Billing/Accounts Receivable/RCM Systems, 2024

wdt_ID	Company	Contact	Email	City, State	Phone	Website	Name of billing/accounts receivable/revenue cycle management system	How billing/AR/RCM functionality is deployed	Configuration of billing/AR/RCM system	How updates to billing/AR/RCM system are covered	Year company began selling billing/AR/RCM systems	Most recent billing/AR/RCM system client go-live (based on Feb. 2024 survey deadline)	Last product release or update of featured billing/AR/RCM system	No. of contracts for sites using billing/AR/RCM system	• No. of sales of billing/AR/RCM system between Feb. 2023–Jan. 2024	• No. of clients that went live with billing/AR/RCM system, Feb. 2023–Jan. 2024	No. of sites operating billing/AR/RCM system that are hospital labs in U.S./commercial medical (nonhospital) sites in U.S.*/foreign medical sites	Company actively markets billing/AR/RCM system outside the U.S.	• Foreign locations in which billing/AR/RCM system is installed	Human languages (other than English) supported by system	No. of invoices handled by installed sites annually	No. of requisitions handled by installed sites annually	No. of users who have access to system in smallest site/in largest site	Approximate No. of employees in entire company	Company provides list of client sites to potential customers on request	Programming languages and development applications or environments	Operating systems	Databases	Functionality incorporated in product:	• Generates CMS 1500 (HCFA-1500) claim form (paper version)	• Generates UB-04 (CMS 1450) claim form (paper version)	• Generates client invoices/Generates patient invoices/Generates family invoices	• Guarantor billing	• Ability to produce a GAAP, FASB, and SOX-compliant end-of-month financial package with referential integrity	• Billing by test profile/Component billing	• Medical-necessity screening for Medicare	• Ability to split technical component and professional component and bill separately	• Prevents billing for nonbillable procedures	• Patient demographic data transferred via interface from LIS or EHR to billing system	• Retains demographic data for repeating patients	• Account and patient payment posting/Full accounts receivable functionality	• Credit card processing	• Automatic balance billing to patient after receiving remittance that satisfies PT codes on insurance	• Ability to fee-for-service bill tests and codes carved out of capitated plans	• Generates utilization reports for managed care	• Generates global charges for lab tests	• Ability to set an unlimited No. of user-defined fee schedules	• Ability to separate payers into lab-defined groups and report on the groups	• Displays expected reimbursement by payer	• Allows open-item accounting	• Client services or call tracking module	• Benefit eligibility checking with auto-update	• User-defined patient dunning cycles/User-defined patient collections process	• User report writer	• Client control of software edits for preferences and configurations	• Client control of payer-specific rules and configurations	• Ability to audit activity per user/Ability to measure productivity per user	• Storage and management of supporting documentation for claims and appeals	• Automated workflow for identifying errors up front and addressing them prior to claim submission	• Appeals tracking/Appeals success metrics	• Underpayment tracking/Key indicator tracking	• Generates financial reports/Generates operational reports	• Reports client performance in terms of payment rates, denials, similar metrics	• AI-enabled analytics that support workflow automation and configuration	Portals provided on billing/AR/RCM system	Means by which billing/AR/RCM system tracks profitability	Advanced system capabilities	Voluntary coding systems, standards, or formats supported	System supports EDI with third-party payers and claims clearinghouses	Code changes automatically accepted by billing/AR/RCM system via interfaces	Billing/AR/RCM system provides indexed field in each test definition for LOINC code	Client gets copy of source code/User group that meets on established schedule	Methods by which users can tailor billing/AR/RCM system in their own setting	Qualified users or third parties can modify or augment standard billing/AR/RCM system functionality or features	Distinguishing product features (supplied by company)	*breakdown of commercial medical (nonhospital) sites generalized	Note: A dash in lieu of an answer means company did not answer question or question is not applicable
