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Helping you get “In-Network” Coverage – Faster and Easier

  • Executive Vice President & General Manager of Diagnostic Services

Achieving “in-network” coverage with payors for new or differentiated diagnostics, technology, or remote patient monitoring devices can provide significant advantages for novel diagnostic and medical device companies. The first step in gaining these advantages is getting payors to cover a new test or device for the applicable patient indications. The next step is to negotiate a favorable price point (i.e. the dollar amount for which your organization will receive reimbursement from the payor).

One of the benefits of gaining “in-network” status is better consistency in payment and lower patient responsibility for the service.  Processing services as “out-of-network” can lead to large variances in reimbursement rates and the patient responsibility portion making physician and patient adoption for a novel product far more difficult.  Furthermore, in many “out-of-network” situations, the payor reimburses the patient directly and your team is left chasing the payment from the patient. This is costly, elongates the reimbursement timeframe, and inevitably results in uncollected revenue and write-offs. If a provider can get in-network coverage at a favorable rate, larger percentages of the allowed rates getting paid by the carrier coupled with the lower amount due from the patient remove one of the most challenging barriers to test or device adoption.

Before a laboratory or device company gains “in-network” coverage, the organization is burdened with a lot of denials and appeals. Done manually, appeals drive up costs and are often unsuccessful. XIFIN RPM clients typically see a 300% increase in appeals success and 250% increase in staff productivity in performing appeals. By automating the appeals process, XIFIN clients can cost-effectively drive a maximum number of eligible appeals through the system. XIFIN also makes the appeals process easier by automatically incorporating the relevant supporting documentation into the appeal.

Last year, the XIFIN platform facilitated roughly 1.1 million appeals on behalf of our clients. This included more than 1,100 different types of appeals to more than 2,400 payor plans. As a result, we collected more than an additional $150 million for our clients. Optimizing appeal success helps collect the data for you to use toward gaining “in-network” status with payors and negotiating contract pricing.

XIFIN works closely with you to provide advice and guidance on your “in-network” strategy as well as to support you with an optimized appeals process that provides the data and business intelligence you need to establish the best negotiating position with payors. We also have a network of consultants we work with to help you get the best possible reimbursement agreements with payors.

Platform Statistics

1.1 Million Client Appeals

1,100 Different Types of Appeals

2,400 Payor Plans

$150 Million collected for clients

As a result, XIFIN RPM clients, whether using the system in-house themselves or through our outsourced billing service, are highly successful at earning “in-network” coverage status with strong reimbursement rates.  This means faster physician adoption of their products tied to better collections for services performed. We’d be happy to talk with you about using our system to your advantage, especially when it comes to introducing new diagnostic tests, technology, or medical devices. Contact us today! 

Published by XIFIN
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