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Maximize lab reimbursements with RCM services

August 6, 2021 | Daniel Doll

Laboratory billing is increasingly complex, and our RCM assessments show that clinical labs are leaving a lot of money on the table.

As the nation's leading vendor of laboratory information systems, CompuGroup Medical helps labs improve their revenue cycle management by leveraging ARIA RCM Services, a dedicated team of experts that implements the best practices it has developed over 20+ years in the business.

Many clinical labs attempt to manage their revenue cycle in-house, and CompuGroup Medical offers excellent tools to help in this effort. Small to mid-size medical practices that use the CGM LABDAQ Laboratory Information System for their POL will integrate their software with CGM DAQbilling Practice Management to reduce costs and improve their revenue. Reference laboratories with CGM SCHUYLAB adopt the system's integrated billing options to manage claims from the LIS itself.

With powerful software like this at your disposal, it's possible to maximize your lab's reimbursements and manage your revenue cycle on your own. However, far too many labs are also dealing with the challenges of limited resources and a limited clinical laboratory workforce.

When we help clients assess their RCM efforts, we often find that they are missing out on thousands of dollars in revenue, and these missing reimbursements are critical to the long-term success of any laboratory.

The most common areas for improvement are:

  • Eliminating write-offs
  • Reducing aging claims
  • Finding missing claims information

It's a lot of work, but addressing these problem areas is key to maximizing your lab's reimbursements and getting paid faster. Luckily, your lab doesn't have to take this on alone. CompuGroup Medical offers ARIA RCM Services  to manage this for you.

Jan Chennault, VP of Product Management, CGM SCHUYLAB
When I look at our clients' write-offs, I find that they're doing way too many of these.

Jan Chennault, VP of Product Management, CGM SCHUYLAB

Eliminating write-offs

Denials have risen steadily over the last five years in the healthcare industry. According to MLO, labs experience average denial rates of 15% for in-network claims and 30% for out-of-network claims.

The patient may be responsible for 100% of the cost when insurance companies won't issue a payment because of a high deductible requirement, out-of-network claim, or some other reason. When this happens, too many labs are simply writing off the claim.

"When I look at our clients' write-offs, I find that they're doing way too many of these, such as for patient bills. This represents thousands of dollars in lost revenue, but there is a solution available to help," said Jan Chennault, VP of Product Management, CGM SCHUYLAB.

That solution is ARIA RCM Services.

The experts at ARIA have the resources to follow up on every claim, easily increasing your reimbursements and greatly reducing the number of open claims that your lab is writing off.

Reducing aging claims

Aging claims are a nagging problem.

How many of your claims have been open for 60 days? 90? 120+?

An aging claims report is a frustrating indication of missing reimbursements, and the older your accounts receivable is, the harder it is to collect. Sometimes a claim gets stuck in a loop between the lab and the insurance company. The cause may be as simple as an overlooked error or mistyped information, but it takes resources and effort to track down these issues while keeping up with the day-to-day demands of a high-volume laboratory.

Your team at ARIA RCM Services brings a focus to this specific problem to maximize your revenue collection and bring your AR back into balance.

ARIA offers a complete service that takes on the burden of reconciling aging claims and frees up your laboratory to put its focus back where it belongs: on patients, testing, and results.

Tracey Hoffman, VP of ARIA RCM Operations
We make sure the claims go out the door correctly, and we help that cash flow back through.

Tracey Hoffman, VP of ARIA RCM Operations

Finding missing claims information

Speaking of burdens, missing claims information is a thorn in the side of your clinical laboratory's administrative staff.

"In a practice environment, the practice itself usually has the data necessary to 'clean' claims," said William Shipley, VP of Product Development, CGM SCHUYLAB. "In a reference lab, the lab doesn't have that, and some third-party services refuse to do this work, too."

Laboratories are usually a step further removed from the patient compared to practices. This distance makes it harder to track down the information needed to clean an open claim and collect the outstanding revenue.

Missing information ties directly into aging claims and write-offs. Filling in the gaps on these open or incomplete claims means a lot of manual effort, and many third-party services will even draw the line here—but not ARIA.

From the beginning, the experts at ARIA understood the importance of tracking down missing information to help a lab maximize its revenue.

According to Tracey Hoffman, VP of ARIA RCM Operations, "Our ARIA customers love the fact that they have somebody here who is like their best friend. They can call them night and day, and we have really good processes in place. We make sure the claims go out the door correctly, and we help that cash flow back through."

CompuGroup Medical is a trusted partner for laboratories across the United States. With powerful lab management software and ARIA RCM Services, CGM is committed to the success of your laboratory. Maximize your revenue, overcome the challenge of a limited workforce, and make sure you're never leaving money on the table again.

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