Opportunity

Laboratories are under continuing pressure to maximize operational efficiency in an increasingly challenging reimbursement environment and patients are demanding more involvement in their care. This means that more engagement and greater communication is required between patients, healthcare providers, and diagnostic companies.

Pathnostics wanted a technology partner that could provide a full “patient-to-payment” workflow by providing both the laboratory information system (LIS or LIMS) and the revenue cycle management (RCM) solution. The Pathnostics team was looking for an LIS that would handle all of their case types, including surgical pathology, gynecologic cytology, molecular diagnostics, and fluorescent in situ hybridization (FISH), among others. It was also imperative to have an LIS that can easily handle TCPC (technical component/professional component) partnerships as a way to grow the core business. At the same time, there was a desire by the Pathnostics team to have the LIS integrate easily with the revenue cycle management system.

To meet these needs, Pathnostics chose to implement XiFin® LIS and XiFin® RPM at the same time. Together the solutions help to deliver the right information, to the right people, at the right time.

Pathnostics chose XiFin LIS, the leading cloud-based LIS platform with the multi-specialty workflows and collaboration tools necessary to support the needs of the lab. Pathnostics selected XiFin LIS for a variety of reasons, including:

• Flexibility to easily manage test and workflow variety
• Ability to actively manage sample progress and turnaround
• Connectivity within and outside of the lab
• Capabilities needed to support Pathnostics’ TCPC program
• Ability to easily integrate with XiFin RPM for revenue cycle management for streamlined billing and reimbursement
• Intuitive, flexible cloud-based workflow management for streamlined laboratory operations
• Automating sample throughput by connecting to EMRs for electronic sample receipt and reporting, and laboratory instruments for results upload

XiFin LIS also provides comprehensive Diagnostic Patient Reports that synthesize and display all the information that needs to be conveyed, including multi-modal tests, graphical charts and diagnostic images, prior test results, and narrative and graphical interpretations. The reports are professionally branded with Pathnostics’ logo and other customized information. Comprehensive reports are an essential cornerstone in maximizing the value to referring physicians and coordinated care teams.

The Pathnostics team also selected XiFin RPM and XiFin outsource billing services. Outsourcing benefits, include:

• Access to expertise necessary to manage diagnostic billing and claims processing effectively
• Prevention against fraud, waste, and abuse by separating billing from coding, reducing compliance risk
• Optimizes billing and accounts receivable processes
• Visibility across thousands of payors
• Outsourcing with XiFin provides a full view of the RCM process at every stage to understand the financial status of every claim

Whether managed in-house or through XiFin outsourced billing services, XiFin RPM intelligently automates revenue workflow, facilitating claim and appeal filing, and reducing regulatory compliance risk. XiFin RPM also incorporates artificial intelligence (AI) as well as advanced analytics and visualization options in addition to its enterprise-grade business intelligence (BI) with built-in reporting packages for PAMA and FASB requirements.

Results

Quickly Responding to Changing Market Dynamics

At the start of the COVID-19 pandemic in early 2020, the team at Pathnostics began running COVID-19 polymerase chain reaction (PCR) tests. Immediately their testing volume soared to an unprecedented level requiring the LIS to apply additional system resources to accommodate the growth. The Pathnostics revenue cycle management team quickly found that the reimbursement process needed optimization in order to keep up with this pace.

With the addition of COVID testing, volume soared. A significant number of people were needed to manage the multiple touchpoints with payors and notifications. In collaboration with XiFin, many performance enhancements were introduced to streamline the workflow and update the prior process. A new COVID reporting module with batch reporting on results of COVID testing was also implemented. As a result of these improvements, the payor information was getting into XiFin RPM more efficiently and the Pathnostics team was able to submit claims in a timely manner, helping to speed reimbursement.

At the same time, there was an opportunity for Pathnostics to improve their patient demographic data discovery process. Working with XiFin partner, Waveland Technologies, Pathnostics gained patient demographic data discovery as part of the XiFin RPM workflow, which delivers billable insurance coverage when the payor data is incomplete or invalid. Within two weeks XiFin and Waveland had a new process in place which identified additional patient demographic data and insurance information for 45% of claims thereby significantly improving clean claim submission rates and expediting reimbursement.

COVID Testing

For the patients where active insurance coverage is identified, XiFin automatically submits claims to the corresponding insurance carrier. On the other hand, patients for whom active insurance coverage could not be identified had their information uploaded to the HRSA COVID-19 Uninsured Program Portal to obtain a HRSA Temporary Member ID, for COVID-19 claims reimbursement as part of the enacted legislation, the Families First Coronavirus Response Act, the Paycheck Protection Program and Health Care Enhancement Act, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and the Coronavirus Response and Relief Supplemental Appropriations Act (CRRSA), through the US Department of Health and Human Services (HHS).

Ongoing RCM Optimization is Critical

To maximize reimbursements, the Pathnostics team automated its appeals process within XiFin RPM. All appeal letters were rewritten to more explicitly address the rationale for the appeal, including clinical value, cost reduction, improvement in patient outcomes. They can also easily customize their appeals strategy by payor, which improves appeal success. Pathnostics actively tracks the percentage of claims paid and the value of the payments and as a result, identified opportunities to refine its eligibility response translation and client and payor billing rules to further streamline the billing process for more timely claims submissions, billing to the appropriate payor based on payor-specific requirements, and to ensure compliant billing practices.

Making the Patient to Payment Workflow a Reality

An integrated LIS and RCM provides labs with a comprehensive billing solution without having to create complex, third-party interfaces. In tandem with an LIS, an integrated RCM solution makes the transition from laboratory workflow process to revenue cycle management completely seamless. Pairing these two solutions puts a laboratory’s richest sources of business analytics—clinical and financial data—right at the team’s fingertips, to make better-informed decisions that will help the lab grow and compete more effectively. The Pathnostics team also appreciates the process by which LIS clients can submit requests and inquiries to the XiFin team, which responds in a timely and effective manner.

Pathnostics vice president of revenue cycle, Gemma English, said that she relies on XiFin Business Intelligence (BI) every day. In particular, she regularly focuses on error reports, payment reports, and dashboards. She also pulls ad hoc reports, as needed. She appreciates the XiFin RPM user experience. It is easy to train new employees much more quickly, often in a single day.

With XiFin LIS, Pathnostics management is able to get the data and reporting they need to run the business. They also now have a XiFin portal that enables them to communicate test results back to the ordering physician automatically, as soon as the report is available. Most importantly, they can deliver test results to patients directly through the XiFin Patient Portal.

They are pleased that they selected an industry-based solution provider that offers both an LIS and RCM solution that are designed to work seamlessly together. Using both systems together provides Pathnostics with the capabilities to:

• Get bills out faster, which improves A/R days
• Eliminate errors, whether keystroke or misinterpretations, which reduces denials and speeds claim processing and reimbursement
• Better understand the impact a change in one of the systems has on the other
• Optimize the patient-to-payment journey
• Improve communication and collaboration between all stakeholders in a patient’s care

Ultimately, the value to Pathnostics in having an integrated LIS and RCM solution is their ability to accelerate cost savings and better serve their patients and physician partners.