Measuring Real Client Profitability for Diagnostic Providers with Large National Sales Teams

Finance and sales executives for diagnostics companies with large national sales teams are becoming sophisticated in measuring sales productivity in terms of number of calls, revenue per client, revenue per rep, and even revenue per call. To better serve clients and patients, providers can leverage analytics covering the full transaction cycle—order-to-cash—to determine actual client profitability and to determine the root cause of positive and negative fluctuations in revenue.

Order-to-cash analytics can help answer the following questions:

• Which tests for which clients are not profitable?
• What is the reason the client isn’t profitable, and how can it be fixed?
• What is the actual profitability contribution of reps and sales territories?

Understanding client profitability is a significant factor that impacts the expenses and revenue of a business. Examining client profitability, rather than just revenue generated by the client, will provide more accurate insight into how customers impact your financial health. Establishing key performance indicators (KPIs) that can be measured routinely and compared by clients will help quickly identify client inefficiencies and improvement areas.

Relevant metrics could include ordering patterns, ordering quality, adoption of automation, and its impact on reducing costs and improving outcomes. Information can be extracted from billing data regarding the ordering patterns of referring physician clients.

This information can be monitored monthly to analyze client profitability, including:

• Fluctuations in the payor mix, including changes in self-pay, out-of-network status, Medicaid, etc.
• Fluctuations in the test/service mix
• Medical necessity denials, prior authorization turnaround times, and other challenges
• Orders/requisitions with errors, such as missing or incomplete information, uncovered insurance, etc.

Client Analytics

Client analytics dashboards help identify client trends and monitor the trend by client for change. The dashboard allows the comparison of selected clients to your enterprise average.

Additionally, clients can be monitored by quarter by payor group, posted paid by payor group, accession count, billed price per accession, expected price per accession, and reimbursement rate.

Test/ Level Analytics

The Test Level Analysis dashboard provides a summary view of the ordering pattern of tests based on units and/or sales. The dashboard helps identify trends, analyze specific ordered tests, and view the most profitable tests. Paired with client-level ordering patterns, the information can be used to determine which tests a provider should add to its test directory. This report can also be utilized to compare actual profitability of the test compared to the expected average reimbursement when test was implemented.

Error Analytics

XiFin’s Error Processing Analysis dashboards detect the most common errors and enables diagnostic providers to identify specific errors associated with required prior authorization to determine how often those errors occur, how long it takes to correct them, and what is paid after the error is fixed.

The dashboard also provides a means to measure human vs. automated error correction efficiency and effectiveness. An upward trend of system-fixed errors could indicate the effectiveness of automated workflows, which reduce the need for manually fixing errors and thus reducing labor costs devoted to such tasks.

Automation/Engagement Analytics

Client portals are an important means for educating clients on requirements to process a clean claim and how to efficiently provide complete and accurate billing information, as well as facilitating a streamlined method for collecting additional information requested by the payor on the backend. The XiFin Client Portal Analysis dashboard provides diagnostic providers with insight into how their clients utilize the Client Portal. For example, it shows which clients are fixing errors using the automated process offered through the Client portal and which need additional advocacy on the importance and benefits of utilizing the portal to fix their own errors. Increased Client Portal usage translates to reduced labor efforts on these tasks.

Client Top Offenders Call

Finance, Sales and Billing leaders should meet regularly to review these analytics, discuss which clients are profitable, analyze which clients are not profitable and identify what corrective action needed. Often referred to as a Client Top Offenders Call, several XiFin clients hold the call monthly or quarterly. This call provides an opportunity for leaders to discuss clients which are not profitable, identify the root cause impacting profitability, determine a plan of action to make the client profitable, and also monitor the client for change.

Published by XiFin