How a Precision Diagnostics Company Reduced Billing Costs by 50%

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When a leading molecular diagnostics company expanded its test portfolio by acquiring a new test, it faced a familiar yet formidable challenge: efficiently managing billing for a newly acquired, high-complexity test without overwhelming its existing revenue cycle management (RCM) resources.

The solution? A strategic, phased transition from the outsourced RCM provider managing the billing and revenue cycle management before the acquisition to its own in-house team using XiFin^® Empower RCM.

Challenge: Managing Complexity and Volume Post-Acquisition

Shortly after acquiring a molecular diagnostic test from another company, the customer knew its internal team wasn’t yet staffed to manage the additional billing volume. For the first year after the acquisition, the billing was outsourced to the vendor already managing it—but cracks quickly showed:

• The outsourced vendor relied on manual processes for much of its work
• Prior authorization workflows were slow and inconsistent
• Claims required frequent appeals, with medical documentation retrieved manually due to poor system integration

The result? Lower reimbursement rates, administrative inefficiencies, and high costs.

Solution: Bringing Billing In-House with Empower RCM

To regain control and scale effectively, the customer transitioned billing operations for the acquired test to its internal RCM team, consolidating all processes on Empower RCM.

Key improvements included:

Automating Authorization and Insurance Discovery

Using Empower RCM integrations, prior authorizations are triggered automatically through Glidian (acquired by Infinx in 2025) at the time of test ordering. Invalid or missing patient data is auto-corrected through XiFin’s Auto Match Compare process, and if coverage is unclear, insurance discovery is initiated via FrontRunner HC, reducing missed revenue opportunities.

Simplifying Documentation Management

XiFin Empower DocStore automatically captures and stores documentation from the customer’s laboratory information management (LIM) system, eliminating the need for manual uploads or record chasing. New documents from ordering providers are added in real time.

Streamlining Billing Through Two-Step Data Submission

Patient data and documentation are submitted early (first send), while final billing—including codes—is automatically submitted post-sign-off (second send). This two-step model ensures accuracy and supports compliance with payor requirements.

Optimizing Collections with Clear KPIs

Dedicated billing and collections teams use payor-specific strategies, automated appeals, and clean claim goals (targeting 78–80%) to drive faster, more accurate reimbursement.

Results: Financial and Operational Impact

By transitioning to a centralized, technology-driven model, the customer achieved:

• 12% Increase in Average Sales Price (ASP) – Strategic payor management and appeal automation boosted per-test reimbursements by $50
• 50% Reduction in Billing Costs – Eliminating outsourced vendor fees and manual processes drove dramatic cost savings
• Higher Efficiency and Fewer Errors – Automation across eligibility, authorization, and documentation minimized human error
• Better Forecasting and Reporting – Unified LIM and RCM data improved visibility into reimbursement trends and performance
• Scalable Reimbursement – Customized workflows and exception processing aligned with reimbursement complexity

Takeaway: Scalable, Automated RCM Delivers ROI

This customer success story exemplifies the tangible ROI of centralized, automated revenue cycle management for high-complexity lab testing. The customer transformed a costly, fragmented process into a streamlined, revenue-optimizing engine by consolidating systems, integrating vendors through APIs, and applying data-driven workflows. Read the full case study to see how automation made the difference.