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Understanding the Effects of Regulatory Changes on Laboratory Revenue Cycle Management

September 6, 2023

Compliance is a critical component of comprehensive and efficient revenue cycle management (RCM) in the laboratory industry. With the ever-changing rules and regulations, a diligent laboratory RCM should establish a stringent compliance plan to prevent loss of income due to heavy fines and legal fees.

Impact of Regulatory Changes on Lab Billing and Coding

Lab billing and coding compliance focuses on monitoring and executing the appropriate clinical documentation of patient services. Compliance with regulatory changes ensures the billing and coding process upholds all applicable state and federal laws, regulations, and policies.

Failure to bill and code accurately may result in denied and rejected claims or strict penalties.

Leveraging Technology for Efficient Laboratory Revenue Cycle Management

Manual billing systems are no longer adequate to manage the complexities and demands of today’s laboratory business. Advanced laboratory RCM software tools, like our own RCM Clarity and Ai4AR, automate and streamline workflows while providing decision support and sophisticated information databases. Technology tools can instantly flag problems and identify missing or incorrect data. 

Technology enables the RCM process to achieve a more agile system that is updated in real-time, optimizes the billing process, and ensures compliance for timely reimbursement.

laboratory microscope close up

Strategies for Adapting to Regulatory Changes

Compliance requires continuous adaptation, education, and dedication to maintain the highest standards of collections, processing, and patient care. Many strategies can help laboratories adapt to regulatory changes, including:

infographic illustrating laboratory regulatory changes
  • Stay abreast of healthcare compliance regulatory changes – remain informed of changes in laws and guidelines. Establish a system by hiring a dedicated team and using technology to monitor updates from key regulatory bodies, reviewing industry publications, pursuing continued education, and attending conferences to stay current with trends and best practices in compliance.
  • Conduct a compliance analysis – assess your lab’s current practices, identify non-compliance areas, and evaluate associated risks. Performing a gap analysis provides valuable insights into facets of your system that require improvement, helping you create policies and procedures that guide your laboratory’s compliance efforts.
  • Ensure data security and protect patient information – store patient information securely in electronic formats and implement the appropriate access controls, encryption, and storage systems.
  • Maintain an efficient documentation system – use software and other technology tools to collect and store data for accurate documentation. Provide ongoing education to billing and coding staff and establish systems that prevent and detect potential fraud or abuse. Constantly review your documentation system to ensure it aligns with regulatory standards. 
  • Foster a culture of compliance – build and promote a work environment that upholds integrity, ethics, and compliance. Establish transparency and encourage communication regarding compliance issues while providing adequate training tools, resources, and ongoing training to support staff.

Benefits of Proactive Compliance with Regulatory Changes

Regulatory compliance strategies help laboratories meet specific goals, remain competitive, and increase revenue. Other benefits of being proactive with compliance include:

  • Improves workflows and business efficiency – following regulatory standards proactively boosts efficiency by creating streamlined workflows that enhance accuracy in laboratory billing and coding and finding strategies for data entry, organization, transmission, and storage. 
  • Protects your business – maintaining compliance helps your laboratory build a credible reputation for peers and patients. Fines, penalties, and other legal issues may harm your reputation and impact your business. Compliance eliminates these risks.
  • Increases your profitability – non-compliance can lead to fines and lawsuits, which are costly. Your laboratory might be unable to handle the payments on top of your typical operational costs, resulting in financial strain. Regulatory compliance may increase profitability by avoiding hefty fines, improving your reputation, and expanding your base.
coronis health benefits of proactive compliance in laboratories infographic

Utilizing Data Analytics for Improved Lab Revenue Cycle Management Performance

Laboratory RCM solutions include data analytics to identify trends and patterns in financial data. By analyzing data, you gain key insights into optimizing your revenue streams. For example, data analytics can help identify which services are most profitable. This allows you to focus on these areas while improving other services to maximize revenue. 

Data analytics can also help you identify and improve inefficiencies in your billing and payment processes. By analyzing data on denied claims, you can identify common reasons for denied claims and develop strategies to prevent them in the future. This reduces the number of denied claims, optimizes revenue cycle management overall, and boosts your revenue.

Collaborating with Industry Experts and Regulatory Bodies for Effective Compliance

When you partner with industry experts, you have direct access to knowledge, training, and experience that strengthen your organization. Working with experts means having a team who know healthcare compliance inside and out, are aware of trends, and are up to date on changing regulations. 

Collaborating with these experts and taking advantage of technology-driven laboratory RCM services are excellent ways to save time, resources, and money while improving the overall efficiency of your compliance processes. 

Coronis Health Laboratory & Pathology has a team of former laboratory leaders and RCM experts with the experience and expertise to maintain compliance, navigate regulatory changes, and uncover hidden revenue streams for your lab. Our goal is to improve operational efficiency, reduce costs, and increase revenue for your lab. We leverage industry-leading technology and high-touch relationships that allow you to remain compliant while you focus on maintaining exceptional care with the best possible financial results.

If you’d like to learn more about how outsourcing laboratory billing can maximize reimbursements while helping you remain compliant, contact Coronis Health to request your complimentary financial checkup today.

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