1	Advanced Data Systems Corp.	Marc Klar	marc.klar@adsc.com	Paramus, NJ	800-899-4237 ext. 2264	https://www.adsc.com	MedicsPremier	remote hosting or local server and software (client option)	available as a standalone product designed to interface with any company’s LIS and EHR	via standard software maintenance fee	1977 (began selling MedicsPremier in 1998)	Jan-2024	September 2023 (version 10.0)	251	31	20	0/251 (85 AP labs + 46 molecular or NGS labs + 74 clinical reference labs + 14 physician office labs + 32 other U.S. sites–toxicology, esoteric labs)/0	no	none	none	—	—	6/148	300	yes (partial list of comparable sites but prospective client must sign a nondisclosure agreement)	C++, SQL, Caché	Microsoft Windows	Caché, SQL		installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (all three features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	client/physician Web portal, patient service center Web portal, patient Web portal, sales portal	test, payer, client (user’s choice)	rules-based processing, claims scrubbing, bundling/unbundling, 72-hour rule, 14-day rule	ICD-10, CPT, HCPCS level II	yes (with Change Healthcare; 100% of data exchange via direct electronic connection)	yes (if codes provided in CSV format)	yes	escrow/—	ad hoc query tools, user-defined interfaces, workflow configuration, tailored worklists	yes (client users)	supports an option for insurance discovery for patients who don’t have insurance coverage listed; supports a built-in sales portal that allows a lab’s sales team to self-serve on needed information
2	CompuGroup Medical	Patrick Hall	patrick.hall@cgm.com	Austin, TX	877-564-4414	https://www.cgm.com/us	CGM SCHUYLAB†	local server and software	available as an integrated component of CompuGroup Medical’s clinical LIS	via standard software maintenance fee	1990 (began selling CGM SCHUYLAB in 2020)	Jan-2024	July 2023 (version 4.0)	110	4	4	4/75 (5 AP labs + 5 molecular or NGS labs + 45 clinical reference labs + 10 physician office labs + 10 other U.S. sites–veterinary, independent reference labs)/31–independent reference labs, physician office labs, hospitals	yes (in Guam, Caribbean, Canada, Africa, Pacific Rim, South East Asia)	Guam, Caribbean, Canada, Africa, Pacific Rim, South East Asia	Spanish, Portuguese, Chinese, Italian, Japanese, French German, Dutch	100–1,000,000+	100–1,000,000+	Jan-65	1,650	yes (list of customers who have agreed to speak with prospective clients)	C++	Microsoft Windows	FairCom C-Tree		installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (all three features)	installed at laboratory sites	—	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	not available for this software	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	not available for this software	not available for this software	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	not available for this software	installed at laboratory sites	not available for this software (both features)	installed at laboratory sites/not available for this software	installed at laboratory sites (both features)	installed at laboratory sites	not available for this software	client/physician Web portal, patient service center Web portal, patient Web portal	functionality not provided	rules-based processing, claims scrubbing, bundling/unbundling, 72-hour rule, 14-day rule	ICD-10, CPT, HIPAA transaction sets, X12 5010A1	yes (with eMedix, Office Ally, ProxyMed, Ontario Health Insurance Plan; 100% of data exchange via direct electronic connection)	yes (using CodeMap)	yes	escrow/no	user-defined interfaces, workflow configuration	yes (client users)	direct Medicare and Medicaid billing, including claims and remittance, in all regions of United States; not third-party software; fully integrated with CGM SCHUYLAB laboratory information system	†formerly Schuyler House SchuyLab
3	Cortex Medical Management Systems	Carrie Cohen	ccohen@cortexmed.com	Seattle, WA	206-812-6981	https://www.cortexmed.com	Cortex Medical Billing RCM	remote hosting or local server and software (client option)	available as a standalone product designed to interface with any company’s LIS and EHR	via standard software maintenance fee	1983 (began selling Cortex Medical Billing RCM in 1983)	—	October 2023 (version 10.2.18)	44	2	2	0/43 (42 AP labs + 1 other U.S. site–hospital ER)/0	no	—	—	—	—	1/30	10	yes (with permission from existing clients)	.Net	—	Microsoft SQL		installed at laboratory sites	—	installed at laboratory sites (all three features)	installed at laboratory sites	—	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	available via a third party	installed at laboratory sites	installed at laboratory sites	—	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	—	available via a third party	installed at laboratory sites (both features)	installed at laboratory sites	—	installed at laboratory sites	installed at laboratory sites (both features)	—	installed at laboratory sites	—	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites	—	none	test, payer, client (user’s choice)	rules-based processing, claims scrubbing, bundling/unbundling, 72-hour rule, 14-day rule	ICD-10, CPT, HCPCS level II	yes (99% of data exchange via direct electronic connection)	—	no	—/yes (in person and via webinar)	user-defined interfaces, dictionary settings, read/write privileges	no (all modifications made by vendor)	balancing hub feature makes daily processes and procedures easy with one place to view and run all queries and reports; unlimited fee schedules
