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Is Your Laboratory Outreach Profitable?

Whether you work for a commercial lab or Why is it so difficult to get this information?
a hospital-based laboratory outreach program, The information may be locked up in different systems,
you face many of the same challenges today or the details are not captured or are difficult to produce.
as your peers.
One of these common challenges is to produce reporting Often, the laboratory systems are a good starting point
that monitors key performance indicators (KPIs) in to capture the information; however, in most cases the
multiple areas. For example, reports should measure financial reporting component is not set up to tie back to
test utilization, profitability by client or ordering doctor, the laboratory side—or worse, the details are not tracked.
billing efficiency, reimbursement monitoring, and the
ability to trend your business growth factored over time. For example, think about payments from an insurance
Reports used this way leverage the analytics for company on a laboratory claim. The payment and the
monitoring purposes. contractual adjustments are usually posted to the account
level, but not to the test level. This means that insurance
Before we get into the dynamics of these reports, payments are not matched up to each individual test,
it’s important to note how the data will be captured for the which is a true representation of reimbursement.
reports. The following list is just an opening sampler of
some of the critical items laboratory and financial Are you getting the maximum reimbursement to which
managers are starved to get their hands on: ordering you’re entitled as outlined in your payer contract?
doctor, client, test ID, test description, test count,
CPT (billing test code), department code, denial codes/ Take it a step further and look at denials from the payer,
reasons, gross/net charges, payments, contractuals, and you will also miss the critical detail of which test
adjustments, billing dates, aging of account balance, received the denial … and why.
and financial class/payer.