CLIENT SUCCESS: Sonora Quest Laboratories


About Sonora Quest Laboratories

Sonora Quest Laboratories, a joint venture between Banner Health and Quest Diagnostics (NYSE: DGX), is part of the nation’s largest integrated laboratory system with approximately 3,500 employees serving more than 28,000 patients every day throughout Arizona. Sonora Quest Laboratories is the market share leader in clinical laboratory testing in Arizona, performing more than 85 million diagnostic tests per year. Sonora Quest Laboratories offers a local comprehensive test menu that encompasses routine, molecular, prescription drug monitoring, genetic/genomic, women’s health and pathology testing services. My Lab ReQuest provides consumers direct access to a diverse range of affordable screening tests that can be ordered online at SonoraQuest.com or in any of Sonora Quest’s 75 patient service centers across Arizona. Ninety-five percent of all testing is performed at the primary testing facilities located in Phoenix, Tucson, Flagstaff, Prescott and Yuma. Sonora Quest Laboratories is accredited by the College of American Pathologists (CAP), which is the gold standard in laboratory accreditation, helping laboratories to maintain accuracy of test results and ensure accurate patient diagnosis. This accreditation ensures the highest standard of care for all laboratory patients as CAP inspectors examine laboratory staff.


OPPORTUNITY

Sonora Quest Laboratories, a XIFIN RPM customer, was using a number of traditional methods to capture and validate insurance eligibility and coverage information to maximize reimbursement. However, the laboratory system continued to encounter claims without enough valid in­formation to fill in the missing gaps in insurance coverage data.


Being unable to identify valid insurance coverage for even a small portion of patients causes a loss in revenue collect­ed as well as an increase in operating expenses due to the costs associated with correspondence and other attempts to gather correct coverage information. The Sonora Quest team recognized an opportunity to improve their financial performance by integrating additional insurance discovery capabilities into their revenue cycle management (RCM) process.


SOLUTION

Because the FrontRunner Health Care (FrontRunnerHC) SaaS solution is integrated with XIFIN RPM, Sonora Quest turned to FrontRunnerHC for advanced insurance discovery capabilities. FrontRunner­HC leverages proprietary network connections with access to 2000+ data sources to find, cross-check, and fix patients’ demographic and insurance information, improving the ability for touchless clean claim submission and expediting reimbursement.


The team at Sonora Quest identified several important dimensions of success to measure, including:

  • Revenue

  • Cash Collections

  • Write-offs

  • Bad debt

  • Aging account receivables, such as 90 days or more past due

Sonora Quest took a staged approach to rolling out the integrated insurance discovery solution, which now covers the majority of its patients. While the Sonora Quest team con­tinues to use the XIFIN eligibility checks as a match/compare on the front end of the XIFIN RPM process, they also use the integrated FrontRunnerHC capabilities for automated insurance mapping to identify accurate infor­mation such as MCOs and Medicare Advan­tage Plans before sending expensive corre­spondence to patients requesting additional insurance coverage information.


RESULTS

The combined SaaS solutions are now helping Sonora Quest successfully bill and collect on more claims. Since going live with the addition of FrontRunnerHC to XIFIN RPM in 2017, the Sonora Quest team has measured the success of this integrated solution for insurance discovery.


Key findings include:

  • Days sales outstanding (DSO) has declined by 10-13 days.

  • Cash collection is more stable, enabling the team to reach their goals more consistently.

  • Amounts and cost of correspondence have decreased.

  • Fewer errors are getting to the Hold queue — meaning more errors are being resolved, faster.

  • Write-offs due to claims being too old to bill have gone down 10 to 15%, saving more than $1 million each year.

  • With increased insurance discovery automation, the Sonora Quest team is able to prioritize, focusing on solving the root causes of errors and denials and tackling error categories they had limited capacity to handle with their prior billing vendor.

  • The team can also focus on working with those clients that are contributing the most error types and share best practices.

Sonora Quest also saw a benefit of using FrontRunnerHC during the pandemic. While the govern­ment offered COVID testing reimbursement for uninsured Americans, it was a complex process. The team faced a backlog of 100,000 orders as they tried to address the process required by the Health Resources and Services Administration (HRSA). FrontRunnerHC’s automated solution helped them identify insurance coverage, verify uninsured patients, and comply with the HRSA process, increas­ing their collections more than twentyfold the first year.


Going forward, the Sonora Quest team is incorporating the XIFIN Client Portal within their work­flow. It simplifies and automates communications and collection of missing or corrected information from the referring physician and their office staff.


Sonora Quest continues to fine tune its strategies to maximize the value earned through the integrated XIFIN - FrontRunnerHC solution. Nichole added they are pleased with the collaboration between the three companies and the commitment she has seen to continual solution enhance­ments. For example, when the randomly generated Medicare Beneficiary Identifiers (MBIs) were introduced, it could have slowed down the reimbursement process considerably. A significant number of Medicare patients were not using their new number. In response, a solution was created to automatically identify and replace the old numbers with the new to correct the claims. Nichole shared, “While our team was looking for ways to solve the problem, they proactively identified the client need and evolved the solution to address what was happening in the industry. This type of partnership is very valuable.”



Case Study from XIFIN