Your lab is struggling with the classic challenges of laboratory billing. Your billing team swears there’s nothing more that they can do and guarantee they’re doing everything they can. You either have no data and are managing by crossing your fingers. Or you’re swimming in a sea of numbers none of which point you in any particular actionable direction.
If it does, then you’ve come to the right place. Some of your problems can be solved – with the right partner.
The right partner will have a management team and billers each of whom has many years of experience in laboratory billing. You will feel them listening to your challenges. You will hear them speak with clarity and purpose, but only after hearing and understanding your challenges.
“Thank you for working with us”– Laboratory in Georgia
“I am happy that you are our partner”– Laboratory in California
We have satisfied laboratory revenue cycle management clients across the country.
Quantifiable Results and Transparency
Track your performance
Are deposits dropping? Are increases in test volumes not seeing revenue follow? Are these things happening despite what your billing group promised? Do you see payers where other labs are getting paid and you’re not? And does your billing group rain excuses as to why the money’s not coming in… and you’re starting to wonder?
How would you like a second opinion? One based on fact – based on data you provide?
Does your billing company share its plan to improve your results? Does it measure progress towards those goals? Does your inhouse billing or billing company give you tools to review your performance? Your billing company should provide credible, verifiable data. That data should let you measure your progress towards your financial targets. Do they make themselves available to explain the data and tools they do share? Do you feel confident in the results?
Or even more radical – Does your laboratory billing company compare itself to other laboratory billing companies? Does it share the results with you? Would they share the good AND the bad? If you share a competitor’s data – do they have tools to learn from that data to improve your results?
Do you feel the only time they’re concerned is when you find a problem with their performance? Do you feel like they would do nothing if they could but still get paid?
Does the standard process of your lab billing show you:
- How much money you’re making
- Which components of your system are under performing / generating losses
- Where there are opportunities to institute improvements that lead to greater profitability.
Experience, Transparency, Analytics
Is your billing team dedicated to Pathology and Laboratory billing? Do they have significant experience? Decades?
Does your billing group invest in continuous improvement? To be the best in the industry and maximize your collections? Do you see data that compares your performance to the industry? Is it verifiable?
Your RCM Analytics
“Successful laboratories leverage data and analytics”
Do you feel your billing is (a little) out of control?
Are you in the dark about how your laboratory RCM is performing? Do you want to improve your processes and increase profitability? Do you want to make business decisions based on data and analysis rather than opinion and conjecture?
The truth is analytics done poorly are a waste of time. Does your current reporting drown you in numbers but provide no information? Does it confuse more than that it compels?
However, you can get insight from your systems even if your dashboard feels like an ocean of numbers.
That’s the power of an experienced and knowledgeable billing partner.
Are you in the dark about how your laboratory is performing? Do you want to improve your processes and increase profitability? Does your provider help unlock insights and intelligence within your data? Do they apply those insights to your business?
We’re quant jocks! We understand what you need from your data.
Our Analytics are browser-based and available 24/7 in Excel or pdf. We provide a dashboard that is customized to your particular needs and includes trending analyses. Perhaps most importantly, the output of the data if you choose to manipulate it further in Excel is usable, i.e. without interrupting blank lines that discourage summing and calculations, and with normal square block formatting in a number format. Data for quants.
Resolve Important Business Concerns
Do you use your analytics solution to drive behavior? Does your billing offer help with the following:
- Manage cash flow – look at expected reimbursement rather than charges
- Whether to add or end a payer contract (is it profitable?)
- Whether to add or drop particular services or procedures
- Evaluating draw station locations
- Referral sources
- Salesperson or distributor performance
- Credit card payments from patients
- Other financial or strategic questions for which data would help you make an informed decision
How We Support You
Do you feel a true sense of partnership with your billing solution? Do they remain knowledgeable about your business? Are they tracking current and emerging industry trends? Do translate what those trends mean for your business? Do they tailor your revenue cycle management process to reflect those new trends? Can you tailor your own processes and policies as part of their solution?
Your future billing partner should tailor your revenue cycle management process for you. You shouldn’t feel forced into any service. You should be able to select your own patient billing and collections policies. You should have the freedom to choose your registration, credentialing, and contracting solution.
