As consumers, we often take for granted the experiences we have in pharmacies, physician offices, and sometimes even hospitals. In these situations, we have direct interactions with the service provider, and usually know ahead of time what we can expect in terms of cost. Sure, there are exceptions, but as a general rule, we have a better understanding of the expenses for these types of services than we do for more indirect services, such as laboratories or medical devices like diabetes monitoring. The indirect nature of how labs and medical device companies serve their patients oftentimes leads to “surprise” bills where consumers receive bills weeks, or even months, after the office visit.
This is particularly challenging for medical device organizations and their patients when it comes to billing insurance carriers and beneficiaries. They have a lack of direct access to the patient, and oftentimes the physician, at the time of the device order. This results in a larger than average percentage of challenges from insurance companies related to incorrect coverage information and lack of medical necessity. Ultimately, this leads to sub-optimal payment for services rendered.
Kyle Fetter, Executive Vice President & General Manager of Diagnostic Services, XIFIN
Laboratories have dealt with similar issues over the years, especially when it comes to developing new and complex tests. In response they have developed a strategic approach where they leverage their billing system known as a revenue cycle management (RCM) system to maximize efficiencies and improve cash collection. Remote Patient Monitoring and Medical Device Companies can learn from labs and leverage these same approaches and billing solutions to their advantage.
There are many similarities between the RCM and reimbursement challenges encountered by clinical laboratories and those issues faced by medical device companies that are increasingly moving toward billing insurance carriers directly. Margins for lab services and medical devices continue to be compressed, thus optimizing claim reimbursement is critical to financial success. The most notable of these challenges for medical device companies, including companies that develop remote patient monitoring and wearable products are shown in the infographic to the right:
The good news is that the U.S. Food and Drug Administration (FDA) is approving new devices at a rapid pace. This is true for cardiac and glucose-related monitoring devices as well as new sleep med and other breathing-related devices.
The number of devices that monitor key aspects of our health only continue to grow and provide us optimal and efficient medical care. Unfortunately, FDA approval is only the first hurdle for most medical device companies when it comes to new product adoption. From there you encounter the classic “chicken and egg” paradox ― physicians may be interested in using the technology but will resist adoption so long as payors are not providing coverage, no matter how much they believe in the technology, and payors generally resist covering new devices until doctors are prescribing them.
When compared to traditional treatment, the ability to improve diagnosis and outcomes using these technological improvements makes a cost-effective RCM process imperative. Unless a company has a highly automated and effective process for collecting on device-related claims, it’s simply too complex and expensive to appeal a denied or improperly paid claim. Eventually, these claims end up getting written off or the patient share of the cost increases unnecessarily. This creates a bad patient and physician experience and a poor business model for companies making a significant investment in these technologies. Since physician offices generally do not have sophisticated RCM environments, it does not take them long to realize problems associated with getting paid, and therefore they will stop prescribing a device if they are at risk of not getting reimbursed.
To this end, many medical device companies find that an important step in removing the barriers to gaining market acceptance is by moving to a third-party billing model, which places control of the RCM process and associated reimbursement responsibilities in the hands of the device companies. While there are risks inherent with billing the payors directly, eliminating barriers to physician adoption is critical to the company’s success and ultimately gives the device company more control over both pricing and reimbursement as well as fostering direct patient relationships.
That said, dealing with new CPT codes, modifications in payor rules, fee schedules, and industry-specific regulations, isn’t generally the core competency of the company. Nor is it where they want to be spending their time and effort. This situation is identical for clinical laboratories. Device companies need an RCM partner that provides the system and expertise needed to handle all of the stringent coverage criteria in this market. This is exactly why the most successful clinical laboratories in the country choose XIFIN.
Clearly, an experienced RCM partner is critical to the strategy of the company in helping gain physician and thus patient adoption. As an example, at XIFIN we help our medical device clients by streamlining the submissions and appeals process and leveraging metrics on individual payors to significantly improve appeals success. Reducing the resource-related costs of performing an appeal, and strategically targeting the process, helps appeal more claims and allows the company to better demonstrate the necessity for payor acceptance and appropriate coverage.
XIFIN Is Your Partner for Medical Device Billing and Revenue Cycle Management
XIFIN RPM delivers the intelligent workflow automation, real-time connectivity, and financial integrity you need to take control of pricing and reimbursement. Not only does XIFIN RPM remove reimbursement obstacles, but it also gives you the tools you need to maximize efficiency and cash collection.
If managing the complexities of revenue cycle and reimbursement for your medical device company isn’t part of your core focus, you may choose to outsource the entire revenue cycle management process to XIFIN. Should you choose to transition part or all of the process in-house at some point, it’s an easy transition.
Whether you choose XIFIN’s in-house or outsourced partnership model for your medical device billing or revenue cycle management, you get a proven, highly-automated cloud-based solution for workflow automation, financial management, and regulatory compliance. Its automated workflow is designed to help your company maximize claim reimbursement for every device. Other billing systems leave money on the table from underpaid claims and higher labor costs. XIFIN RPM delivers 100% reconciliation, identifying the source of any revenue shortfalls. You get the visibility you need to pursue and appeal any denied or underpaid claims, with minimal staff intervention.
XIFIN RPM drives increased revenue and collections while improving operational efficiency by eliminating clerical decision-making. Start increasing your device adoption and cash collection rate while gaining the visibility you need to optimize your financial performance.
Learn more about XIFIN RPM for medical device companies.