With advanced laboratory testing becoming the pacesetter for care in much of the healthcare community, prior authorizations (and their requisite denials) are continuing to rise as insurance payers struggle with containing their costs and controlling expensive patient care. As our partners, XIFIN, concluded after analyzing their collective intelligence, there has been a 311% increase in denials related to prior authorization, with a 52% increase for genetic and molecular testing, and a full 92% for proprietary testing.
As an example, according to XIFIN, the impact to non-invasive prenatal testing providers is a 62% increase in denials representing a cash impact of $98.72 per procedure. Compound that by sheer volume and the multiple effect overall becomes evident.
Improving Laboratory Revenue Cycle Management
From the profitability perspective, prior authorizations and their denial counterparts impact revenue and the ability to collect full reimbursement in a timely manner, but also negatively affects the patient experience.
A Solid Solution – Infinx Healthcare is partnering with XIFIN to launch an industry-leading laboratory revenue cycle management solution that fully integrates the Infinx Prior Authorization Software solution with XIFIN’s fully optimized RCM powerhouse financial system. With this complementary suite of technology services, a machine learning-enabled system is created that can integrate with a laboratory’s LIS to provide a state-of-the-art automated workflow.
With margins shrinking and reimbursement rates falling, automated processes that result in increased reimbursement, streamlined processes, and reduced denials will positively impact the bottom line for both hospital outreach labs and clinical laboratories alike. We believe that by integrating with strategic partners with core competencies, like XIFIN, financial management is enhanced end-to-end, delivering maximized revenue and profitability by utilizing AI-driven technology.
Streamlining Laboratory Prior Authorizations
As the menu of available genetic and molecular testing applications continues to grow, so do laboratory prior authorization requirements. While prior authorization responsibilities may rest with the ordering provider, often they are missing, or patient information is incorrect, creating a cascading follow-up process that wastes time and can impact patient care.
Prior authorizations can be processed before accessioning, or testing is even done by moving expectations to the point of care delivery. With an AI-driven software solution fully integrated with the lab’s LIS, required prior authorizations can be isolated, approvals initiated and sent, follow-up performed 24/7, and notification of successful resolution returned to the lab in real-time.
Using an intelligent automated system significantly reduces the need for burdensome manual follow-up (i.e., waiting on hold, faxing and refaxing, etc.), saving time and resources. A process that historically has taken from several hours, days or even weeks can now be accomplished in minutes.
Infinx Prior Authorization Software allows you to:
- Process prior authorizations in real-time through advanced automation using AI and machine learning
- Initiate prior authorizations within 24 hours and emergent requests in 30 minutes
- Reduce administrative and clinical time currently being used to process prior authorizations
- Integrate a bi-directional communication between the lab LIS, revenue cycle management system, and the Infinx Prior Authorization Software
XIFIN RPM allows you to:
- Prevent front-end denials through workflow reconfiguration
- Maximize efficiency, improve cash collections, and increase financial accuracy through a comprehensive automated laboratory revenue cycle management system
- Appeal denials through an automated workflow that includes individual claims and batch processing
- Gain insights through business intelligence reporting and superior analytics
Without a doubt, AI and machine learning capabilities are opening opportunities throughout healthcare and patient billing lifecycle. As the healthcare reimbursement structure continues to evolve, high definition solutions that equate to resource savings (from reduced administrative burdens) and revenue capture will pay for themselves and then some, easily bringing swift ROI to any laboratory organization.
With today’s technology advancements brought together through our partnership with XIFIN, laboratories, hospital outreach programs, and molecular diagnostic providers can facilitate patient access and improve their bottom lines through reduced costs and much greater revenue capture. When weighing the benefits of these technological advancements, consider that the financial savings recognized by applying automated and AI-driven software solutions far outweigh the cost for acquisition and implementation, both in terms of labor required and realized revenue.
Learn more about this exciting partnership with XIFIN and how our joint prior authorization and revenue cycle management solution can optimize your laboratory revenue lifecycle and streamline business operation processes. Schedule a time to chat with us here.