Patient Access Management – A Smart Start for Labs

March 01, 2018 By: Quadax

iStock-693635000-347104-edited.jpgHealthcare may be the only industry where a company has no idea how much it will get paid for services rendered, or whether or not it will be paid at all. This is especially challenging for laboratories that are on the cutting edge with new procedures and technology. For a lab to accurately track expected reimbursement, it is necessary to know whether or not a lab test is covered by a patient’s insurance and who will be paying what. The good news is that with timely benefit investigation, properly performed, a patient’s eligibility and financial responsibility can be identified before the lab performs the test and incurs the cost. One way to accomplish this is to integrate patient access management (PAM) functionality into the lab’s ordering portal. In this way, financial clearance can be expedited as an adjunct to ordering a lab test.

Applying one-stop-shop methodology, automated eligibility verification and bill estimation can be incorporated into the test ordering decision process to make it easy for physicians and patients to do business with your lab. For a self-serve PAM solution that is fully integrated into your current order processing, consider augmenting your lab’s ordering portal with PAM functionality powered by application programming interfaces (API) packaged for plug and play integration.

While reviewing your current PAM process, explore how quicker results, more complete information, efficient automation, and ease of use could help improve your lab’s reimbursement outcomes.

Patient Eligibility and Responsibility

Start with an efficient and reliable process to verify insurance and coverage for every patient. Knowing what payers will cover and their pre-service administrative requirements can help patients make informed decisions and physicians to help meet pre-test requirements. You’ll want a PAM solution that can guide a user through data entry and assist in payer selection, ensure the correct patient data is used to find patient coverage, give your staff a consistent process across all payers, and save your staff the hours spent foraging multiple payer sites for patient benefit information. Find a PAM partner you can trust, one who has the insurance intelligence you require and can transform the payer’s data into actionable information by providing it when, where, and how you need it.   


Patient Out-of-Pocket Estimate

More than 80% of covered employees have an average annual deductible of $1,505Most patients will need to pay at least a portion of their lab bill. Patients require an accurate out-of-pocket estimate (OOPE) to help them make informed choices and be aware of their financial responsibility. Being able to provide patients with an accurate, comprehensive OOPE properly sets patients’ expectations and improves successful collection of patient balances. To automate the patient OOPE process, your lab will need a PAM solution that can normalize the differences and inconsistencies found in how various payers report patient insurance coverage and create a workable single format across all payers. For ongoing maintenance of this normalization subroutine, your PAM partner will need to regularly monitor payer eligibility responses for changes in order to ensure that estimates continue to be accurate.

Bringing Ease of Access to the Physician and the Patient

Deploy PAM processing at a point when it can provide your lab greatest benefit, during the test selection and ordering process. Behind-the-scenes you can seamlessly integrate PAM APIs into your ordering portal’s workflow while maintaining your lab’s branding and unique experience. You need a PAM processing partner who can provide your program engineers with a library of developer-friendly API resources. The goal is to bring ease of access to the PAM user, whether it be the physician, patient, or your laboratory billing staff. While on your lab’s ordering portal, PAM information need never be more than a click away.

Start Smart – Physician and Patient-Friendly PAM Processing

Integrating PAM capabilities into your lab portal ordering process and your lab information system can bring revenue cycle efficiencies and increased reimbursement to your organization. It can also enhance your lab’s relationships with referring physicians through ease of use and increased patient satisfaction. With upfront hassle-free PAM processing, there are no financial surprises—physicians and their patients know what to expect. Starting smart, your lab’s revenue cycle is optimized, reimbursement outcomes are maximized, and referring physician loyalty is enhanced. 

A Solution that Goes Beyond Software – Business Process Outsourcing (BPO)

Even with the best PAM solution, there will always be a need for billing and claims follow-up. When reimbursement is denied, delayed, or underpaid, it helps to have healthcare billing specialists fully trained and current in healthcare regulations and payer requirements on your team. Managing a staff to process specialized laboratory claims can be an arduous undertaking. Does your PAM partner supplement insurance intelligence and efficient technology with a BPO service solution to fully realize the optimizing effects of PAM throughout your lab’s entire revenue cycle? You need a partner who can provide you the service options you require. To learn more about how Quadax can help, visit our start smart revenue cycle solutions for labs


About This Blog

We write about topics relevant to the complex world of revenue cycle management. Our posts feature best practices, helpful ideas, and industry trends in areas such as patient access, claims management, reimbursement, regulatory compliance, and much more! 

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