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The Importance of Building Expect Pricing Into Your Revenue Forecast

In order to calculate the contractual allowance for third-party payors in legacy billing and revenue cycle management (RCM) systems, laboratories and other diagnostic providers had to calculate an estimate, based on an analysis of historical data at the payor group level (e.g. Medicare, Medicaid, Contracted Payors, etc.). In today’s environment, where many labs do not have contracts with all providers and there are many more tests, forecasting revenue becomes much more difficult.

XIFIN RPM delivers a FASB, GAAP, and SOX compliant and GL-ready financial package.

  • Designed to comply with the requirements of FASB ASC 606 from day one.
  • Detailed tracking at individual test/accession level ensures full reportability and referential integrity
  • Includes PAMA reports to easily generate the required submission data as well as detailed reports to help audit the data, including a breakdown of what is submitted versus excluded
  • Allows laboratories to efficiently model financial data to best suit their unique mix of tests, payors, and patients, providing a reporting formula for every class or type of contract they have with health insurers

To handle these challenges, the XIFIN system allows you to load expect prices at a payor group or at the individual payor level. You can then pull a XIFIN report that compares allowed to expect prices to identify any variances. Not only does this enable you to much more accurately forecast revenue, it also serves as a check and balance that your organization is receiving all of the reimbursements that you are due.

Even for situations where a payor does not have a contract with a specific provider, within a few months, you should have sufficient data to know the expect pricing. To get started, you can look at your top 20 payors to get an estimate of the relationship between allowed and expect, and the expect prices can be refined over time as you get more data.

Upon payment posting, you will know both the allowable (from the ERA) and compare it to the expect price to make updates and provide your CFO with a much more accurate revenue forecast. This makes things much easier for your finance team as they might be relying on a complex Excel spreadsheet to forecast off of gross revenue, which is both time consuming and less accurate than the recommended approach.

By building expect pricing into your revenue cycle management system at the individual payor level, not only will you be better able to forecast topline revenue, you’ll be able to analyze revenue trends and forecast revenue by payor. XIFIN RPM helps you make this easy. Specifically developed in a financial language with full referential integrity, XIFIN RPM balances every client to the penny, every month and delivers a complete financial accounting package with GAAP and Sarbanes-Oxley compliant financial data for the general ledger. The system gives your management team the accuracy and detail needed to manage the business with confidence.


Published by XIFIN
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