Best Practices for Labs to Remain Competitive

May 20, 2021 By: Quadax

Mitigate financial challenges by securing patient revenue. 

We recognize every lab is different, each with their own set of unique challenges as it relates to patient access and engagement. In our experience, we have found three key factors to keep labs competitive:

  1. Include the patient experience as part of your strategy—they want a say in their care when finances are involved.
  2. Consider the communication between the provider and the patient—this is reliant on how labs manage the provider’s expectations.
  3. Make it easy for patients to update demographic and payer information and pay their bills.

We have identified 5 best practices to help mitigate those challenges.


#1 Establish and Support Payer Billing Policies

Some labs, especially those in the early stages of testing acceptance, are challenged with a lack of payer contracts and are fighting for payer payment, or have to under-bill patients in order to get any sort of reimbursement. Regardless of your lab’s situation, it is important to establish standard operating procedures (SOPs), determine thresholds and execute a set of business rules to support payer billing policies.

How Quadax Helps
An automated benefit investigation workflow will determine if a test is not covered by the payer or the test is covered but not under the patient’s insurance policy. If the test is not covered, labs should then determine patient out-of-pocket estimate and run financial clearance to understand a patient’s willingness to pay and identify if a payment plan/financial assistance should be offered.

#2 Perform Benefit Investigation

Many labs are not able to obtain patient plan-level insurance information from the referring provider. They may not have an online ordering system in place for those providers or it is under-utilized. It is important for labs to establish a course to identify coverage.

How Quadax Helps
Quadax helps validate a patient’s coverage and eligibility in order to verify benefits and ensure reimbursement. If labs are using a portal, they can create a trigger set of questions based on Quadax’s eligibility request to be answered by the physician that will deliver key information and appropriate documentation. If no portal is in place, the lab will need to determine how and when to perform benefit investigation in conjunction with it’s testing practices.

#3 Run Advanced Eligibility

In addition to lacking plan-level details, labs often receive other incomplete or inaccurate information, including wrong date of birth, misspelled name, outdated insurance, etc. Labs then struggle to capture this information and inquiries to the referring provider’s office create tension, delays testing, and can result in billing the wrong payer—all of which extends and can falsify the revenue cycle process. Labs need to be able to access additional demographic and coverage information applicable to the patient sooner to allow for decisions around next steps, reduce the frustrations with provider offices, and save time and resources around manual processes.

How Quadax Helps
Quadax can help set up an Advanced Eligibility workflow to verify and correct patient demographics, and take a deep dive into plan-level details to validate insurance benefits and active coverage if and when a 271 comes back rejected.

#4 Include Out-of-Pocket Estimates and Determine Propensity to Pay

Patients don’t want to deal with surprise bills and want advance notice of their financial responsibilities so they can be engaged with their care and treatment decisions. As labs are understanding payer coverage, they can also determine patient responsibility and share their findings.

How Quadax Helps
Upon completion of benefit investigation and advanced eligibility, lab clients can determine patient responsibility using Out-of-Pocket Estimation. Furthermore, using Quadax Patient Financial Clearance, labs can investigate a patient’s willingness or propensity to pay and determine if financial assistance is warranted. In many cases, our clients have created and out-of-pocket “ceiling” (e.g., greater than $100) and outsource a team of in-house Quadax professionals to contact patients or providers with the information.

#5 Offer Patient Engagement Payment Portals

In today’s world, patients are very vocal about the payment experience—they want the speed, flexibility, reliability, and transparency online bill-paying solutions provide. Healthcare organizations are having to adjust from traditional means of mailed statements to include payment portals and live service teams to collect payments. Fortunately, these online tools are also useful in furthering communications with patients, such as updating demographic or insurance information.

How Quadax Helps
Patient Engagement solutions by Quadax offers patients and service teams a convenient way to pay their bills and update their information. For labs, this means securing patient revenue, optimizing communication methods based on patient preference, and improving the patient experience.

Contact us for more information on Patient Access Management and how we can help your lab. Want to learn more? Download our white paper!


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