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The Cost of Preserving the Status Quo – It’s Not an All or Nothing Decision Anymore

  • AVP Product & Partner Marketing, XIFIN

Whether you’re a laboratory, pathology practice, molecular diagnostic provider, remote patient monitoring organization, or one of the nation’s largest hospitals offering ancillary services, factors causing revenue compression are threatening your bottom line. They include:

  • Testing volume and reimbursement related to COVID-19. With volume initially dropping as much as 60% during the pandemic, that is permanently lost revenue. Though increasing volumes of COVID testing offsets some of this revenue for many diagnostics providers, it does so at lower margins than their standard test mix.
  • The cost of more claim denials and appeals.
  • Lower fee schedules dictated by the Protecting Access to Medicare Act (PAMA), which came into effect in early 2018.
  • Changing regulations and billing practices that traditional billing systems can’t handle and therefore lead to lost revenue. Most traditional billing systems lack the referential and financial integrity required to deliver accurate, auditable information.

For many organizations, running on relatively slim profit margins has become the norm. These challenging times, underscored by lost revenue, can lead a leadership team to want to defer investments as a way to protect profits. But remaining in the status quo can end up costing you more than you ever dreamed. I believe not investing in technology that can optimize your RCM and increase reimbursements is a mistake. Here’s why.

If you're not using a modern RCM system, you're likely lacking:

Advanced rules-engines with built-in compliance logic
 
Real-time visability into errors and exceptions
 
Automated appeals process and payor specific forms
 
 
Automated eligibility verification and correction of missing or incorrect information
 
Patient and client portals
 
 
Patient responsibility estimator
 
 

When diagnostic providers weigh whether to invest in their information technology infrastructure, it’s essential to understand the true cost of accepting and maintaining the status quo, especially when deciding on RCM. Doing nothing has very tangible opportunity costs and business risks associated with it, including:

  • Business and Compliance Risk
  • Lost Revenue
  • Lack of Visibility into Business and Operational Performance
  • Limited Financial Integrity
  • Insufficient Client and Patient Engagement
  • Out of Date Systems and Processes

Outsourcing as an Alternative to the Status Quo

One misconception about RCM is that you need an in-house team to manage it. In actuality, healthcare executives are increasingly choosing to outsource their billing and claims management. According to a 2019 survey of managers, 90% of hospital leaders are evaluating whether to work with third-party vendors for cost efficiencies in both clinical and non-clinical functions.

Why? Because the benefits of outsourcing outweigh the RCM status quo. Diagnostic providers who outsource their RCM to XIFIN improve their cash collections on average by 20% to 40%.

Other benefits of outsourcing your RCM include:

Expertise

Outsourcing can provide access to hard to recruit and retain expertise, which is necessary to manage diagnostic billing and claims processing effectively.

Compliance

The most effective prevention against fraud waste and abuse is separating the billing from the coding. As such, providers can further reduce their compliance concerns by outsourcing their revenue cycle management to an RCM partner like XIFIN that is designed to exceed legal requirements.

Secure Cloud-Based Infrastructure

Outsourcing with a secure cloud-based platform minimizes time and money spent on maintenance of complex hardware and software environments used by traditional premise-based systems. More recently, cloud-based RCM has provided the flexibility needed to support changing work/remote work locations so that claim processing and payment posting are not impacted.

Payor Relations

With more than 3,000 payors, it’s virtually impossible for a single diagnostic provider to keep up. By outsourcing your RCM to a best-in-class RCM vendor that has a payor relations team, you benefit from the cross-payor acumen the payor relations team has developed.

Visibility and Control

Outsourcing gives you clarity at every stage to understand the financial status of every claim.

Flexibility and Scalability

Outsourcing lets your RCM be flexible to grow and respond to new market dynamics.

Not Ready? Rather Than Choosing the Status Quo – Outsource Part of Your RCM

At its core, revenue cycle management is about submitting clean claims to payors and tracking them until reimbursement is complete – as quickly as possible. Without an advanced SaaS-based RCM solution, it is very easy for a system to become outdated. To maximize your eligible reimbursements, you need a highly automated revenue cycle management solution that maximizes efficiency, optimizes cash collection, and has financial integrity. Frankly, most systems just cannot do this.

As a result, deferring or choosing not to upgrade your RCM system leaves you potentially vulnerable to severe business and compliance risks and actively prevents you from improving your operational and financial performance.

Irrespective of your profit margin, can you afford not to optimize your revenue cycle management? In almost all cases, the investment more than pays for itself in improved cash collections alone, and your compliance risk is further minimized.

XIFIN offers flexibility by allowing you to engage us at a level suited to your needs, whether it be in-house billing, outsourced to our internal operations, or a hybrid of both. With our unique model, XIFIN can help design a solution that fits today and provides the flexibility necessary to adapt to your changing needs in the future. For example, many start-ups choose to begin with fully outsourced billing services and later transition to in-house billing once they are ready with the team and the processes to handle these critical functions. Likewise, some established diagnostic providers that have been handling billing services in house choose to outsource for the flexibility it provides in terms of staffing and related costs. At XIFIN, we use XIFIN RPM to drive all outsourced billing operations, so we experience the value of the solution ourselves.

To learn more details about the true cost of maintaining the status quo, download the XIFIN white paper, “The Cost of Preserving the Status Quo.”

XIFIN was recognized as the No. 1 company for outsourced laboratory support and RCM in an independent survey conducted by Black Book Market Research LLC.


Published by XIFIN
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