4	LigoLab Information Systems	Suren Avunjian	suren@ligolab.com	Glendale, CA	818-395-4659	https://www.ligolab.com	LigoLab LIS & RCM Informatics Platform	remote hosting or local server and software (client option)	billing functionality available as an integrated component of LigoLab LIS & RCM Informatics Platform	via standard software maintenance fee	2018 (began selling LigoLab LIS & RCM Informatics Platform in 2018)	Dec-2023	January 2024 (version 2023.1.77)	not tracked by contract (tracked by net collection)	7	5	0/100+ (>75 AP labs + 8 molecular or NGS labs + 17 clinical reference labs)/0	no	—	—	5,000–5,000,000 (average, 250,000)	5,000–5,000,000 (average, 400,000)	12/300+	75	yes (complete list but prospective client must sign a nondisclosure agreement)	Java, JavaScript, SQL, others	any operating system that supports Java virtual machine	Oracle, Microsoft SQL (database agnostic)		installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (all three features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	available via a third party (on LigoLab platform)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	available via a third party (on LigoLab platform)	available via a third party (on LigoLab platform)	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	client/physician Web portal, patient service center Web portal, patient Web portal	test, payer, client (user’s choice)	rules-based processing, claims scrubbing, bundling/unbundling, 72-hour rule, 14-day rule	IAIABC EDI guidelines, ICD-10, CPT, HCPCS level II	yes (with Waystar, FrontRunner, Availity, others; 100% of data exchange via direct electronic connection)	yes (using CMS functionality or any other that is requested)	yes	escrow/yes (in person, via webinar and conference call)	ad hoc query tools, user-defined interfaces, dictionary settings, read/write privileges, workflow configuration, tailored worklists	yes (client users and designated third parties)	integrated LIS and RCM platform with automation, third-party integration, interwoven billing logic; automated clean claim scrubbing and CPT/ICD coding; complete transparency and control of billing workflow
5	Medical Information Technology (MEDITECH)	Andrea Quinn	aquinn@meditech.com	Canton, MA	781-821-3000	https://www.meditech.com	MEDITECH Expanse Revenue Cycle	remote hosting or local server and software (client option)	available as a standalone product designed to interface with any company’s LIS and EHR	via standard software maintenance fee	1977 (began selling Expanse in 2016)	Jan-2024	January 2024 (Expanse version 2.2.47)	233	41	42	412 /commercial medical (nonhospital) sites not tracked/71–long-term care, short-term acute care	yes (worldwide)	Australia, Bahamas, Canada, England, Ireland, Kenya, Pakistan, Singapore, British Virgin Islands	none	not tracked	not tracked	not tracked	3,360	yes (partial list of comparable sites with no restrictions)	self-developed programming languages	Microsoft Windows 7, 8, 10; others	proprietary (data repository runs on Microsoft SQL Server 2012 or higher)		installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (all three features)	installed at laboratory sites	available via MEDITECH General Financials suite	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	under development	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	available via MEDITECH Authorization and Referral Mgmt.	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	available via MEDITECH Scanning and Archiving	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	integrated patient health portal (separate purchase/line item)	test, payer, client (user’s choice)	rules-based processing, bundling/unbundling, 72-hour rule, 14-day rule	ICD-10, CPT, HCPCS level II, others	yes	no (provides standard routines to load code files)	yes	escrow/no	ad hoc query tools; dictionary settings; workflow configuration; tailored worklists; customer-defined screens, parameters, reports, rules-based logic	yes (client users)	dashboard reporting of key financial performance indicators through an interactive financial status desktop; centralized or decentralized billing with automated charge capture, claim generation, patient statement, collections, denial-management workflows
