Last week, XIFIN had the opportunity to present at G2 Intelligence’s 36th Annual Lab Institute. This was an exciting experience for us to showcase our company’s innovation and deep industry expertise in helping diagnostic providers rethink their business models and refine their technologies and competitive strategies to be successful in this changing market.
XIFIN executive chairman and CEO Lâle White addressed many of the problems that labs are facing in the post-PAMA world in her presentation, “Master Your Fate.” Here are some of the core strategies mentioned in her presentation:
Reporting and business intelligence
Solid reporting from labs is the key to mitigating future price cutsReport on actual allowables vs. paymentsValidate accuracy of payments
Optimize appeals activity to avoid reporting underpayments
Private payor contract negotiations
Leverage hospital to negotiate better lab pricing
Leverage regional presence and value-based pricing concepts
Cost reduction efforts
Workflow automation to remove clerical decision-making and achieve labor efficiencies
Reduce total cost of billing to below 4% while achieving bad debt targets
According to Lâle, the biggest factor in labs offsetting Protecting Access to Medicare Act (PAMA) cuts is the ability to employ proper fiscal leadership. Private payors will follow Medicare’s lead and try to reduce reimbursement in contracts, which are expected to be approximately 3.5% lower in 2018. Laboratories need to be prepared for contractual process reviews and reimbursement due diligence. Laboratories will be more effective if they understand the costs involved with the actual tests.
In addition to the PAMA presentation, XIFIN VP of Informatics Patricia Goede covered the importance of MACRA in her presentation, “MACRA: What is it? And Why is it Important?” Quoting CMS Chief Medical Officer Kate Goodrich, Patricia explained the goal of MACRA is “to have a single unified program with flexibility for all physicians that benefits patient care.” In addition, she gave these three defining factors of MACRA:
Physician reimbursement on Medicare Part B claims based on the quality of care and how that quality was reportedPhysician-based with very few exceptions
Reimbursement established and based on composite score derived from all types of submissions
For more information on MACRA, read Patricia’s blog post.
Prior authorizations were also a big topic discussed at G2 Lab Institute, as XIFIN EVP and General Manager of Diagnostic Services Kyle Fetter gave his presentation on “The Changing Landscape of Prior Authorization.” Kyle presented some interesting and alarming stats on prior authorizations:
$31 billion spent in prior authorizations per year40% of prior authorizations abandon due to complex approval policies
About 1% of a health system’s revenue is written off due to lack of prior authorization
Kyle proceeded to show how integrated prior authorization can help change these stats through:
- Higher adoptionClean prior authorization submissionsExpedited decisionsElimination of administrative/manual follow-upPrior authorization visibility and transparency
Prior authorization performance metrics
Beyond these informative presentations by XIFIN experts, we also had the pleasure of showcasing our newest and most innovative revenue cycle management (RCM) solution, XIFIN RPM 10. This is the industry’s first machine learning-enabled RCM solution for diagnostic providers. With its next-generation business intelligence visualization and analytics, XIFIN RPM 10 works to mitigate lost revenue, helping diagnostic providers of all types address the various reimbursement pressures and fee cuts they face due to evolving policies, such as PAMA.
Missed out on meeting with XIFIN at G2 Lab Institute? Catch up with us at one of our other upcoming conferences.