Laboratory RCM Case Study: Brown University Health

A Q&A with Christopher Burks, Vice President of Laboratory and Support Services, Brown University Health.

How laboratory-specialized RCM consulting helped a high-volume health system strengthen billing oversight, refine workflows, and create a durable plan for continued improvement.

“It is best to work with an organization that understands the laboratory. Lighthouse could speak directly to our needs, and the conversations flowed because we were all coming from the same world.” – Christopher Burks | Brown University Health

Background

Brown University Health operates a complex, high-volume laboratory enterprise. The laboratory performs more than 20 million billable tests each year and accounts for roughly 38% of the health system’s contribution margin, with an operating margin of approximately 14%. Even so, the laboratory was often viewed internally primarily as a cost center, making it essential for laboratory leadership to demonstrate both operational efficiency and financial performance.

The challenge was visibility. Brown University did not have a complete internal framework for auditing laboratory billing, testing whether charges accurately reflected the work performed, or identifying where revenue might be missed. Brown engaged Lighthouse Lab Services for a laboratory-specific revenue cycle review that could translate complex billing workflows into practical recommendations for laboratory, compliance, revenue cycle, and finance leaders.

 

The Conversation

Q: What prompted Brown University Health to bring in Lighthouse?

We did not have the internal capacity to perform the kind of comprehensive laboratory billing audit we needed. Administration often viewed the laboratory as a cost center, so we were constantly looking for ways to demonstrate that we were operating cost-effectively and signing out cases appropriately.

We had some internal informatics support that could perform retrospective checks, but we did not have a full framework to tell us whether we were billing correctly, whether there were compliance concerns, or whether money was being left on the table. We needed an independent, laboratory-focused review that could give us a clearer picture of both risk and opportunity.

Q: What made the billing environment especially difficult to evaluate?

Laboratory cases do not always follow a simple path. A bone marrow case, for example, may move to a specialized hematology group, then to genomics if there is a positive finding, and sometimes back to the anatomic pathology team. We found situations in which the billing workflow could follow each step even when the case should have generated a charge only once.

When that happens, corporate compliance may need to become involved, a broader retrospective review may be required, and patient accounts may need to be credited. At the same time, we also needed to know where appropriate revenue might not be captured. The audit had to look at accuracy from both directions: preventing inappropriate billing while helping us avoid leaving valid revenue on the table.

That visibility became even more important as our organization began moving from global billing toward a split-billing model. The change gave us a clearer view of the professional revenue associated with faculty, but it also increased the need for disciplined, well-understood workflows.

 

Q: Why was laboratory-specific revenue cycle expertise important?

We had considered another organization that performed audits, but it was not specialized in laboratories. For this kind of work, that difference matters. Lighthouse was able to speak directly to our needs because its team understood both laboratory operations and laboratory revenue cycle management.

Our pathologists were comfortable speaking with the Lighthouse team, and our operations staff could have an operator-to-operator conversation. We were all coming from the same world, so the discussions flowed naturally. Lighthouse did not need us to translate how the laboratory works before it could begin evaluating the revenue cycle implications.

 

Q: What stood out about Lighthouse’s approach to the engagement?

Lighthouse offered several ways to structure the work. The team could support an ongoing third-party relationship, work through a defined consulting engagement, connect more directly with our systems, or use a file-upload process. That flexibility was important because our organization was not going to allow a direct interface into our environment.

The resulting data-transfer process was more tedious on our side, but Lighthouse worked within our constraints. The team met us where we were instead of forcing the engagement into a single delivery model.

 

Q: How did the team handle the practical challenges of the project?

Once Lighthouse had the information it needed from us, the team turned the work around in a relatively short timeframe. It provided a clear readout, useful feedback, and a plan of action. The process felt practical and collaborative, even when our own data-gathering requirements made the project longer than expected.

 

Q: What changed as a result of Lighthouse’s recommendations?

Our pathologists are now signing out cases based on the recommendations Lighthouse provided. The work also helped us identify where we needed to look more closely at the technical side of the process, including whether certain cases were reflexing through the billing workflow in ways they should not.

Most importantly, the engagement produced usable workflows rather than a report that sat on a shelf. We are still using those workflows today. Lighthouse gave us a structure we could continue applying as we strengthened our own review capabilities.

 

Q: How was the final readout received by senior leadership?

The final presentation brought together the vice president of revenue cycle, corporate compliance, hospital finance leadership, and senior health system finance leadership. It was a high-level, cross-functional audience, and the response was positive.

That breadth was valuable because laboratory billing is not only a coding issue. It touches operations, compliance, revenue cycle, financial planning, and the way the organization understands the laboratory’s contribution. Lighthouse was able to present the findings in a way that was relevant to all of those stakeholders.

 

Q: What would you tell a peer considering Lighthouse for a similar engagement?

For a laboratory revenue cycle review, I would recommend working with people who are specialized in both laboratory science and laboratory revenue cycle. Lighthouse could have credible conversations with our pathologists, our operations leaders, and our administrative stakeholders. That common language made the engagement more effective.

 

The Lasting Value

For Brown University Health, the value of the engagement extended beyond a one-time audit. Lighthouse helped create greater visibility into laboratory operations, bringing leadership, clinical teams, and hospital departments together around a clearer understanding of laboratory workflows and their impact across the organization.

“With improved visibility into billing, operational processes, and financial performance, leadership is better positioned to identify opportunities for improvement, promote efficiency, and understand the laboratory not simply as a cost center, but as an important contributor to the organization’s overall financial and operational performance.” – Ann Lambrix, Executive Director of RCM Consulting for Lighthouse Lab Services.

Learn More: Lighthouse’s Revenue Cycle Management Team helps organizations move beyond simply working claims to understanding where revenue is being lost and why. Through billing audits, denial and appeal analysis, payer strategy, contract review, and broader revenue cycle consulting, we help clients protect earned revenue and build a more financially sustainable operation.

Contact us today to schedule a complimentary consultation.

 

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