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Practical Approaches to Diagnostic RCM Digital Transformation

A lot has been written over the past several years about digital transformation. While there is agreement that digital transformation is a valuable investment, often it isn't easy to know where to start. The COVID-19 pandemic has so increased volume for many diagnostic laboratories that digital transformation is no longer an option. It is mandated to keep up with the pre-pandemic levels of routine lab testing, which has mostly returned, plus all the COVID-19-related testing. This volume surge has accelerated digital transformation initiatives in many laboratories.

The XIFIN team recommends that laboratories start digital transformation initiatives with data and analytics. This includes analyzing process data across the entire claim lifecycle to identify where remaining manual parts of the claim billing and reimbursement process are negatively impacting:

Productivity

Effectiveness

Profitability

The COVID-19 pandemic also accelerated telehealth and patient self-service tools. It is imperative to leverage automation and integration to  serve better  patients' needs during a public health emergency. Self-service capabilities, such as client and patient portals, are natural extensions of the revenue cycle management (RCM) process moved closer to the user. Using digital tools, such as insurance discovery, to move and automate portions of the RCM process to where they are most effective improves customer satisfaction and reduces operating cost, thus boosting profitability.

A National Laboratory Case Study

A XIFIN client  with a national diagnostic laboratory implemented a digital transformation process following the XIFIN team’s recommended approach. As suggested, the laboratory team started with data and analytics. The team reviewed key data, including:

  • Monthly financials
  • American National Standards Institute (ANSI) denial trends
  • Profitability by client
  • Payor mix and denial trends by client
  • Fee schedule
  • Payors on hold

 Next, the laboratory leaders set specific, measurable goals for digital transformation results, including:

  • Reducing average days in accounts receivable (A/R)
  • Increasing collections of claims with A/R days greater than 120 days
  • Decreasing timely filing delays
  • Declining turnaround time for resolving missing or incorrect information

Then the laboratory team embarked on adding automation to improve productivity and data quality while reducing cost. For example, the denial and appeals processes were automated, including the attachment of relevant clinical documentation. Finally, the lab set up a pilot of a client portal. To evaluate the client portal's impact, the traditional process was compared directly with the new process leveraging the client portal. The client portal was shown to provide significant value.

Ultimately, by deploying the client portal, this lab was able to reallocate the resources that had spent time on manual processes to more complex transactions, such as appeals processing.  Based on these results, there is no doubt that adding automation and providing digital resources to help clients, such as referring physicians, reduce their A/R days increases profitability.

Another way a diagnostic provider can increase profitability is to outsource its billing and RCM process to XIFIN. The XIFIN team is continually testing new ways to automate even the smallest parts of the process to improve profitability further.


To learn more, watch and listen to the full discussion in this Dark Daily webinar “Practical Approaches to Diagnostic RCM Digital Transformation that Increases Client Engagement and Profitability.”

Watch Now

Published by XIFIN
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