criteria route the failed accessions to the appriate party - billing department, laboratory, patient service center, or back to the referring client.
  • Collect copay or deductible at point of service.
  • Estimate the lab bill based on the payer and tests ordered.
  • The 270-payer request and 271-response message are systematically stamped and tracked in the AR system.

  • Helps authorization teams to automate their workflow.
  • Dashboard monitoring that lets you know the count and percent that is in process, pending, denied, or has inactive coverage.
  • 80% of payers do not follow the recommend (ePA) standards which means policies and guidelines very with each payer creating cumbersome workflows to follow. The system automates these workflows and address the challenges of collecting, sending, confirming, and monitoring for status updates.
  • Paper forms are now converted to electronic PDFs that are tracked through the submission process.
  • Often the end user has no choice but to use the payer or benefit manager portal, however these steps are mapped out requiring minimal effort
  • Medical records requests are handled and stored in the system

  • Access is available at client ordering location, patient service center, laboratory department, and billing department.
  • Attachment examples, lab order, medical records, ABN, insurance card, driver’s license
  • Stored at the lab accession/encounter level for quick retrieval.
  • Added benefit any information requests to the physician ordering location is handled directly in the system avoiding the need to fax, email, or mail

  • Distinguish True self-pay vs. self-pay after insurance, allows for trending and tracking of patterns as related to self-pay.
  • Option to select Individual statement or consolidated statement for patients with multiple DOS.
  • Statements have configurable messages to address scenarios example reason level detail.
  • System automates letter generation for missing information, example insurance.
  • Statements can be printed, emailed, or transferred to a mailing service for distribution.
  • Using dedicated work queues to manage Patient Payment Plans.
  • Patient Statements - contain the name of the ordering doctor, what is paid and outlines what is remaining for patient responsibility or denied.
  • Ability to post patient checks formatted in 835 payment files from the bank electronic lockbox.
  • Available self-serve Patient Portal for online credit card and ACH check payments referencing the patient statements.

A systematic way to manage orders with send-out or miscellaneous tests. The ability to define the test description, CPT code, CDM, charge, other needed information. The test status monitoring keeps the claim in a fully visual holding pattern waiting for the information to be updated. Ability to manage cancelled and add-on testing, billing is placed on hold until the test status is changed.

Benefit: no late charges, no missed or forgotten tests, and serves as a pending reminder for claim submission.

System Features

The software monitors all automated functions occurring in the background to track trend and alert. Example, reconciliation of orders from the LIS to AR system, charge generation, billing, files sent from AR system to claim scrubber, patient statement generation, setup missing or incomplete for test, doctor, insurance.

Audit trails of changes to patent’s information allows you to see who made the change and what the changes were thus giving you full control of access into the system. Setup files changes are tracked with time stamp and id of the person creating or editing setups

System allows for automatic scheduling of recurring billing and reporting functions. This enables you to schedule your jobs and reports when you need them and to minimize impact on system efficiency.

Frequencies limitations, when the number of billable units per procedure is exceeded, it is flagged with edit provided.

Provides the ability to bill and/or monitor by specific locations. Benefit: great for labs that have been consolidated, or merged providing the detail to manage specific locations, spot potential problems or drill down for performance monitoring per facility.

When multiple tests exist on the order the system configures either single line repeated multiple times or multiple line with quantity of units and insertion of repeat modifier based on payer guidelines.

  • File is tracked sent and received and reconciled with the number of claims and dollars.
  • Additional feature system stamps and tracks Claim Status Inquiry (276) and Claim Status Response (277) transactions.

  • Monitor for timely filing limits by payer routing at risk claims to the front of the work queue for expedited follow-up
  • Sales commission reporting based off multiple criteria
  • For hospital lab outreach, tracking related business income (not taxed) vs. unrelated business income (taxed)
  • Ability to report cost per test
  • Assigns CDM (Charge Description Master) to the test following hospital guidelines.

Additional Feature Sets

  • Client Billing
  • Remittance
  • Reporting
Physician Offices
  • Supports multiple fee schedules, test carve outs, capitation arrangements, trip charges.
  • Pricing by physician office.
  • Aging report by client.
  • Client statement delivery is an automated process with minimal required labor resources to maintain.
  • Client statement is formatted and sorted following client preferences.
  • System has module that provides the client the ability to review client statements, review price schedules and process ACH payments.
Skilled Nursing Facilities (SNF)
  • Supports nursing home census reporting Part-A bill client (SNF) and Part-B bill Medicare or insurance, can be adjusted by the client during the month.
  • Ability to route “Skilled Nursing Facility” denial to the nursing home client.
  • Multiple sort options for statement printing based on client preferences.
  • Aging report by client.
  • Client statement delivery is an automated process with minimal required labor resources to maintain.
  • System has module that provides the client the ability to review client statements, review price schedules and process ACH payments.
Industry Health

  • Handle multiple scenarios for billing or payment arrangements.

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