Bringing intelligent automation to the healthcare billing and payment lifecycle will improve laboratory revenue through increased reimbursement, streamlined processes, and reduced denials. With margins shrinking and reimbursement rates falling, artificial intelligence (AI) and machine learning technology stand ready to positively impact the bottom line for both hospital outreach labs and clinical laboratories alike.

By partnering the Infinx Prior Authorization Software solution with XIFIN’s fully optimized RCM powerhouse financial system, we are creating a machine learning-enabled system that is capable of integrating with a laboratory’s LIS and providing state-of-the-art automated workflow. Upon 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.
Based on client data, our partners at XIFIN identified a 311% increase in prior authorization-related denials. This has a significant effect on diagnostic providers’ labor requirements and profitability. Women’s health prior authorization-related denials, for example, increased by more than 60% in the 24-month period between January 2018 and December 2019. This creates a financial impact of close to $100 per procedure for non-invasive prenatal testing providers. Likewise, cardiovascular disease-related prior authorization denials rose more than 54% over the same 24-month time period.

Where Intelligent Automation Brings Added Efficiencies

Too often, claims are abandoned due to lack of pertinent insurance information, properly obtained prior authorizations, or unknown coverage details. When systems are implemented that bring AI-driven solutions to the reimbursement process, the reduction in errors coupled with the savings in time adds up to significant bottom-line improvements.

Streamlining Laboratory Prior Authorizations

As the menu of available genetic and molecular testing applications continues to grow, so do laboratory prior authorization requirements, and the future promises to hold an ever-growing collection of tests. While preauthorization 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.

By moving expectations to the point of care delivery, prior authorizations can be processed before accessioning, or testing is even done. With an AI-driven software solution fully integrated with the lab’s own 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 anywhere from several hours to days or even weeks can now be accomplished in minutes.

To illustrate even more clearly, the 2019 CAQH Index looked at the average cost per transaction for manual versus fully-electronic prior authorization transactions and found that automating the process would save an average of $9.04 for providers. Couple that with estimated savings for insurance payers of $3.27, and the industry-wide savings per prior authorization would be $12.31. Add that savings to the increased revenue recognized as denials and write-offs decline significantly, and intelligent automation solutions speak for themselves.

Most importantly, not only will this increase and accelerate the reimbursement cycle, but it should greatly improve the patient’s experience and confidence in their care.

What About Emergent or Complex Prior Authorizations?

When analyzing solutions of this type, remember that while most prior authorizations can be handled in this manner, some may still require a more hands-on remedy. Any solution implemented must be coupled with a team of highly-trained specialists to handle the small percentage of emergent, acute, or complex requests that present as outliers.

Without a doubt, AI and machine learning are opening opportunities throughout healthcare and the 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 advancements in technology 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 contact us to discuss AI solutions that improve your laboratories revenue and streamline the business operations processes.