Lab

Introduction

Clinical medical laboratories play a critical role in the healthcare ecosystem, providing essential diagnostic services that inform patient care decisions. However, these laboratories face significant challenges in managing their revenue cycle due to complex billing procedures, regulatory requirements, and the need for precise coding and documentation.

This case study explores how our US Medical Billing Company helped a mid-sized clinical medical laboratory streamline its billing process, reduce claim denials, and improve overall financial performance.

Background

Our client, a clinical medical laboratory based in California, provides a wide range of diagnostic testing services and processes thousands of samples weekly. Despite its critical role in healthcare, the lab faced several revenue cycle challenges:

• High Claim Denial Rates: Due to delays, incorrect coding, improper eligibility verification, and wrong payer submissions.
• Complex Coding Requirements: Diverse test codes required precise billing.
• Regulatory Compliance: Frequent Medicare and insurance changes were difficult to track and apply.
• Manual Billing Processes: Heavy reliance on manual entry led to increased errors and inefficiencies.

Objectives

• Reduce claim denials to below 5%
• Shorten revenue cycle and improve cash flow
• Ensure full regulatory compliance with minimal errors
• Automate billing to reduce human errors and boost efficiency

Intervention

• Comprehensive assessment of existing billing process
• Advanced coding system implementation and training for lab staff
• Automation integrated with Laboratory Information System (LIS)
• Dedicated denial management and appeals team

Results

The following table highlights improvements in turnaround time, clean claims, denials, payments, and revenue: