How Real-Time Connectivity Can Drive Revenue, Reduce Cost, and Increase Client Satisfaction

In today’s healthcare environment, there is a lot of uncertainty about what revenue will look like in the face of declining reimbursement, increasing payor denials, and staffing shortages. At the same time, there are greater expectations on the workforce to comply with regulations and payor reimbursement requirements, which can differ by payor and state. Therefore, it is essential for healthcare and healthcare services providers to have an infrastructure in place that supports efficient day-to-day workstreams, encourages compliance, and addresses reimbursement challenges.

An advanced revenue cycle management (RCM) solution with web services integration providing end-to-end real-time connectivity is key to optimizing revenue and workflow—and ensuring financial stability. Robust web services options, including patient or client portals, can help reduce cost, improve cash collections, improve patient and client satisfaction while freeing up billing staff for more complex and valuable activities.

Web Services

Web services provide two-way real-time data exchange. They enable “digital conversations” between internet-connected systems without requiring hard-coded integration. Web services integration provides access to data between providers and third parties before and during claim processing.

By enabling connected systems to share new or updated data immediately with other systems, productivity is enhanced, and the risk of errors is minimized. Utilizing web services can shorten the turn-around time to resolve issues to file a clean claim while also making employees more efficient by having access to real-time data.

XIFIN Web Services address a host of needs, delivering valuable benefits for providers including:

  • Validate errors before accession/encounter/visit is created and search, create, update, or retrieve information, reducing errors and claim filing time.
  • Update missing or invalid information submitted by the client and retrieve all demographic, insurance, and pricing data associated with a client, minimizing the time and labor needed to correct errors or access information.
  • Share edits with upstream systems to increase claim cleanliness, decrease denials and the need for appeals to help speed up reimbursement.
  • Check eligibility automatically at the time of registration and before submitting claims, calculate and deliver out-of-pocket estimates to patients, increasing patient satisfaction and collection rates.
  • Upload documents (e.g., medical records or prior authorization forms) to minimize denials and enhance the appeal process.
  • Deliver and retrieve data seamlessly and keep systems in sync effortlessly, eliminating duplicate data entry to reduce front-end errors.

Web services enable providers to engage with patients and referring physicians more deeply, increasing patient satisfaction, improving patient and referring client retention, and decreasing write-offs.

Patient and Client Portals

Portals collect and deliver data needed for patients and physician offices through an intuitive web interface.

Through an integrated Client Portal, ordering physicians and their staff can more effectively...

  • Examine statements at the line item level
  • View test information and pricing
  • Correct billing errors upfront to expedite reimbursement
  • Provide patients with an estimate of their out-of-pocket costs
  • Upload insurance cards and other requested documentation securely

A client portal helps providers more deeply integrate communication and data exchange with ordering physicians. Physicians and their teams are challenged by following up with specialty groups and labs via phone calls during specific office hours. Correcting missing information and work errors online when it suits the physician office’s schedule improves satisfaction, reduces errors, speeds reimbursement, and provides cost savings.

A robust, connected Patient Portal enables patients to log in, anytime to securely...

  • View their statement
  • Make credit card payments
  • Set up payment plans
  • Establish paperless billing
  • View patient responsibility estimate
  • View test results

A patient portal enables patients to securely access financial data, diagnostic results and make real-time payments online. The portal creates an additional patient touch point to increase engagement and present balances and billing options, which results in more revenue collected faster.

XIFIN Web Services Integration

Through XIFIN Web Services, integration with the following system can significantly benefit 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 System

Ensures no duplicate order entry and fewer errors.

Additional Benefits of Web Services and Portals

  • Compliance with No Surprises Act Good Faith Estimate: To address the new no-surprise billing regulations and the need for transparency before services are rendered, XIFIN developed a sophisticated patient responsibility estimator that leverages real-time eligibility and the concept of "expected 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 estimates are ready to be viewed.
  • Confirming Test Pricing for Client or Patient: Web services can be incorporated into a client’s existing portal or website, allowing clients direct access to real-time information on test pricing for clients and identifying outstanding patient balances from prior visits.
  • Resolve Errors and Automatically Update Billing in Real Time: The client can be notified automatically when errors are encountered. Updated information provided by the client electronically flows into the revenue cycle management system, automatically updates the accession/encounter record, and if the updated information resolves the error, the claim is then filed automatically without any manual touches.

Web services also deliver added flexibility to providers. 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 removes reimbursement obstacles and provides the tools needed to maximize efficiency and cash collection.

With web services, providers can quickly 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.

See how diagnostics innovators Ambry Genetics, BioReference, and Pathnostics are leveraging XIFIN capabilities to transform their patient and physician experience and improve their bottom line.

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Published by XIFIN
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