Key Market Trends Impacting RCM Laboratories

In a discussion with Dark Daily, Sarah Stewart, Vice President, Revenue Cycle Services, TELCOR, discusses what’s ahead for clinical lab billing. The following is a brief summary.
Revenue cycle management (RCM) landscape for clinical laboratories is rapidly evolving. Understanding key market trends is essential for laboratories to adapt their strategies effectively. Three key marketing trends are:
1 Shift of Payment Responsibility to Patients
Insurance companies are increasingly shifting financial burdens to patients, resulting in rising deductibles and more claims requiring direct patient payment. This change poses challenges for laboratories, as patients often don’t know which lab conducted their tests, leading to skepticism about payment requests.

2 Complex Payer Structures
Payer structures are becoming more intricate, with Medicare featuring multiple MACs and Advantage plans, and Medicaid varying by state. Commercial payers complicate the process further, as coverage rules differ widely among plans.

3 Variability in Appeals and Coverage
Appeals processes and coverage for specific tests can differ significantly among payers. Some tests may require unique handling or may not be covered unless negotiated by specific employers, adding to laboratories' confusion and complexity.

"These trends lead to increased labor with decreased reimbursement and the burden falls squarely on laboratories. Increased dependence on patient payments means labs have to be more proactive and aggressive in order to be paid for their services. But labs have to balance this against both patient and provider satisfaction so ordering providers do not take their business elsewhere."

— Sarah Stewart, Vice President, TELCOR

TELCOR Strategic Innovations to help laboratories navigate these challenges:

• Real-Time Accounts Receivable Access: Customers can view accounts receivable data in real time from one application.
• Smart Workqueues: Streamlining processes reduces manual intervention and enhances efficiency.
• Auto-Driven Solutions: Automated compilation of prior authorization and appeal packages simplifies administrative tasks.
• Flexibility and Adaptability: TELCOR technology adapts to changing payer regulations, helping laboratories reduce denials and improve collections.

As the RCM landscape for clinical laboratories evolves, staying ahead of market trends is crucial. TELCOR is dedicated to providing innovative solutions to help laboratories thrive in this complex environment. Contact us today to learn how we can assist your laboratory in meeting these challenges.