Vertical Outsourcing - Seven Key Features of Integrated Pathology Lab Workflow and Billing Solutions

Chairing a Pathology Department at Centrastate Hospital in New Jersey and simultaneously running two laboratories in two remote states (Oklahoma and New Jersey) require Dr. Michael McGinnis to match his medical expertise with savvy business sense.

"A pathologist must track workflow of the entire laboratory from receiving a sample and requisition form, to accessioning, to patient demographics, to history, to gross, dictation, proof, distribution, and billing," says Dr. McGinnis. "I need to know precisely what unfinished work is left at each stage in every lab. I need to track every step and know exactly who has done what regardless of their location. And I need this information in real time. For instance, I need the list of signed off reports arranged by requesting doctor, date, patient, or payer, in real time."

Information Systems Challenges in a Pathology Laboratory

Pathology billing is especially complicated because it requires:

1. Data flowing between
   1. Hospital system,
   2. Multiple requesting doctors,
   3. Internal laboratory system,
   4. External billing service, and
   5. Multiple insurance companies
2. A system of checks and balances to
   1. Prevent losing a case
   2. Ensure full and timely payment

Continuous Measurement

Billing quality is best understood by observing the distribution of Accounts Receivable. A well-performing service will have half of the claims paid within 15 days, with over 90% of all claims being paid within 45 days. The narrower "bell-curve" of Accounts Receivable means better cash flow predictability while its lower "tail" means added revenue.

Software-as-a-Service (SaaS)

"Gone are the disk crashes and software maintenance. No more office staff moods and conflicts to resolve or benefits to pay. I now pay only for performance, which makes perfect business sense," says Dr. McGinnis. "Finally, I can replace my administrative assistants with medical specialists that can take over some of my workload and add revenue."

Mission-Critical System Features

The following seven features are critical for accomplishing the benefits listed above:

1. Comprehensive integrated functionality covering entire laboratory workflow
2. Internet-based access to data entry and reporting
3. An interface between hospital internal system and external billing service
4. Arbitrary aggregation and comprehensive analysis of all laboratory and billing data
5. Full and transparent access to each and every claim, from accession number to coding to payment
6. 24x7 status reports about received payments, submitted claims, rejections, follow-ups, and delays
7. HIPAA compliance. Role-based access control to clinical and billing data