Revenue cycle departments at diagnostics labs face some really daunting challenges when it comes to managing patient copays and billing. 

We wanted to get a better understanding for the pain points that they face on a day-to-day basis, so we commissioned a market research firm to conduct a series of interviews with revenue cycle executives from across a spectrum of lab services types. This is the final installment in a series of five blog posts that reveals the findings from these interviews. To start reading from the first installment in the series, click here. You can also download the full report. 

RCM Technology & Personnel Challenges at Diagnostics Labs

Revenue cycle management at diagnostics labs is an order of magnitude more challenging than traditional hospital settings. There is a huge volume of claims that must be managed. A growing pile of prior authorization requests that must be addressed. And a convergence of differing systems, methods, and participants that amplify the billing complexity at diagnostics labs.

Revenue cycle staff must also be able to manage all the idiosyncrasies as they relate to payer changes, reimbursement cuts and the transition to value-based billing. So, it’s no wonder that it can take even an experienced healthcare billing professional half a year or more to get up to speed and fully comprehend the nuances of RCM at diagnostics labs. 

“It’s a complex system. Even if you have a revenue cycle and billing healthcare background, training and proficiency take at least six months to get fully acclimated into the laboratory because it is different than working in any other healthcare system,” said the Director of Revenue Cycle for a national diagnostics service. 

Diagnostics labs are also dependent on referring providers and one step removed from the patient. Which is why one interviewee cited the need for significant technology investments to improve communications around the prior authorization process, especially to alert an ordering physician that a prior auth is missing and that a test would be held.

Due to the difficulty in finding skilled revenue cycle personnel, labs often resort to outsourcing. But a growing number of the nation’s larger laboratories are leveraging health IT to automate the management of the laboratory revenue cycle. 

“You have to be really smart about how you tackle things. You just can’t print out all of your outstanding bills over $50,000 and have somebody work it. You are dealing with a large volume of low dollar charges, and trying to make sense of that,”  said the Director of Revenue Cycle for a national imaging provider 

 Conclusion:

Managing revenue cycle at diagnostics labs require specialized training and purpose-built technology that can address the volume, velocity, and vagaries inherent in the process, especially as it pertains to prior authorization.    

To download our entire report, “Diagnostics Lab Execs Reveal Their Biggest Revenue Cycle Challenges,” click here.

To learn more about how Myndshft automates and accelerates patient intake and revenue cycle management, please click here.