Laboratory RCM – Revenue Sphere

Revenue Sphere – Billing done right

Hospital and Independent Labs – single location or national multi-location: Laboratory operations are essential diagnostic components of the patient process driving decision making across every aspect of the treatment plan. However, in today’s challenging reimbursement arena both hospital and independent organizations are struggling to maintain margin while growing responsibly. At US Medsci, our team has more than 50 years collective experience in all facets of laboratory operations. For hospital organizations we offer both consulting services and full lab integration, construction, management and revenue cycle assistance. Unlike many of our peers, our model educates the organization while building them a world class and profitable center of excellence while keeping the majority of the profit within the organization. Rather than allowing third parties to take over these lucrative assets, we stabilize, optimize, and grow your existing resources. We also add much needed additional management resources in both IT and science in order to help the organization to meet it’s fiscal and service level goals while rigorously meeting all regulatory and compliance laws, regulations and rules. Our model is governed by your board of directors, falls under your accreditation (whether JACO or Joint Commission), always CLIA certified, and becomes a conservative and profitable division of your organization. Some of the benefits of our approach are:

1. Hyper-connectivity with all LIMS, EMR/EHR (both within your facility and with the referring physicians in your network)

2. Fully integrated RCM with automated coding (getting accurate claims released within 24-48 hours of report)

3. Outreach management through proprietary CRM

4. Reporting

5. Inventory management

6. Logistics

Our Revenue Cycle Management system provides
• A tracking system detailing insurance carrier payments. This allows the ability to make informed decisions about insurance contracting, procedures offered, and testing available to act in the company’s best interest.
• Alerts and flags to reimbursement risks and areas of concern. Real-time analysis of patient data enables the Revenue Cycle Management system to automatically alert staff to CPT coding errors, insurance company CPT code edits in place, payor policies regarding diagnosis codes or frequency of testing and insurance coverage policy limitations.
• Actionable insight for improved Revenue Cycle Management. Providing transparency from data and charge entry to reimbursement by CPT code with corresponding diagnosis codes, insurance appeal directions and revenue projection reporting, The Revenue Cycle Management system provides staff the tools they need to optimize efficiency and reimbursement.

Using our Revenue Cycle Management system, you are able to see the whole picture of what is happening through the payment cycle so you are able to react quickly, make informed decisions about carrier contracts and charge reimbursement, and accurately project revenue so you know what to expect.

Our approach is proprietary, fulling integrated, automated and proven. Let us lead your laboratory operations back into profitability while maintaining/improving offerings and level of service provided to your patient population. We do not subscribe to HOPD models, do not accept specimens from MSOs, and will not allow your organization to participate (through us) in any referral arrangements that provide incentive or income to the ordering physicians. We strive to build a low cost (no exploiting contracts for higher reimbursements – always trying to be in parity with other national laboratories in each market), very high quality service offerings that are beneficial to all stakeholders including the organization, payers and patients.

If you’re interested in what we can do to improve your goals for laboratory operations and profitability contact Michael Shaffer, CSO, US Medsci at mobile (770)823-7671