6	SCC Soft Computer	Ellie Vahman	ellie@softcomputer.com	Clearwater, FL	727-789-0100	https://www.softcomputer.com	Soft A/R†	remote hosting or local server and software (client option)	available as an integrated component of SCC Soft Computer’s LIS and as a standalone product designed to interface with any company’s LIS	via standard software maintenance fee	1993 (began selling Soft A/R in 1993)	Jan-2024	May 2022 (version 4.5.10.1)	111	5	5	388/145 (4 AP labs + 16 molecular or NGS labs + 18 clinical reference labs + 107 other U.S. sites–outpatient, clinics)/46–public health system, commercial labs	yes (worldwide)	Australia, Bermuda, Jamaica, United Kingdom	—	—	100,000–10,000,000 (average, 4,000,000)	Apr-60	2,000	yes (partial list of comparable sites but prospective client must sign a nondisclosure agreement)	C, Java, Oracle	server: AIX, Linux, cloud; workstation: Microsoft Windows, thin-client supported	Oracle, PostgreSQL		installed at laboratory sites	installed at laboratory sites	installed at laboratory sites/installed at laboratory sites/not available for this software	installed at laboratory sites	not available for this software	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	available via SCC’s SoftExpress	available via a third party	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	available via SCC’s SoftMedia	installed at laboratory sites	not available for this software (both features)	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites	available via SCC’s SoftBI Business Intelligence	client/physician Web portal, patient service center Web portal	test, payer, client (user’s choice)	rules-based processing, claims scrubbing, bundling/unbundling, 72-hour rule, 14-day rule	IAIABC EDI guidelines, CPT	yes (with CMS, Change Healthcare, Waystar, others)	yes (using MediQuant, CMS, AMA, 3M)	yes	escrow/yes (in person, via webinar and conference call)	ad hoc query tools, user-defined interfaces, dictionary settings, rules engine	—	modular product that can be tailored to most lab environments; on premises or cloud deployment; unlimited multi-tiered pricing, unlimited payer rules, carve-outs, edits, centralized billing or outsourced RCM	†also marketed by RCM Enterprise Services
7	Seacoast Laboratory Data Systems	Lisa M. Turgeon	info@sldsi.com	Dover, NH	603-431-4114	https://www.sldsi.com	SurroundLab AR	remote hosting or local server and software (client option)	available as a standalone product designed to interface with any company’s LIS and EHR	some via standard software maintenance fee†	2001 (began selling SurroundLab AR in 2001)	Dec-2023	October 2021 (version 2021001)	—	3	3	3/84 (clinical reference labs)/0	no	—	—	—	13,500–4,000,000 (average, 400,000)	6/325	25	yes (partial list of comparable sites but prospective client must sign a nondisclosure agreement)	MUMPS, Caché	Microsoft Windows, Unix	Caché, GT.M		installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (all three features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites	—	client/physician Web portal, patient Web portal	test, payer, client (user’s choice)	rules-based processing, claims scrubbing, bundling/unbundling, 72-hour rule, 14-day rule	IAIABC EDI guidelines, ICD-10, CPT, HCPCS level II	yes (with Ability, Availity, CHC, others; 99% of data exchange via direct electronic connection)	yes (using CodeMap, Optum360)	yes	no/no	ad hoc query tools, dictionary settings, tailored worklists	yes (client users can change master file definitions)	commercial lab centric; scalable; fully customizable; complete product suite for the commercial laboratory, including nursing home functions, AP billing	†annual updates to base software
8	TELCOR	Corey Wilbeck	corey.wilbeck@telcor.com	Lincoln, NE	855-489-1207	https://www.telcor.com	TELCOR RCM	remote hosting or local server and software (client option)	available as a standalone product designed to interface with any company’s LIS and EHR	via standard software maintenance fee	2004 (began selling TELCOR RCM in 2004)	Feb-2024	July 2023 (version 21.3)	229	12	14	45/184 (46 AP labs + 41 molecular or NGS labs + 89 clinical reference labs + 8 other U.S. sites–mobile radiology, environmental, public health, sleep study, others)/0	no	—	—	50–1,750,000 (average, 120,000)	50–11,500,000 (average, 2,000,000)	2/700	300	yes (list of customers who have agreed to speak with prospective clients)	Microsoft .Net, C#, Visual Basic .Net	Microsoft