Hospital CEOs, according to research, are most concerned by the financial challenges they face. Clinical labs have been seen as a cost center for years but now need to drive profitability and provide hospitals with revenue and cost savings. Seamless integration with physicians and providers to automate orders, reconciliation and reporting processes for tests is the best place to start for hard-pressed lab managers.
COVID-19 highlighted many shortcomings resulting from the lack of lab integration. The lack of lab integration during COVID-19 highlighted the worrying growth of inaccurate test. One research study found that, although good labs returned virtually no false positives, others had a false positive rate of 8% or more. Or, I could discuss the way delayed test results can simply be missed or ignored, leading to potentially disastrous patient outcomes.
Instead, I want to examine lab profitability so I will focus on one very small element to illustrate my point: Denial of claims.
Denial of claims can devastate the bottom line
Rejected lab claims are perhaps the biggest hit that a clinical lab must deal with. Each rejected claim adds time and cost and worse still, it often leads to the lab not being paid at all. Research suggests that the average cost to re-submit a claim is $25. Damaging enough but consider that the average net revenue for a lab outreach requisition is between $50 and $80. This means, if the hospital write-off threshold is above that, then this revenue is likely to never be reconciled or chased.
The scale of this problem should keep lab managers up at night. A 2021 survey showed rejection rates of up to 13% – with hospital claims denials growing by 23% in 2020 alone!
One of the major reasons for rejection of claims is poor and inaccurate ordering. The first step to timely results and a low rate of denials is clean, complete, and error-free orders that ensure patient tests are not delayed and that the correct test is run, eliminating call-backs and retesting.
Integrating and automating order-to-reporting workflows
Lab managers need to understand that physician practices, clinics and outpatient facilities must enhance their own workflows when ordering and receiving test results. They need to be able to seamlessly integrate ordering, reporting and diagnostic systems into the myriad of electronic medical records (EMR) systems in use at different customer facilities.
The integration challenge is massive and growing. There are over 400 different EMR systems to choose from and most physicians have their own preferred solution. More than this, a lab may form direct connections to a wide variety of different EMRs with different requirements and data formats.
This results in complexity and inefficiency. At the same time, physicians expect a clinical lab to be able to connect to any EMR while maintaining an effective clinical workflow for orders and ensuring timely, accurate test results. EMR integration becomes the first part of automation but nearly 45% of healthcare organizations have had to place integration projects on hold due to the lack of required skills.
Taking a managed services approach with EMR-Link
An increasing number of labs worldwide are now adopting OpenText™ EMR-Link that replaces manual interventions that drive up cost and slow reimbursements with highly automated, clean, complete and error-free electronic orders.
This solution streamlines the exchange of orders, requisitions and reports between the lab and all of their clinic and physician customers. With OpenText EMR-Link, the lab can easily achieve a unified, orchestrated and standardized EMR integration, regardless of application or complexity.
If you’d like to know more about the benefits of the OpenText EMR-Link, please visit our website.
