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How Real-Time Web Services Help IDTFs and Medical Device Grow Revenue Faster

Krista Nadolski
Sr. Director, Genetics and Novel Technologies, XIFIN

Michael Hein
Technical Implementations Manager, XIFIN

Diagnostic technology companies are known for innovation. The latest diagnostic and monitoring devices and applications collect more information than ever before, save time, and reduce healthcare costs, as well as helping physicians monitor patient metrics and provide proper treatment more quickly. The flipside of this trend however is that payors are often cautious in covering new devices and technologies in the absence of evidence such as clinical utility or medical necessity. This makes independent device testing facility (IDTF) billing and claim processing especially complicated. It is a chicken and egg situation. Providers may not prescribe a device unless it is covered by payors, yet payors will not cover devices until they achieve significant adoption.

IDTFs and remote patient monitoring organizations must continue to find ways to optimize their patient and physician experience. What many leaders may not realize is that an end-to-end revenue cycle management (RCM) solution may be part of the solution. Executives should consider an RCM vendor whose system and expertise are built to handle the stringent coverage criteria and complex rules prevalent in this market and maximize reimbursement. A next-generation RCM solution delivers the workflow automation, connectivity, and financial integrity IDTFs need to take control of reimbursement and maximize cash collections. Seek out solutions that have robust web services options. Web services enable internet-connected systems to inform one another in near real-time as new information becomes available and to share that data with other systems to enhance productivity and minimize risks of error. No hard-coded integration between systems is required.

For example, web services enable access to data exchange with providers and other third parties prior to and during claim processing. XIFIN offers a robust set of web services but some of the most popular allow IDTFs to:

  • Check eligibility automatically at the time of registration and/or before submitting claims
  • Calculate and deliver out-of-pocket estimates to patients
  • Share edits with the upstream systems to increase claim cleanliness, thus reducing denials and the need for appeals, and speed reimbursement
  • Upload documents (e.g., medical records or prior authorization forms) to improve the claims submission and appeal process
  • Deliver and retrieve data seamlessly
  • Keep systems in synch effortlessly

All of these web services enable IDTFs to engage with patients and referring physicians earlier and more deeply, which increases patient satisfaction, improves patient and referring client retention, and decreases write-offs. Web services are also used for patients to view statements and pay balances. 

There has been a lot written about surprise billing lately. To address the new surprise billing regulations and need for transparency prior to services, XIFIN developed a sophisticated patient responsibility estimator that leverages real-time eligibility and the concept of "expect pricing" to more accurately calculate and forecast a patient's out of pocket expense. Email or text notifications are sent to patients when their patient responsibility estimations are ready to be viewed. By providing patients with real-time estimates of their portion due, IDTFs not only achieve the elusive goal of interacting directly with the patient prior to services but also vastly increase the potential for collecting at or before the time of service. Receiving payments upfront can be very valuable for IDTFs. Too often a monitoring device is shipped to a patient, but the patient neither uses it nor returns it. Being able to engage with the patient upfront allows IDTFs to establish direct relationships with patients from a clinical and collections perspective, improving their ability to share their sophisticated device technology. Having the ability to communicate with referral sources and patients earlier in the process and providing them the ability to address barriers to service prior to the product being shipped can make the difference in IDFT or device profitability.

Web services also provide IDFTs with added flexibility. Services can be added over time when resources can be allocated to the project. A cloud-based RCM solution makes it easy to add new services when they become available. A purpose-built RCM solution not only removes reimbursement obstacles but also provides the tools IDTFs need to maximize efficiency and cash collection. With web services, IDTFs can easily gain visibility into potential billing errors, use a patient portal for online bill pay, and use a client portal to deliver pricing and eligibility to referring physicians and for information updates or error correction.

Using XIFIN Web Services to integrate with the following systems delivers significant benefits to diagnostic providers, their clients, and their patients.

Physician’s Office Systems

Results in fewer calls to the diagnostic provider to obtain information-related to services and pricing and faster response time leading to increased client satisfaction.

Back-Office Diagnostic Provider Information Systems

Ensures no duplicate order entry and fewer errors.

Front-Office Diagnostic Provider Information Systems

Minimizes front-end rejections and eliminates most manual reconciliation of electronic payments or cash to XIFIN RPM.

Portals or IVR Systems

Accelerates receipt of payments, provides 24/7 payment acceptance and processing, and frees up billing staff for more complex and valuable activities.

XIFIN RPM is designed for connectivity and interoperability, which enables secure, flexible, bidirectional communications and information delivery to and from other internal and external systems, such as patient and client portals. XIFIN web services operate flexibly, seamlessly, and with standard internet and healthcare interoperability and security protocols built-in. Real-time, bidirectional data exchange removes redundancy and data latencies. With XIFIN web services, IDTFs can improve the speed and security of communication and information exchange across the RCM process. 

If you would like a full list of web services offered by XIFIN contact us here.

Interested in strategies to improve revenue, patient & physician engagement for medical device & digital health providers? Watch this on demand webinar.

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Published by XIFIN
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