First-of-its-kind online tool maps aggregate billing code reimbursement data from three top payors to improve provider financial health and support patient testing needs
XiFin, Inc., a leading provider of innovative healthcare information technologies and services that deliver artificial intelligence (AI)-enabled operational efficiency, interoperability, and simplicity, announced that it has launched the Payor Rate Transparency Monitor, the first-of-its-kind interactive visualization tool that compares contracted rates published by UnitedHealthcare, Aetna, and Cigna.
The Monitor takes a further step in advancing transparency of contracted rates across health plans by drilling down into specific billing codes and modifiers that have been developed by the Centers for Medicare & Medicaid Services (CMS). These data help laboratories and diagnostic providers in defining and refining their managed care, market access, and contracting strategies, by showing the range of contracted rates for the most common services, as well as actual reimbursement rates. Providers are then able to compare this to their cost data to make informed decisions and negotiate rates with renewed confidence.
“In a complex healthcare landscape, XiFin’s new Monitor empowers our customers with intelligence and insights to make informed, timely decisions that maximize reimbursement,” said Kyle Fetter, XiFin chief operating officer. “But beyond the benefit to individual laboratories, these data shed light on the reimbursement landscape as a whole and have the potential to clarify pricing data, such as industry averages for services, to inform policies. Among other things, the Monitor highlights absurdities, such as a basic metabolic panel with contracted rates that vary from less than a penny to several hundred dollars. Additionally, it underscores the unsustainably low average rates offered by some of the largest payors in the country for certain services, while other payors appear to adopt a more supportable approach.”
“The Payor Rate Transparency Monitor provides, in a clear and meaningful way, insights into how payors set contracted rates,” said Jondavid Klipp, President of Laboratory Economics. “Having this information will help level the playing field the next time your laboratory sits down at the negotiating table with a payor.”
The data analyzed by XiFin’s Payor Rate Transparency Monitor is a result of the Health Plan Transparency in Coverage Rule. The Rule requires payors to provide data files of billing codes for all agreed-upon in-network and out-of-network reimbursement rates to CMS. Though publicly available, these petabytes of health plan data are difficult to work with and complex to summarize. For the Monitor, XiFin data scientists have meticulously processed, analyzed, and converted such data into consumable insights, including cross-payor visualizations.
Leveraging rich data and robust visualization, the Monitor allows users to examine the following:
- Explore In-Network Contract Rates: Compare UnitedHealthcare, Aetna, and Cigna across common billing codes and related billing modifiers.
- Spotlight Detailed Visualizations: Dive into interactive bubble charts and comprehensive analyses that showcase the lowest, highest, and weighted average rates for each payor for specific services.
- Feature New Codes Monthly: While the Monitor starts with 23 common codes, such as lipid panel and urinalysis, each month XiFin will highlight a new set of codes.
“With over two decades’ experience within the complicated world of diagnostic revenue cycle, XiFin is uniquely positioned to provide an accurate understanding of the contracted reimbursement rate landscape. The Payor Rate Transparency Monitor’s data visualizations help users to quickly digest the data and see across contract rate highs, lows, and weighted averages by billing code to better inform payor relations strategies,” said Jeff Carmichael, senior vice president, engineering and analytics at XiFin. “By marrying this information to XiFin’s highly accurate and detailed revenue cycle data, XiFin customers will have amazing insight into how their financial strategy compares to others.”
