Executive Summary:
A National Women's Health Genetics Lab faced significant financial challenges due to inefficiencies in their order management processes, leading to frequent claim denials and delayed revenue collection. Gistia identified critical issues and implemented targeted solutions, including custom order workflows and advanced data integration tools. These enhancements resulted in fewer billing errors, reduced claim denials, and improved financial predictability, positioning the lab for sustainable growth.
Background Information:
The client, a leading National Genetics Lab, specializes in highly specialized molecular testing services. As their test menu expanded, their existing order management system became inadequate, causing operational inefficiencies and financial strain. The lab required a more sophisticated system capable of capturing the precise data needed to meet payer requirements and reduce claim denials. Gistia was brought in to redesign the lab’s order management workflows, with a primary focus on improving revenue collection and ensuring financial stability.
Problem:
The lab’s rapid growth and outdated order management processes led to several key challenges:
Revenue Leakage: Inefficient workflows caused incomplete or inaccurate order data, resulting in billing errors and delayed revenue collection.
High Claim Denials: The absence of a sophisticated system to manage specific data requirements for various test types led to frequent claim denials.
Scalability Concerns: As the lab’s test menu expanded, it became increasingly difficult to scale operations without incurring financial losses.
Difficulty in Meeting Payer Requirements: Inconsistent data capture prevented the lab from meeting payer requirements, leading to financial penalties and lost revenue.
Gistia’s Approach:
Step 1: Identify Sources of Revenue Leakage
Order Management Diagnostics: Gistia conducted a detailed analysis to pinpoint the exact stages in the order management process that were contributing to data errors and revenue leakage.
Data Integration: We implemented a unified data system, ensuring that all relevant information from multiple sources was accurately captured and met payer requirements.
Step 2: Deploy Targeted Solutions
Custom Order Workflows: We developed adaptable workflows tailored to capture the specific data needed for each test type, ensuring compliance with payer requirements and significantly reducing billing errors.
Unified Data Interface: Gistia created a single, integrated platform that streamlined the billing process and reduced the frequency of claim denials.
Order & Result Modernization: We upgraded the lab’s order management system to include real-time tracking and automated updates, ensuring accuracy and completeness from the point of order creation.
Step 3: Continuous Order Management Monitoring & Optimization
Ongoing Workflow Monitoring: Gistia set up continuous monitoring of the lab’s order management processes to quickly identify and resolve any new issues that could lead to revenue losses.
Revenue Forecasting: We implemented advanced tools that allowed the lab to predict revenue based on current data, helping them manage financial risks and plan for future growth.
Results:
The improvements implemented by Gistia had a substantial impact on the lab’s financial performance:
Increased Revenue Collection: Enhanced data accuracy and completeness led to fewer billing errors, faster collections, and a significant increase in overall revenue.
Reduced Claim Denials: The introduction of custom workflows and data integration tools directly reduced the rate of claim denials, improving cash flow.
Scalability Achieved: The lab is now equipped to handle a larger volume of tests without the previous financial strain, supporting their growth ambitions.
Improved Financial Predictability: With improved data accuracy and real-time tracking, the lab can now forecast revenue more precisely and manage financial risks more effectively.
Gistia’s solutions provided the lab with a robust, scalable order management system that not only resolved their immediate financial challenges but also set them up for future success.
