A Revenue Cycle Transformation for a Leading Diagnostic Lab, Boosting Collections and Reducing Denials
An independent diagnostic laboratory, specializing in biopsy testing, was poised for growth but lacked the necessary billing expertise and systems to sustain its financial health. With over 25,000 biopsy samples processed annually and $54M in annual billing, this reference lab needed a reliable partner to manage its complex revenue operations.
Client Profile
Type: Independent diagnostic lab
Annual Volume: 25,000 Biopsies
Systems Used: Medisoft for billing
The Problem
The lab faced critical challenges:
- No prior experience in biopsy lab billing solutions
- Lack of an EMR platform for efficient workflows
- Authorization gaps leading to revenue leakage
- Eligibility verification errors and incomplete patient information
- Manual payment processes are slowing down reimbursements
Without a clear plan, the lab risked incurring denial rates above industry benchmarks and delayed payments, which threatened its profitability and future expansion.
The Guide
Plutus Health stepped in as a trusted partner, bringing proven expertise in lab billing services, diagnostic lab billing services, and RCM for laboratories. Acting as both guide and implementer, Plutus provided the systems, processes, and education the lab’s team needed to succeed.
The Plan
To stabilize operations and boost collections, Plutus implemented a comprehensive laboratory revenue cycle management strategy:
- Introduced Medisoft + TriZetto EMR integration to establish a reliable billing foundation
- Implemented proactive eligibility verification before sample processing
- Closed authorization gaps through client education and standardized approvals
- Established a pre-billing audit process to improve the clean claim ratio to 98%
- Transitioned the lab from manual to automated EFT and ERA workflows for faster cash flow
- Reduced AR >90 days to under 30% through tighter processes and timely appeals
- Leveraged Anodyne automation platform for patient e-statements, secure payment links, and text reminders
- Developed a custom dashboard to monitor collections by provider and location