Xifin has added two major payors, Humana and Blue Shield of California, to its Payor Rate Transparency Monitor. Labs will now have even more data to help negotiate their reimbursements.
By Chris Wolski
Summary:
Xifin, Inc. has developed the Payor Rate Transparency Monitor to help clinical labs navigate reimbursement rates from major U.S. healthcare payors, providing insights into contracted rates and aiding in business decisions.
Takeaways:
- Comprehensive Data Access: The addition of payors like Humana and Blue Shield of California significantly increases the amount of reimbursement data available, enhancing insights for labs.
- Enhanced User Experience: The updated tool features faster load times, responsive design for mobile and desktop, and options for targeted payor analysis.
- Best Practices and Additional Services: Xifin offers guidelines for evaluating payors and negotiating rates, and while the Payor Rate Transparency Monitor is free, consultative services are available for a fee.
Reimbursement is among the trickiest parts of doing business as a healthcare entity—particularly if you manage a clinical lab. New tests, new regulations, and evolving technologies make contracting with payors a minefield.
Adding Payor Rate Transparency
To help labs navigate this pricing minefield, Xifin, Inc., a provider of healthcare information technologies and services, developed its Payor Rate Transparency Monitor to give labs insights into the reimbursement rates for specific tests from major U.S. healthcare payors—United Healthcare, Aetna, and Cigna—providing the high to low rates and weighted averages.
The tool is necessary says Clarisa Blattner, XiFin’s senior director, revenue and payor optimization, because “we’re seeing lots of discrepancies in the way payors are contracting with providers.” The data available is non-geographic specific.
The amount of data that labs can tap with the Payor Rate Transparency Monitor is increasing exponentially thanks to the addition of Humana and Blue Shield of California (BSCA). According to XiFin, the addition of these payors provides deeper insights into in-network contracted rates across millions of payor-reported records. In total, these two payors process about 718,000 files, or 700 times more files than United Healthcare, Aetna, and Cigna had combined over the past 10 months.
Blattner notes that this combined data gives labs both better insights to help negotiate their reimbursement rates. It provides labs the data they need to decide whether they want their labs to even join a health network. She also noted many labs are out of network and both being in- and out of network could have benefits—the Payor Rate Transparency Monitor can help make that fundamental businzee decision.
Better User Experience
Along with the increased amount of data, the updated Payor Rate Transparency Monitor is also offering a better user experience with faster load times, responsive formatting for mobile and desktop devices, and the option to select specific payors for targeted analysis.
Additionally, the XiFin Payor Intelligence hub provides insights on denials, another key metric labs can use to help negotiate reimbursement rates and whether it’s worth joining the network.
Payor Rate Transparency Best Practices
Blattner noted that there are several best practices labs should follow when evaluating healthcare payors and negotiating reimbursement rates, including:
- Ensuring that you’re monitoring what payors are doing—are organizations being paid at the contracted rate?
- Whether there are any changes in the payor’s policies—in other words, examining trends and payment discrepancies.
- What is the payor’s demographic analysis?
XiFin provides the data in the Payor Rate Transparency Monitor free of charge, which is unique in the industry, Blattner says.
Blattner added that the company also offers a paid consultative service, including workflow analysis, industry and market insights, and deeper exploration of optimization opportunities.
Chris Wolski is the chief editor of CLP.
