Select Page

Industry Insights

Improving Denial Management Through Artificial Intelligence

As CMS and private payors have increased the use of Medically Unlikely Edits and prior authorization programs over that past decade to control costs and utilization, providers and their billers have had to commit an increasing amount of time and resources to denial management through the appeals process in order to show why they should be compensated for their services.

Oftentimes, it can be difficult to manually determine which denials are worth working, and which are low-value and should be written off. Fortunately, Lighthouse Lab Services offers an AI-driven solution, RCM Spotlight, to help efficiently identify and manage denials.


Issue identified:

We were contacted by an independent pathology practice in Louisiana that offers services including Fine Needle Aspirations, pap smear screening, full surgical pathology, and cytology services, as well as complete clinical laboratory testing. The practice was seeking an RCM solution that would allow them to begin at a 10,000-foot view and identify their largest denials, according to Josh Darby, COO of The Pathology Laboratory, Inc.

“Our process of working denials was very manual and time-consuming,” Darby says. “We could not easily aggregate similar denials and could not easily assign value to denials.”



RCM Spotlight uses a copy of the standard claim and remittance data labs and pathology groups exchange with their payers and analyzes the data to compare reimbursement and denial results across payers and similar providers. After a brief trial period of using the cloud-based software, Darby says his team was able to quickly identify $40,000 worth of easily corrected claims.

“It would have taken considerable time to correct these claims before having Spotlight,” Darby says. “As a result, Spotlight will speed up our cash flow, reducing our bad debt.”


Interested in learning how RCM Spotlight can improve your collections?

Lighthouse Lab Services offers RCM Spotlight to all existing clients and as a standalone add-on to improve your billing processes.

If you’re interested in a free demo or trial period, contact us today for a free consultation!


Sharing is caring!