Sonora Quest Laboratories was using all of the traditional methods to capture and validate insurance eligibility and coverage information to maximize the opportunity to receive full reimbursement for its services. However, cases were still being encountered that lacked enough valid information to fill in the missing gaps and gather complete insurance coverage data.
Being unable to identify valid insurance coverage for a portion of patients caused a loss in revenue collected as well as an increase in operating expenses due to the attempts to gather correct coverage information. The Sonora Quest Laboratories team recognized an opportunity to improve its cash collections by integrating more effective insurance discovery capabilities into its revenue cycle management (RCM) process.
SQL evaluated several solutions before selecting XIFIN. Some of the key factors in choosing XIFIN were:
XIFIN CEO’s vision for a patient-centric systemRecognition of XIFIN as a customer-conscious organization with a wide variety of customers, enabling strong insight into industry trendsRecognition of XIFIN as a customer-conscious organization with a wide variety of customers, enabling strong insight into industry trends
The credibility of the XIFIN leadership team and experience within the lab industry
The SQL team sees XIFIN as an end-to-end solution for revenue cycle management (RCM), where scale and growth are never an obstacle because the system is cloud-based. The SQL team notes that:
XIFIN is a highly functional system that allows for editing in the session, in real-time. The most beneficial thing is that XIFIN created a lot of business information (BI) reports that let us know if we are getting paid correctly from an insurance carrier, what we should expect to receive, and runs reports for different CPT codes and by payor with just a few clicks. There are a lot of pre-configured reports for receivables, errors, days sales outstanding (DSO), and lots of granular reporting.
98% of the time in our business the patient gets their blood drawn, and the lab does our work, but we don’t see payment until insurance takes care of everything else. We needed a solution that helped us get paid at the time of service and facilitate a clean claim.
SQL also selected XIFIN RPM because it was “created by people who knew the lab industry well” and who “do an outstanding job maintaining relationships with all payors.”
Sonora Quest Laboratories adopted XIFIN RPM with the goal of streamlining the laboratories’ financial, clinical, and accounts receivables processes. The SQL team believes that the continuing transition from fee-for-service to payfor- performance translates to a need for labs to be nimble in managing the reimbursement cycle and that this is an area where XIFIN RPM will continue to add value to its business.
The SQL team also refers to the XIFIN analytics as being transformational in that “we have done extraordinary things in terms of using analytics to isolate and correlate issues with the data. This has helped us identify trends and the root causes of issues.” The SQL team recommends working closely with XIFIN throughout the implementation process and beyond to get the most out of the system.
Recommended Best Practice:
Work with XIFIN to get the most out of the system. “We were concerned we weren’t utilizing the system to its optimum extent. We asked for XIFIN to do its own independent audit and make recommendations, which has worked very well for us.”