The core of any billing department is medical billing and claims creation. But, actually, they are only one step in the lab revenue cycle management. Each stage in the revenue cycle adds to your income in numerous ways, and because of the solid associations between each stage, errors can swell through your whole billing department or beyond.
Here we’ll go over each stage in the revenue cycle in detail, and portray what sorts of challenges and complexities you can search for a particular stage, and look for approaches to tackle them.
Though each practice is exceptional, this guide will give you the understanding you need to audit your own financial collections process, organize a billing department from scratch, and discover how to develop your revenue stream.
But before moving further, let’s take a glance at ‘What is the Revenue Cycle?
What is Lab Revenue Cycle Management?
The RCM in a laboratory includes overseeing patient scheduling or registration, collecting payments, reviewing medical services, medical coding procedures, and diagnosis.
As per a new report by BBR (a medical care examination association, 92% of high-level heads in medical care areas are currently focusing on RCM). Focusing on your lab’s RCM is fundamental since studies have tracked down that 30% of laboratory practices are yet not ready to fulfill their expectations of the yearly net revenue collections.
The Nine Steps
There are various approaches to break down the revenue cycle, however here we’ll go on nine phases.
Initially, they are:
Verifying data: Discovering insurance and patient data that is related to the billing procedures.
Collecting fixed balance: Gathering fixed balances, generally owned by the patient at the hour of administration.
Preparing medical claims: Making the claims based on the data accumulated during the verification stage, and sending it out to the clearinghouse or to your payer.
Handling denials: Receiving rejections from the payer, discovering how can be dealt with right the rejection when the claim is re-submitted once more, and tracking down any further documentation that might be needed by the payer.
Follow up: Contacting payers to decide more reasons behind the denials and postponed or missed payment.
Take patient statements: Once the balance of patients is resolved, send them an assertion to inform them of the charges.
Installment receipt: Getting payments (along with remittance advice) from either patients or insurance payers.
Posting installment: Posting got installments to monitor your claims status and income, alongside other information points.
Viewing analytics: Using information from the posting stage to get more familiar with the current overall financial situation of your lab practice.
First Stage: Verifying Information
When a patient schedules an appointment at your lab office, you’ll need to confirm what their insurance status is so you realize how to continue with their billing. A reliable and robust eligibility verification service can enable you to ensure a patient’s demographics and insurance status once they stroll into your lab facility.
Numerous lab revenue cycle management programs are able to automate some parts of the eligibility verifications process. If you feel that this stage is limiting your collections or slowing down, an investment into some of this advanced solution may end up in your favor.
While a cost analysis on the basis of your revenue, associated overtime fees, team size, and expected additional productivity gained from these changes can aid you to determine if these lab billing solutions is right for you, or if your practice just needs additional support or training.
Second Stage: Collecting Fixed Balance
Balance assortment refers to gathering fixed balance from your patients. Commonly, that will be a copay that they repay on their date of administration. This step is a clear part of the lab revenue cycle management.
If a patient isn’t able to pay the copay. These charges are passed to other stages of the revenue cycle to ensure that those collections are received. Even if you have a good procedure in place and you face consistent problems then you should check that your eligibility verification is running properly.
Third Stage: Preparing Claims
Claims creation is an essential stage that can have a colossal gradual expanding influence on your reimbursements. At the point when you prepare a claim, it must be coded appropriately to guarantee that the services charged for are in accordance with the rendered services.
Moreover, bundling codes, modification codes, and specific service codes must be utilized appropriately on the off chance that you desire to get the most extreme revenue for your task.
Make sure that your staff is up-to-date and well-trained to go a long way towards keeping your rejections low, and your revenue high. If your billing team isn’t able to consistently keep track of updates to coding, it could be beneficial to outsource your laboratory billing services and lab revenue cycle management.
Fourth Stage: Processing Denials
When you send claims to either clearinghouse or a payer, they might be denied for a number of reasons. It is possible that patient data is wrong, extra documentation is required, or that there was an error made in deciding the patient’s coverage.
Making sure that your eligibility verifications along with your coding and billing are functioning properly to ensure that your rejections are low.
Fifth Stage: Follow Up
Once a claim has been denied or dismissed, you have to follow up with that payer to decide how the claim gets reimbursed. When the claim is adjusted, you can process it, ideally bringing about reimbursements.
The subsequent staff should resume claims or afterward adopt different techniques to decide how to get paid for those claims.
Sixth Stage: Taking Patient Statements
When you have discovered that a patient either as a coinsurance, deductible, has an outstanding balance. You should notify them of their balance by sending them a statement.
This should be possible on paper or electronically, and will expect you to have exceptional data about your patients, just as a system is set up that can get them the statement straight away after their service date.
Seventh Stage: Payment Receipt
Some parts of payment processing are distributed to staff who handle analytics, accounting, billing, and payment posting. Basic tasks such as the EOB sheets removing perforated checks can end up being very cumbersome.
It is essential to streamline this process of your lab revenue cycle management_ so that it fits your office’s workflow & can make the whole procedure more effective for everyone involved. As the payments go from your electronic receipt systems to your payment posters to your accounting department and beyond.
Eight Stage: Posting Payment
It includes taking the payments that you receive with payer remittance advice, putting this data into a record-keeping system. Entering into a remittance agreement & electronic payment with heavy volume payers can reduce the workload for your administrative team. In light of that, it can diminish work considerably by processing remittance advice in various formats.
Ninth Stage: Reviewing Analytics:
Analytics include taking the entirety of your payment information from the payment posting stage and going ahead to comprehend it at an overall level.
Without great analytics, you’ll never know which payers are paying faster or paying more? Which claims are bringing about more income than others? Or how much revenue you can sensibly expect inside a certain time span? What is significant when you reason about significant high-cost expenses to your training, new lab equipment, or other huge costs.
Well, that’s the revenue cycle, though lab revenue cycle management is complex. To truly master every unique quirk_ Laboratory Billings is here to help you grow your revenue, or understand the RCM if you are starting a new practice of your own!