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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.
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