Windows	Microsoft SQL server		installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (all three features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	available via a third party	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	client/physician Web portal, patient service center Web portal, patient Web portal	test, payer, client (user’s choice)	rules-based processing, claims scrubbing, bundling/unbundling, 72-hour rule, 14-day rule	ICD-10, CPT, HCPCS level II	yes (with Aetna, Anthem, Availity, BCBS, Change Healthcare, Claim.MD, Trizetto, Waystar, many others; 100% of data exchange via direct electronic connection)	yes (using AMA, CMS)	yes	optional/yes (in person and via webinar)	ad hoc query tools, user-defined interfaces, dictionary settings, others	yes (client users and designated third parties)	online, dynamic rules-based technology drives workflow efficiencies, cleaner claims submissions, and improved collections; unlimited real-time reporting to track payer reimbursement, sales trends, denials, appeals, accounts receivable, and user productivity
9	XiFin	Kyle Fetter	info@xifin.com	San Diego, CA	866-934-6364	https://www.xifin.com	XiFin RPM	remote hosting	available as a standalone product designed to interface with any company’s LIS and EHR	via standard software maintenance fee	2001 (began selling XiFin RPM in 2002)	Feb-2024	November 2023 (version XiFin RPM 16)	not tracked by contract (tracked by facility)	14	17	72/297 (77 AP labs + 97 molecular or NGS labs + 60 clinical reference labs + 63 other U.S. sites–pain management, toxicology, radiology, remote patient monitoring, independent diagnostic testing facility)/0	no	—	—	—	20,000,000 maximum (average, 5,000,000)	10/3,000	1,110	yes (partial list of comparable sites with no restrictions)	Java, JavaScript, SQL	Web-based application (client platform agnostic)	Oracle		installed at laboratory sites	installed at laboratory sites	installed at laboratory sites/installed at laboratory sites/under development	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites (both features)	installed at laboratory sites	installed at laboratory sites	client/physician Web portal, patient service center Web portal, patient Web portal	test, payer, client (user’s choice)	rules-based processing, claims scrubbing, bundling/unbundling, 72-hour rule, 14-day rule	ICD-10, CPT, HCPCS level II	yes	yes (using AMA, CMS)	no (ability to bring in LOINC codes passed from another system)	no/yes (in person, via webinar and conference call)	ad hoc query tools, user-defined interfaces, dictionary settings, workflow configuration, many others	client users cannot modify software code but can configure workflow functionality, rules logic	HITRUST-certified SaaS platform with patient and client portals, APIs, analytics, and patient responsibility estimator; automated and configurable RCM workflow with AI embedded for payer translation and error processing prioritization
	Company	Contact	Email	City, State	Phone	Website	Name of billing/accounts receivable/revenue cycle management system	How billing/AR/RCM functionality is deployed	Configuration of billing/AR/RCM system	How updates to billing/AR/RCM system are covered	Year company began selling billing/AR/RCM systems	Most recent billing/AR/RCM system client go-live (based on Feb. 2024 survey deadline)	Last product release or update of featured billing/AR/RCM system	No. of contracts for sites using billing/AR/RCM system	• No. of sales of billing/AR/RCM system between Feb. 2023–Jan. 2024	• No. of clients that went live with billing/AR/RCM system, Feb. 2023–Jan. 2024	No. of sites operating billing/AR/RCM system that are hospital labs in U.S./commercial medical (nonhospital) sites in U.S.*/foreign medical sites	Company actively markets billing/AR/RCM system outside the U.S.	• Foreign locations in which billing/AR/RCM system is installed	Human languages (other than English) supported by system	No. of invoices handled by installed sites annually	No. of requisitions handled by installed sites annually	No. of users who have access to system in smallest site/in largest site	Approximate No. of employees in entire company	Company provides list of client sites to potential customers on request	Programming languages and development applications or environments	Operating systems	Databases	Functionality incorporated in product:	• Generates CMS 1500 (HCFA-1500) claim form (paper version)	• Generates UB-04 (CMS 1450) claim form (paper version)	• Generates client invoices/Generates patient invoices/Generates family invoices	• Guarantor billing	• Ability to produce a GAAP, FASB, and SOX-compliant end-of-month financial package