Can you buy value added services from your billing partner:
- Coding consulting
- Coding from requisitions/results
- Coding auditing
- Coding feedback to clients and documentation support
Charges and Reconciliation
- Charge entry
- Claim submission
- Clearinghouse and integration, clearinghouse reports
- Charge reconciliation with LIS/LIMS
Payer Policies and Compliance
- Payer policy research
- Payer rules engine to ensure claims submitted correctly
- Billing compliance
Accounts Receivable management
- Complete AR management and follow up on all claims
- Denials and appeals management
- Denials reporting
- Explaining denials to clients
Lab admin support
- Billing coordination, getting updated or corrected demographic or charge information from referring physicians
- Pulling requisitions or reports from the LIS
- Eligibility verification
- Benefits verification
- Pre-authorizations / pre-certifications, retro-authorizations
Payment Posting and Contract Compliance
- Payment posting
- Catching insurance underpayments
Patient Revenue Cycle Management
- Sending all patient statements
- Special patient balance billing procedures for out of network patients
- Handling all patient inquiries
- Patient balance negotiations
- Patient payment plans
- Automatic patient payment plan direct debit or credit card
- Patient pre-collections calls
- Handling patient financial hardship applications
- Managing patient collections process
- Out-of-network patient negotiation with insurance companies
- Past due notifications
- Credit card merchant account for patient balances and credit card processing
- Online submission of credit card payments for patient balances
- Mobile bill payment
- Balance billing consulting
Laboratory Setup and Consulting
- Payer registration
- Payer enrollment, credentialing, and contracting
- Contract consulting
- Contract negotiation
- Setting up electronic funds transfer (EFT) for clients with all payers eligible
- Fee schedule consulting, analysis, and optimization
- Electronic document management for archiving of all client billing documentation
Reporting and Analytics
- CRM for lab salespeople and distributors
- Interfaces, HL7
How did your billing solution make you feel before you signed? How about after? Was it different?
Do you feel like you’re the guinea pig whenever they try something new? Have they implemented LIMS interfaces? Do they even have a detailed project plan to share? You should ask about their experience and have a walk through their project plan. Do you have one contact for the entire implementation? The truth is, you shouldn’t have to navigate their various departments.
What considerations did your billing provider consider when tailoring your implementation plan? Did they ask you about your financial goals?
Has your billing provider done hundreds of billing implementations? Have they reduced the process to a science? Was your implementation seamless? Did your billing solution build an interface to your LIS/LIMS?
How do you feel about your billing provider’s team? Would you call them tenacious? Are they creative and persistent problem solvers? Do they have laboratory-specific expertise? Do they pay attention to details? Do they reach past the simple reports? Do they help you get paid?
Are they your allies and advocates when engaging insurance companies about denials? Do they tackle the challenging claims – not just the easy wins? Do they proactively identify opportunities to prevent problems? Do they try to prevent rejections and denials? Do they blend expertise and experiments to improve AR cycle times?
Have you ever wondered who you should talk to fix your problem? Have you ever wondered if you’re following “the process” the get the answer in a timely fashion?
Does your billing company adapt to your needs? Does it consider you a partner? Does your billing provider help you manage your business? Does it take the lead on implementing changes that benefit your business? Do you have confidence that your billing partner will deliver on its promises.
Does your partner simply deliver data, or does it ask you what question you’re trying to answer? Do you see the effort they put into understanding you? Do you hear the sophistication in the answer they provide? Do their answers help you feel confident your business is in good hands?
Do they do this regularly?
The truth is, most billing providers don’t even begin to give you confidence. Most can’t dream of hitting even two of these criteria.
Remember, you need more than a good relationship with medical billing service. You need efficacy in delivering the results on which your business depends. Do you feel confident your billing partner can deliver those results?
Lab billing is not like physician billing, and the differences can cost you dearly. Is your laboratory RCM up to the task?
We only do laboratory and pathology billing. Ibex‘s management team has hundreds of years of revenue cycle management experience. Lab billing is different than physician billing and we only do laboratory revenue cycle management.
Medical billing companies often make a key mistake:
They assume that their medical billing acumen for physicians will translate to billing for laboratories. But the skill set is not the same. If your billing company’s core skill set is not lab RCM, you are undoubtedly leaving money on the table.
Ask your partner how they handle these pitfalls:
Bad order information: labs receive orders from physicians. Many physicians fail to take the necessary care in getting them right. This causes labs and their billers to burn hours chasing information. And this information needs to be secured from doctors with no interest or incentive to help.
Unbillable Work: laboratories often perform tests that are unbillable. And these tests come as part of their standard workflow. This is unlike a typical medical practice. Labs need to track and differentiate the billable from unbillable. And knowing the difference is critical to maximizing laboratory revenue. This ratio of billable to all tests is critical to lab profitability. Does your billing provider give you feedback of this?
Geographic Dispersal: unlike physicians, labs often do business across state lines. So strong laboratory billing companies know billing rules and regulations across the country. Does your partner know them?
Many Payers, Complex Policies: Labs typically have more payers than a medical practice. This means lab billers need a broader understanding of payer policy than medical billers. And this is more than a coding issue. It’s about understanding these payers’ complex and nuanced billing policies. The only way to do that is to stay on top of their constantly changing rules. How does your billing partner measure up?
Out of Network Claims: labs often bill more claims out of network. This creates some unique challenges – challenges medical billing companies might not encounter. Knowing which payers pay out of network (and which won’t) is critical. Furthermore understanding which will contract and how is important too. Does your billing partner know and understand these nuances?
The Cost of Inaction: labs often feel “forced” to test a sample. This despite payment being uncertain. They do this to maintain good standing with a referral source (among others). It is often a prohibitive risk to delay that testing. Does your billing partner know how to handle this issue? Does it understand how important eligibility & benefits, pre-certifications and pre-auths are? Do they understand how these should influence the billing workflow? Do they understand these process nuances for genomics (CGx / PGx)?