Prior authorization and appeals automation capabilities enhanced to improve reimbursements

Nov. 21, 2019

XIFIN announced prior authorization and appeals enhancements to its revenue cycle management (RCM) platform XIFIN RPM, and a strategic partnership with Infinx to reduce the associated administrative burden, cost, and complexity. Now, XIFIN diagnostic clients have multiple options in how they can secure and manage prior authorizations for proprietary, esoteric and toxicology testing, and remote patient monitoring, helping improve reimbursement and workflow, and reduce labor costs.

Together, XIFIN and Infinx directly impact diagnostic providers’ bottom lines by increasing their revenue through improved reimbursement rates and decreasing the administrative labor costs of complex diagnostic tests and remote patient monitoring devices. XIFIN RPM clients benefit from enhanced RCM automation, including front-end payor and CPT code-specific workflow configuration, back-end exception processing, and automated appeals workflow.

The Infinx prior authorization software is a cloud-based solution driven by AI and automation, and human expertise to deliver a best-in-class approach to patient access. The integration of technology and certified prior authorization specialists gives providers complete coverage of their prior authorization workflow from determination, initiation, status follow-up, through to verification of each authorization.

Health plan prior authorization policies continue to increase, putting an immense burden on clinicians, diagnostic professionals and patients. According to a recent survey from the American Medical Association, 88 percent of physicians reported an increase in prior authorization burdens over the past five years, with more than 90 percent reporting that prior authorizations delayed patient care and 75 percent reporting that prior authorizations can lead to abandoned treatment. As healthcare costs continue to rise, it’s critical that providers and payors turn to technology and automation to address inefficiencies and reduce avoidable denials.

Through the analytics available within XIFIN RPM Business Intelligence, as well as cross-customer trend data, XIFIN has identified the following prior authorization statistics:

·        Prior authorization-related denials across all customers have increased 311 percent, including a 92 percent increase specific to proprietary testing and 52 percent for molecular testing.

·         Women’s health prior authorization-related denials have increased by 62 percent in the last 24 months, representing a cash impact of $98.72 per procedure to non-invasive prenatal testing providers.

·         Cardiovascular disease-related prior authorization denials have increased more than 54 percent in the past two years.

XIFIN RPM is a machine learning-enabled RCM platform that optimizes billing and accounts receivable processes, as well as financial reporting and management. It also intelligently automates revenue workflow, facilitates claim and appeal filing, and reduces regulatory compliance risk. XIFIN serves four of the five largest IDNs and seven of the top 10 labs in the United States.

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