May 2008
Feature Story

Anne Ford

In a laboratory, keeping up with ever-shifting billing regulatory requirements is a bit like herding cats. It’s not that each component is daunting by itself; it’s that there are so darn many of them, and they just won’t hold still. For that and other reasons, says Susan Bollinger, marketing director for Hex Laboratory Systems, “many LIS vendors have chosen to drop their billing systems and are getting out of the financial side of the laboratory,” while in turn, “many labs are going to billing services, which isn’t always the best choice. Billing services don’t follow up as thoroughly as the lab would to try to resolve rejected claims,” Bollinger continues, “and they often leave millions of dollars unresolved. They simply don’t care about the lab’s money the way the lab does.”

If your laboratory is sold on the billing services route, stop right here. Otherwise, keep reading to learn how the vendors listed in this month’s survey of billing and accounts receivable systems are attempting to standardize and simplify the way laboratories manage their revenue cycles.

At Xifin, says executive chairman and CEO Lale White, timeliness and accuracy drive the software-as-a-service platform on which the company introduces 20 to 30 new features each month. “Many of these features are required to stay current with the changing payer, regulatory, or compliance environment,” she says. One such feature is configurable NPI (national provider identifier) logic functionality to accommodate payer-specific requirements for converting to NPI. “A number represent new functionality that enhances connectivity, efficiency, and/or workflow,” she adds.

Recent enhancements have included Web services integration with Oracle’s Siebel CRM offering, which allows users of the customer relationship management solution to seamlessly access and maintain certain billing screens, such as payer contracting and pricing. Coming soon: complete dialysis history and billing management and an online, automated acknowledgements and front-end rejection management workflow. These and other features, White says, allow Xifin to “help its customers collect what they’re owed, streamline operations, eliminate compliance risks, and improve overall profitability, in most cases by more than 50 percent.”

Enhancements at Schuyler House include expanded SchuyLab electronic remittance interfaces, “which automatically receive and post payments from insurance carriers, CMS, and billing consolidators,” says vice president Janet Chennault. Besides saving personnel time and posting errors, the expanded interfaces “introduce a more uniform posting system, eliminating the possible idiosyncrasies of the individual billers,” she adds. Schuyler House is also expanding its billing capabilities to send HL7 financial records to hospital information systems and major reference laboratories.

Given that there are as many ways to bill as there are laboratories, Chennault says, system flexibility has become more important than ever. “Many of our sites bill directly to CMS, or send out some insurance claims to a consolidator, or interface directly to each client’s system as well as generate patient bills in-house,” she explains. “Any imaginable permutation is being tried somewhere by an independent reference laboratory. In the end, every lab has its own image of the right way to bill, and they want an LIS that can implement their vision of this process.”

Speaking of “right ways” to bill, Netlims’ AutoBilling module was designed to address the requirements of what company representative David Hanfling calls “a heterogeneous group of billing and payer entities.” The AutoBilling module is integrated with Netlims’ AutoLims core laboratory module. Among the features added recently are multiple methods of calculating travel by phlebotomist; the ability to handle more complex client billing scenarios, such as exceptions to capitation agreements; and the integration of NCD/LCD (national coverage determinations/local coverage determinations) based on laboratory location.

Laboratories want easy access to revenue and profitability reporting capabilities, automated billing and remittance processes, and electronic links to electronic medical records—“functions that exist with Netlims’ AutoBilling module today,” Hanfling says.

Introduced last year on Hex Laboratory Systems’ Lab/Hex Billing and Cash Management system: NPI numbers (added to fulfill Medicare requirements) and a trip fee calculator. “With a large range of management and financial reports to help labs manage the business side, Hex is always adding to this list [of features],” Bollinger says. She also touts the fact that Hex integrated billing with its LIS when the company developed its first LIS in 1981. “With electronic billing and electronic remittance to all payers,” she says, “day-to-day operations are less labor intensive and labs see their money sooner.”

The key to labs seeing their money sooner is preventing errors on the frond end, says Christina Noel, company spokesperson for Medi­tech. “One of the critical aspects of revenue cycle that has begun to receive more attention lately: dollars discharged, but not final billed,” she says. “The account has been discharged or the service has been completed, but that bill still hasn’t dropped and entered the claim process.”

Medi­tech’s Proactive Unbilled Receivables Checking solution allows patient financial services staff to create individual worklists, which in turn allow billers to review and correct accounts before the bill is issued. “Not only does this reduce the dollars discharged but not final billed due to rejections; it also allows your revenue cycle management team to establish trends and revamp internal procedures,” Noel explains. “Therefore, your organization reduces errors on the front end—instead of having to resort to work­arounds on the back end—in the billing ­office.”

Recent developments at Meditech include Denial Management Desktop functions, as well as the companion Biller and Collector desktops. Each consolidates into one screen the functions most commonly used by billing office staff for a particular task.

MediSolution, too, has introduced a denials management function. “This feature captures denial codes from electronic as well as manual remittances,” says Jim Schroeder, director of product development. “A denial can be resolved automatically based on user-defined rules or routed to an account representative work queue based on type or reason for denial.” The company also recently made its Virtuo RCM 3.0 revenue cycle management system available in a .Net framework, a feature that “provides a user interface with the look and feel common to many other Windows-based applications.”

Finally, Computer Service and Support Laboratory Information Systems has enhanced its A/R-2000 version 8.0 laboratory billing and accounts receivable system, adding NPI compliance, the ability to directly remit 835 files to most carriers, a financial reporting module, and direct integration with the MedAvant online portal. The latter allows users to securely upload ANSI 837 and 835 files for claims transmission and remittance, while the CSS Express Bill feature lets laboratories submit patient statements, notices, and collections electronically to an Express Bill processing center. “Currently, CSS has electronic claims capabilities to 1,850 insurance carriers,” vice president James T. O’Neill says. “Our goal is 100 percent paperless claims processing.”

Another trend, O’Neill adds, is secure ordering, particularly LIS-to-LIS ordering for sending test requisitions, patient demographics, and insurance information from the laboratory to the reference facility. That’s why “CSS has developed the WebOrderView product that can be integrated to our existing LIS or billing system,” he says.

CAP TODAY’s survey of billing and accounts receivable systems (PDF, 116 KB) on pages 20–34 includes products from the aforementioned vendors and from Cerner Corp., Cortex Medical Management Systems, McKesson, Multidata Computer Systems, SCC Soft Computer, Seacoast Laboratory Data Systems, Sunquest Information Systems, and Telcor. Vendors supplied the information listed. Readers interested in a particular product should confirm that it has the stated features and capabilities.

Related Links

• Billing/accounts receivable systems
  (PDF, 116 KB)