Top 6 Tips To Optimize Laboratory Billing Services & Maximize Revenue


A healthcare lab doesn’t run on the shoulders of medical professionals all alone. Perfect coordination of administrative, HR, finance, and medical professionals makes a practice runs successfully. Therefore, it is integral to consider the importance of laboratory medical billing and coding services to drive maximum revenue and improve the practice’s growth. 

The lab billing process constitutes several steps including; patient registration, insurance verification, medical coding, medical billing services, and reimbursement collection. However, despite the importance of lab billing services, it can be a very complex and challenging task for medical labs to effectively manage the healthcare revenue cycle management. 

Did you know? The healthcare labs contribute to 80% of hospital and clinical decisions. However, they only get 35% of the medical collections with respect to the hospital. On top of that, if the laboratory billing specialists experience claim denials and rejections then they miss out on their significant revenue. 

In order to improve your revenue collections, healthcare labs should streamline the entire lab healthcare RCM procedure. Usually, patients don’t know whether their insurance plan covers the lab tests or not. Therefore, the lab billing specialists should verify the patient’s eligibility and validate if the patient’s data is accurate. 

In this article, you will learn the top 10 proven tips to optimize lab healthcare revenue cycle management and improve your medical billing procedure to enhance your revenue growth. We will discuss the challenges involved in lab healthcare RCM and their 

In this article, we will explore the various aspects of medical revenue cycle management and provide insights into how healthcare providers can improve their processes to enhance patient satisfaction. We will discuss the challenges involved in revenue cycle management, their impact on the patient experience, and their reliable lab billing solutions. 

How To Optimize Your Lab Billing Services? 

Though I have mentioned earlier that the financial health of the medical labs is comparatively less than the associated clinical practices. In order to mitigate the potential financial issues and compliance risks, healthcare labs should take a proactive approach to their lab billing solutions. 

Here are the 6 smartest ways you can take a proactive approach to optimize lab billing services and increase revenue growth. 

1 Stay Updated With The Patient’s Demographics:

The primary step of healthcare revenue cycle management is collecting patient demographics. Usually, when patients change their residence (in another state), job, or coverage plan then they forget to inform their providers. Therefore, it is the responsibility of the lab’s registration staff to collect and verify patients’ demographics every time they visit your lab. 

Even a slight error in patient data can lead to claim denials down the line. Also, it is important to know if your patients want to tailor your billing process to their needs. For instance, an older patient may prefer to receive paper bills in the mail, while younger patients want to receive their bills digitally i.e. via email or text message. When you deliver customized options to your patients then they feel more relaxed to visit your office over and again. 

2 Proceed with Prior Authorization:

Several healthcare insurers require prior authorization/ pre-certification for the lab test. If not done properly, there are chances that your claims will be denied/rejected. For those who’re not familiar with prior authorization, let’s probe into the definition. 

Prior authorization is the process of getting approval for the lab test, clinical procedure, or diagnostic test from the healthcare insurance company prior to proceeding. If the patient’s coverage plan doesn’t cover the service or approve then it won’t also reimburse the healthcare lab. 

Now, if the lab billing specialists don’t check the documents (prior authorization) and submit the claim to the insurance company then you’ll definitely experience denials and rejections. Therefore, it is important to proceed with prior authorization and inform everyone on the staff across your healthcare lab. You can also use modern EHR and medical billing software to digitally record your prior authorization data and share it with your medical billing team. 

3 Make Billing Easier For Patients

The most effective way to optimize the lab healthcare revenue cycle management process is to make it easier for patients to pay their bills. For that purpose, you can introduce multiple payment options for patients. In this digital era, if you provide digital payment options then the younger patients are more likely to pay your dues promptly. 

It is also essential to have a dedicated laboratory billing department in place then they answer patients’ concerns and billing-related queries promptly. By making your medical billing system highly patient-centric and responsive help your patients understand their financial responsibilities easily. So they can easily pay your dues and you can drive more revenue in a short interval of time. 

Not only it improves your collection but also earns the satisfaction of your customers and makes them return back to your lab whenever they need a service. 

4 Reduce Errors and Manual Mistakes

Some small and medium-sized healthcare labs in the USA tend to proceed with their medical billing and coding procedures manually. In this traditional paper-based medical billing system, medical claims keep moving back and forth within the department going through a lengthy approval cycle that leads to excessive delays in payment. 

There are several documentation challenges that medical billing and coding staff have to wrestle with. Therefore, manual medical billing and coding procedures are more prone to errors and mistakes. 

In order to mitigate these errors, healthcare labs should shift to automatic lab billing solutions. If medical billing is automated from charge entry to claim submission and patient statements, providers can streamline their billing process and reduce errors. Automation also allows patients to receive their bills and make payments quickly and efficiently, which can lead to better patient satisfaction. 

5 Ensure Accurate Billing

It is important to ensure accuracy in the lab healthcare revenue cycle management process. Medical billing errors and mistakes lead to serious financial problems and revenue loss. Therefore, it is important to conduct accurate checks and balances in the laboratory billing process.

Healthcare labs can reduce errors and ensure the accuracy of patients’ bills with reliable laboratory billing solutions. However, it also requires great expertise to ensure accuracy and smooth workflow of the medical billing process. You can also outsource lab billing services to get professional assistance, and intuitive guidance, and ensure compliance with all relative laws and regulations, such as HIPAA and the Affordable Care Act. In this way, you can avoid legal and financial issues. 

6 Promptly Handle Denied or Rejected Claims

According to a study, 60% of healthcare labs tend to lose their revenue due to claim denials. However, most of the claim denials are easier to recover simply by appealing claim denials/rejections on time. 

Before diving deep into the details, let’s understand the difference between a denied and rejected claim. 

Claim Denial: Denial of a medical claim is the refusal of an insurance company or carrier to pay the reimbursements to the healthcare professional for his/ her patient care services. 

While the timeline may vary depending on your state’s laws, after filing an appeal, a healthcare provider should expect to get a response or appeal decision within 30 days if your internal appeal is for a service you haven’t yet received. However, this time also extends to 60 days if your internal appeal is for a service you’ve already received. 

Claim Rejection: If a medical claim is prepared using incorrect data it often ends up in rejection by clearing houses. Conversely, a claim denial applies to a claim that has been processed and found to be unpayable. This may be due to terms of the patient-payer contract or for other reasons that emerge during processing. 

If your claim is rejected due to mistakes then the lab billing specialists should rectify the claim and resubmit as quickly as possible. 

Usually, healthcare labs can’t keep the track of claim denials/ rejections. Even if they find out that their claims are still unpaid then they don’t have enough resources to manage claim denials. Therefore, practitioners should hire sufficient resources to manage and recover your claim denials. 

However, you can also get all-in-one laboratory billing and claim denial management solutions from an experienced laboratory billing company. In this way, you can streamline your lab healthcare revenue cycle management at the fraction of the expenses of your office-based staff. 

Are you struggling with increasing claim denials and low revenues? Outsource laboratory billing services to CureCloudMD and get assistance from professional billing specialists, certified coding experts, and an experienced RCM team.