Outgrowing RCM capabilities impacts revenue and customer experience

While increases in the use of genetic testing have been good news for Myriad Genetics, a 30-year-old company that develops and provides genetic tests, it also led to an increasingly complex reimbursement system. Due to the company’s growth, Myriad’s RCM capabilities no longer met its needs, resulting in the kinds of challenges that have become increasingly common in life sciences and other companies that venture into the third-party payment realm.

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Front- and middle-office operations were using labor-intensive eligibility and authorization workflows, which struggled to meet growing demands. As a result, rates of third-party reimbursement denials were elevated, along with billing inquiries that frustrated customers and slowed down collections. Vendor and cash management became more complex, making it increasingly difficult for employees to resolve account balances.

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Also in the front office, customers were finding Myriad’s ordering platforms and order-management capabilities difficult to navigate, leading to operational challenges. Of note, those inbound ordering challenges spawned data and workflow issues downstream in RCM workflows.

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In the C-suite, Myriad executives were asking for clearer insights into the growing challenges, but gaps in RCM reporting made these insights difficult to gain.

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Understanding that RCM challenges were impacting its bottom line—and worse, its ability to help more patients gain access to genetic insights—Myriad became committed to a “Connected” RCM transformation.