Wuscott Automated Key RCM Bottlenecks for Southwest Labs

Southwest Labs and Wuscott worked together to reduce bottlenecks and increase revenue 6.7%.

Wuscott

4/30/20253 min read

Key Takeaways

  • Front-end automation (like insurance discovery) delivers fast ROI

  • Denial resolution bots require experimentation, but save time, employee burnout, and can yield significant cash from either immediate appeals or recovering claims destined for accounts receivable

  • Automation is not scalable, it is very specific requiring deep knowledge, actionable data, and valued partner

  • The combination of analytics + automation = compounding results

Background: In today’s healthcare landscape, laboratories are navigating a volatile billing environment: rapidly shifting payer policies, complex coverage requirements, and denials that chip away at revenue with every missed opportunity.

Southwest Labs (SWL), a high-volume diagnostic laboratory serving rural communities in New Mexico and the surrounding region, found itself facing these exact issues. Despite growing accession volumes and a robust test menu, revenue wasn’t keeping pace. Denials for missing information, unenrolled ordering providers, and eligibility gaps created friction at every stage of the revenue cycle.

This case study explores how Wuscott deployed targeted automation to streamline eligibility checks, reduce denial write-offs, and accelerate payment—without disrupting the lab’s clinical or operational workflows.

Insurance Discovery

SWL was experiencing a 7.2% ineligible/no-insurance rate. Many of these claims were being written off due to missing provider information and external insurance discovery vendors were expensive, costing more than $2 per patient.

The Solution: In New Mexico, 40% of patients have Medicaid which created an opportunity for a first discovery attempt to find insurance via the Medicaid portal, which is free. Therefore, Wuscott built and deployed a customized insurance discovery bot using Microsoft Power Automate.

The bot leveraged patient demographic data to check NM Medicaid eligibility via the state portal, flagging patients with active coverage that was missed during intake. If the patient had Medicaid, we immediately fixed the claim and sent it out.

The Impact:

  • Reduced eligibility-related rejections

  • Savings of $1,996 in external vendor costs (insurance discovery)

  • Built in just 4.5 days, delivering immediate ROI at over $300,000 for 2,439 accessions

Infectious Disease Denials

SWL’s infectious disease testing panels were experiencing denials from a specific payer, with two CPT codes either underpaid or outright denied:

  • 87798: Paid $0

  • 87632: Paid $148.90 (vs. expected amount)

The denial reason: missing or invalid information. But what was the payer looking for?

The Solution: Wuscott implemented an experimental appeal strategy, submitting variations of documentation to identify the exact requirements to secure payment. Once identified, we deployed a bot to manage both retrospective and prospective appeals.

The Impact:

  • Enabled faster turnaround on appeals

  • Saved approximately 0.3 FTE in manual effort

  • Yielded over $270,000 in reversed denials for 934 claims

Toxicology Denials

SWL’s infectious disease testing panels were experiencing denials from a specific payer, with two CPT codes either underpaid or outright denied:

  • 87798: Paid $0

  • 87632: Paid $148.90 (vs. expected amount)

The denial reason: missing or invalid information. But what was the payer looking for?

The Solution: Wuscott implemented an experimental appeal strategy, submitting variations of documentation to identify the exact requirements to secure payment. Once identified, we deployed a bot to manage both retrospective and prospective appeals.

The Impact:

  • Enabled faster turnaround on appeals

  • Saved approximately 0.3 FTE in manual effort

  • Yielded over $270,000 in reversed denials for 934 claims

Lessons Learned

Not all automation is plug-and-play. Each solution required:

  • Careful data analysis to isolate the root issue

  • Small-scale testing to prove efficacy

  • Ongoing bot management to handle login issues, portal timeouts, and payer quirks

  • To date, the bot has appealed 2,508 denials and derived nearly $120,000 in payments

But the upside? Once proven, these bots ran 24/7, never missing a step.

Conclusion: From Friction to Flow Wuscott helped Southwest Labs transform billing bottlenecks into scalable automation workflows. In doing so, we didn’t just recover revenue, we reduced friction, freed up staff, and created a new standard for what labs can expect from their RCM. Each automation requires experimentation, curation, and management, so if you’re still treating denials like a dead end, it might be time to call for help.

What Can Automation do for You?