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Revenue & Operations

Laboratory Revenue Cycle Management (RCM) & Billing

Eliminate denials, capture every charge, and accelerate lab cash flow

View Workflow Architecture
Key Metric
First-pass clean claims rate exceeding 96.8%
HIPAA 5010 EDI CMS Guidelines PCI-DSS Compliant OIG Billing Compliance

Solution Overview

Most laboratory revenue leaks happen before the specimen even reaches the testing bench. Inspired by LigoLab’s comprehensive LIS & RCM Operating System, our platform integrates billing directly with the analytical accessioning layer. Every order is checked in real-time for insurance eligibility, prior authorization requirements, and CPT / ICD-10 coding compliance.

Documented Performance Metrics

96.8%
Clean Claims Rate
First-pass submission rate without denial rejections
28 Days
Days in A/R
Reduction in accounts receivable payment turnaround cycle
-35%
Bad Debt Reduction
Immediate front-end insurance discovery and copay collection

End-to-End Operational Lifecycle

How specimens flow seamlessly through this module from intake to verified release.

1
Order Intake & Discovery

Real-time patient demographic verification and active coverage lookup.

2
Medical Necessity Scrubbing

Automatic CPT cross-referencing against diagnostic ICD-10 codes.

3
Electronic Claim Submission

Batch 837 EDI claim generation sent directly to clearinghouses.

4
Auto-Remittance & Appeals

835 ERA automated electronic payment reconciliation and appeal templates.

Architectural Capabilities

Real-time automated insurance eligibility (EDI 270/271) during accessioning
National and Local Coverage Determinations (NCD/LCD) automated scrubbing
Automated Advanced Beneficiary Notice (ABN) generation for Medicare patients
Direct electronic clearinghouse integration (EDI 837P/837I claims, 835 ERA auto-posting)
Patient payment estimation portal with credit card tokenization and digital invoicing
CONSULTATION
Schedule Laboratory Revenue Cycle Management (RCM) & Billing Walkthrough

Our clinical specialists will review your current instrumentation and showcase direct bidirectional interfaces.

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