with referential integrity	• Billing by test profile/Component billing	• Medical-necessity screening for Medicare	• Ability to split technical component and professional component and bill separately	• Prevents billing for nonbillable procedures	• Patient demographic data transferred via interface from LIS or EHR to billing system	• Retains demographic data for repeating patients	• Account and patient payment posting/Full accounts receivable functionality	• Credit card processing	• Automatic balance billing to patient after receiving remittance that satisfies PT codes on insurance	• Ability to fee-for-service bill tests and codes carved out of capitated plans	• Generates utilization reports for managed care	• Generates global charges for lab tests	• Ability to set an unlimited No. of user-defined fee schedules	• Ability to separate payers into lab-defined groups and report on the groups	• Displays expected reimbursement by payer	• Allows open-item accounting	• Client services or call tracking module	• Benefit eligibility checking with auto-update	• User-defined patient dunning cycles/User-defined patient collections process	• User report writer	• Client control of software edits for preferences and configurations	• Client control of payer-specific rules and configurations	• Ability to audit activity per user/Ability to measure productivity per user	• Storage and management of supporting documentation for claims and appeals	• Automated workflow for identifying errors up front and addressing them prior to claim submission	• Appeals tracking/Appeals success metrics	• Underpayment tracking/Key indicator tracking	• Generates financial reports/Generates operational reports	• Reports client performance in terms of payment rates, denials, similar metrics	• AI-enabled analytics that support workflow automation and configuration	Portals provided on billing/AR/RCM system	Means by which billing/AR/RCM system tracks profitability	Advanced system capabilities	Voluntary coding systems, standards, or formats supported	System supports EDI with third-party payers and claims clearinghouses	Code changes automatically accepted by billing/AR/RCM system via interfaces	Billing/AR/RCM system provides indexed field in each test definition for LOINC code	Client gets copy of source code/User group that meets on established schedule	Methods by which users can tailor billing/AR/RCM system in their own setting	Qualified users or third parties can modify or augment standard billing/AR/RCM system functionality or features	Distinguishing product features (supplied by company)	*breakdown of commercial medical (nonhospital) sites generalized	Note: A dash in lieu of an answer means company did not answer question or question is not applicable

Billing headwinds grow stronger for labs

April 2024—In billing for pathology and laboratory services, the hurdles are only getting higher. Narrow networks, prior authorizations, claims denials. Payers “have deeper pockets and figure they can outlast us,” said Joe Saad, MD, chair of the CAP Council on Government and Professional Affairs, in a Feb. 14 roundtable led online by CAP TODAY publisher Bob McGonnagle.

He and others talked about AI, digital pathology codes and molecular Z-Codes, biomarker testing, and unity within the laboratory community.

Dr. Saad

During last year’s roundtable on billing systems we talked about three principal items that were top of mind: the No Surprises Act, the increase in demand for prior authorizations, and denial of payments. Joe Saad, are those still the most important items you think about when you think about pathology and laboratory billing?
Joe Saad, MD, chairman of pathology, director of anatomic pathology, president of medical staff, and medical director of laboratory, Methodist Health System and Methodist Dallas Medical Center: Yes. They’re interrelated because the No Surprises Act has emboldened many payers to pull certain tricks on us, like narrowing the networks, denying claims, and making us jump through hoops with laboratory benefit managers, prior authorization, et cetera. Payers are in the driver’s seat. They can challenge us, and if we don’t like it they don’t mind if we go out of network, which gives them the upper hand when it comes to payment. They know it’s time-consuming, laborious, and costly if we want to contest it, go through the negotiation period, and go to arbitration. They have deeper pockets and figure they can outlast us.

It’s important to press network adequacy laws in various states to limit their ability to sidestep us with inadequate networks, invoke the No Surprises Act, and challenge us to go out of network.