Opportunity

Carent Laboratory Solutions is designed to help its members sustain and optimize their laboratory outreach efforts. Being part of the network helps members:

• Strengthen their hospital’s financial position through new revenue generation
• Expand services and quality of care for the members’ communities
• Enhance ordering physician relationships and satisfaction by offering a full range of laboratory outreach services
• Enable patient choice and better coordination of care

Carent Laboratory Solutions’ network-based model also provides the infrastructure to compete with commercial labs and decreases cost and turnaround times. The network model also provides benefits to health plans, including:

• Reducing plan leakage to regional, non-contracted labs
• Decreasing the cost of hospital-based lab testing services
• Lowering costs of ancillary contracting with multiple hospitals
• Increasing hospital lab member access to preferred in-network services
• Minimizing out-of-pocket expenses for patients
• Not interfering with existing commercial lab national contracts

Carent Laboratory Solutions’ prior outsourced revenue cycle management (RCM) service provider was unable to provide the level of efficiency and communication that its member laboratories needed to be successful. Hold times for customers, lack of communication regarding requests for patient medical records, and inefficiencies in the billing and reimbursement process impacted Carent Laboratory Solutions’ relationships with its member labs. The prior outsourced billing provider was also unable to provide patient-level reconciliation. The Carent Laboratory Solutions leadership team was also concerned that its outsourced RCM service provider was limiting its ability to scale and grow its network membership.

As a result, Carent Laboratory Solutions and Collabatory.US teams began an in-depth evaluation and due diligence process to assess alternative outsourced RCM service providers, in 2021. They evaluated outsourced RCM service providers on a variety of capabilities, including:

• Scope of automation
• Reliance on human intervention in core billing and RCM processes, including denial management and appeals
• Integrated insurance discovery
• Integrated patient demographic data verification
• Data access and reporting

After interviewing several outsourced RCM service providers, the team narrowed the field to a short list of three potential vendor partners. The teams then conducted interviews with current users of each service.

Solution

After its comprehensive due diligence process, the Carent Laboratory Solutions and Collabatory.US teams selected XiFin Outsourced Billing Services. The thoroughness of the due diligence process, including speaking with existing XiFin customers, helped the team prepare for the complex and highly detailed implementation process.

The backbone of XiFin Outsourced Billing Services is the XiFin RPM technology platform. Traditional billing systems lack the financial integrity required to deliver accurate, auditable information. XiFin RPM optimizes billing and accounts receivable processes, as well as financial reporting and management. It also automates workflow, facilitates claim and appeal filing, and reduces regulatory compliance risk.

XiFin RPM delivers complete visibility to understand the financial status of every claim at every stage, from order submission to payment. XiFin clients gain access to the information and tools needed to ensure maximum reimbursement and strategically manage their business.

Today, XiFin provides Carent Laboratory Solutions’ member laboratories with:

• Order entry – Leveraging XiFin RPM’s interoperability with other systems of record, the outsourced billing team enters patient demographic and billing information into an optimized, automated workflow. Even process requisitions received through non-automated mechanisms can be integrated into the workflow.
• Claims processing – The XiFin team manages the entire process – from claims submission and acknowledgment to reconciliation and follow-up if required.
• Exception and error processing – The XiFin team updates patient demographics, remittance advice remark codes, claims adjustment reason codes, processing clearinghouse rejects, and returned mail.
• Payment posting – Payments from third parties, patients, and clients are posted automatically when there are no discrepancies and files are balanced. XiFin also manages manual payment postings when required.
• Customer service – The XiFin team communicates with ordering physicians to obtain or correct information, answers patient calls regarding benefits or billing, resolves customer issues, and manages customer feedback.
• File maintenance – In addition to setting payors up in XiFin RPM and making timely updates to necessary data, XiFin manages the entry of new accounts, pricing, test, and device information.
• Electronic data exchange – XiFin’s EDI team securely moves relevant files back and forth between payors and clients, ensuring everything is tracked and correctly reconciled, and loading it back into the system at the line-item level.
• Payor relations – The XiFin team acts as a provider advocate, identifying problematic payor changes or errors, raising these issues with the appropriate parties, and working to rectify them.

Results

Outsourcing RCM for laboratory outreach services can accelerate billing, claims, and appeals processing. It can also improve cash collections while helping organizations mitigate compliance risk. When outsourced processes are optimized, profitability and patient service can be maximized.

Carent Laboratory Solutions measures the success of XiFin Outsource Billing Services by monitoring several important metrics including:

• Clean claims submission – the timeliness and completeness of electronic claim submission
• Appeals – the timeliness of appeals submission
• Payment posting – the timeliness and accuracy of payment posting
• Claim follow-up – the timeliness of claim follow-up
• Patient statements – the timeliness of issuing patient statements when a patient balance is due
• Customer service – feedback from member laboratories, ordering physicians, and patients regarding any RCM-related concerns or issues.