XIFIN® Backgrounder Today, healthcare providers file more than 10 billion medical claims each year with each claim
requiring as many as 10 sub-transactions. Unfortunately, about 40% are filed manually. The billing management process
is burdened with complexities created by ever-changing state and federal regulations, the plethora of payer
requirements, a multitude of intermediaries involved, and typically outmoded systems. Billing systems have failed to
keep pace with these increasing demands. The general lack of IT automation combined with significant interfacing
challenges results in processes that are largely manual. IT is limited mostly to basic data storage, administration,
transmission and accounting, providing few tools to address the most costly problems - those caused by errors. Errors
are insidious to healthcare billing causing most of its delays, denials, write-offs, and administrative costs.
For ancillary service providers such as clinical reference laboratories, the typical per
claim margin is small, while daily volumes are enormous, allowing little opportunity to aggressively pursue denied
claims. The average industry write-off from 3rd party payers is about 15%. For clinical laboratories, this results
in a fully burden administrative cost of $5 - 7 per transaction, of which at least $3 are attributable to "inevitable"
errors. These costs do not include the costs and liabilities of compliance management issues.
XIFIN was founded in 1997 to address the high costs and complexity associated with billing
management. The founders recognized the need to rethink the entire process. They have a combined total of 100 years
of experience in financial management with clinical reference laboratories. They not only understand the intricacies
of processes such as claims filing and billing and their associated complexities, but have demonstrated expertise
through the successful creation of in-house solutions to address and manage accounts receivable and other financial
systems for some of the largest reference laboratories in the United States.
XIFIN's approach is simple in concept -- develop a billing system that focuses on:
Error Elimination - prevent, identify, track, manage, and fix
Compliance Management - embed compliance logic, monitoring, and reporting throughout
System Maintenance and Management - minimize laboratories' investments and expenses in
billing related hardware, applications, maintenance, and interfaces, as well as regulatory and standards compliance
The challenge was to develop the automated workflow, design the business rules, and then
appropriately apply the best technology to overlay the existing billing process for large clinical laboratories.
The developed transaction technology, e–AutomationTM, essentially automates
steps and the integration of steps and information communications, resulting in comprehensive automation of the
entire billing function. The system streamlines the entire process by eliminating manual steps through automation,
but remains consistent with established workflows. e–Automation employs four key technologies:
Conditional Processing - enables comprehensive automation and communication integration
that reduces errors, manual processing and bad debt
High–End Relational Database - optimizes data access and reporting while maximizing
scalability
"Universal" Communication Interfaces - enables access to and connection with all needed
data resources, users, process, participants and services to increase staff efficiencies
ASP Model - ensures the system is properly updated and maintained while reducing the
overall IT expense and capital related to creating and maintaining a billing system
Additionally, the system's design anticipates and accommodates the seamless integration of current
and future e-Health transaction technologies, leveraging the full potential of such things as on-line eligibility,
adjudication, remittance, EOBs, electronic funds transfers, coordination of benefits (COBs), referrals . . . Meaningful
access to these important advances will depend on web-enabled systems with these capabilities - a significant limitation
of virtually all legacy systems. The value of the system for a typical clinical laboratory is its ability to reduce:
Bad Debt - by up to 75%
Billing Related IT Staff, Investments And Expenses - by half
DSO's - by a third
Compliance Issues - minimized
Critical to ensuring continuous, reliable and compliant services, XIFIN establishes and maintains
partnerships with and interfaces/connectivity to clearinghouses, payers, government agencies and other on-line
information and data sources, essentially freeing laboratories from this never-ending maintenance responsibility. |