Opportunity

MercyOne Des Moines has a full-service reference laboratory that performs hospital-based outreach laboratory services. The laboratory outreach program is viewed by the hospital administration as a profit center. Historically, the laboratory outreach program used the Medical Center’s in-house billing processes for revenue cycle management (RCM).

The Medical Center then transitioned from in-house billing to a contracted outsourced billing service. As a result of this change, the outreach program managers identified some significant gaps – from money left uncollected to a serious lack of financial visibility. With the outsource vendor the lab team had no access to business intelligence (BI) at a granular level. For example, they were unable to identify and take action on clients with overdue balances.

It was also difficult to identify which clients were profitable and which were not. This lack of data insight made it challenging to make good business decisions for the laboratory outreach program. It also made it difficult to provide the required PAMA reporting.

This led the outreach management team to persuade the hospital administration to allow them to use an RCM system purpose-built for laboratories and other diagnostic services providers.

The laboratory management team places a high value on automation and client engagement. Many of the outreach lab’s clients have been with them for 20 years or more. The lab team solicited feedback from these clients and knew they wanted the RCM system to provide a way for clients to be engaged and self-sufficient so any issues could be resolved quickly.

Solution

MercyOne Des Moines selected XiFin RPM in 2018 to unify and improve its billing and financial operations. XiFin RPM is a comprehensive revenue cycle management system, purpose-built for the complex, high speed, high volume laboratory environment. XiFin RPM optimizes billing and accounts receivable practices, automates the RCM workflow, facilitates medical claim filing, and reduces regulatory compliance risk. This results in improved financial performance – both lower costs and higher cash collections and thus revenue.

XiFin RPM also helps organizations succeed by not only maximizing operational efficiencies and cash collections, but also by delivering detailed, actionable business visibility and insight to support making better business decisions down to the client level. Below is an illustration of how XiFin RPM is integrated with the other MercyOne Lab IT systems.

MercyOne Des Moines selected a delivery model for XiFin RPM that outsources most of the daily operations to the XiFin team. That said, the laboratory management team stays in close partnership and communication with XiFin as well as their clients.

Results

Even after taking into account decreased payments as a result of PAMA repricing exercises, the MercyOne Laboratory outreach team has seen an increase of approximately 15% in cash collections. With XiFin, MercyOne is able to maintain a solid business footing, even with PAMA reductions and other industry challenges. The organization has gained end-to-end visibility into the lab’s operational and financial performance to the client and procedure code level, enabling an understanding of profitability that was not previously available.

The level of automation in the RCM process has increased significantly and the MercyOne Des Moines lab team and XiFin continue to proactively identify and address additional opportunities for automation. For example, the joint team examined their denial codes and found new ways to add automation that better manages and rectifies denials. MercyOne Des Moines retains full access to the RCM system and can easily pull reports on its own, and can also access the client portal to address any client-specific questions.

The ordering process has also been highly automated; 95% of orders are now submitted electronically. This saves time, but perhaps more importantly, it also improves the quality of the data. For example, there has been a reduction in orders missing information required to process claims. Together, the team also standardized much of its pricing and substantially reduced its number of fee schedules.

The team at MercyOne Des Moines Laboratory continues building on its program successes to grow its hospital-based outreach laboratory revenue. Among areas of focus are new opportunities to expand services outside the current service area, as well as to bring in additional testing to the lab to gain efficiencies of scale and lower costs.