Success Story: Sonora Quest Laboratories
Featured Customer
"Given the complexity of healthcare billing, especially in the lab industry, SaaS will help us leverage external expertise without replicating resources in house. By utilizing the rules- based engines inherent in the XIFIN software, we will see efficiencies in our process, improvements in our reimbursement and revenue cycle, plus enhancements in our reporting capabilities. With these improvements, we expect to see an immediate return on our SaaS expenditures."
- David Lutich, Former CFO, Sonora Quest Laboratories
Opportunity
Sonora Quest Laboratories was using all of the traditional methods to capture and validate insurance eligibility and coverage information to maximize the opportunity to receive full reimbursement for its services. However,
cases were still being encountered that lacked enough valid information to fill in the missing gaps and gather complete insurance coverage data.
Being unable to identify valid insurance coverage for a portion of patients caused a loss in revenue collected as well as an increase in operating expenses due to the attempts to gather correct coverage information. The Sonora Quest Laboratories team recognized an opportunity to improve its cash collections by integrating more effective insurance discovery capabilities into its revenue cycle management (RCM) process.
Solution
To make insurance discovery easy for XIFIN clients, FrontRunnerHC insurance discovery capabilities were integrated with the XIFIN RPM solution. Sonora Quest Laboratories was already using XIFIN RPM for revenue cycle management and met with the team at FrontRunnerHC to learn more about the company’s insurance discovery capabilities. FrontRunnerHC now provides Sonora Quest Laboratories with access to real-time patient eligibility data by accessing a variety of databases to cross-reference patient identification records, as well as insurance and eligibility information, helping Sonora Quest Laboratories successfully bill and collect on more claims.
Sonora Quest Laboratories has taken a staged approach to its rollout of the integrated insurance discovery solution. The organization continues to use the XIFIN RPM eligibility checks as a match/compare on the front- end of the RCM process. It uses the FrontRunnerHC insurance discovery capabilities as its last action before sending letters to patients requesting additional insurance coverage information.
Results
Sonora Quest Laboratories implemented the integrated XIFIN RPM and FrontRunnerHC insurance discovery solution with the objective of being able to bill insurance for more of its services. At the same time, Sonora Quest Laboratories is undergoing a reengineering process to improve its denial processing. While the organization has seen positive results so far, the full benefits of the automated solution has not yet been realized due to the staged rollout process. The Sonora Quest Laboratories team is measuring the success of the integrated solution for insurance discovery by tracking the reduction in denial rates as well as the increase in cash collected.
Going forward, the Sonora Quest Laboratories team expects to see a reduction in overall error processing rates, improvement in cash collections, as well as a reduction in claims allocated to a final “hold” queue. In coordination with the reengineering of the denial processing, the company is actively engaged in fine-tuning its strategies to maximize the value earned through its investment in the integrated XIFIN FrontRunnerHC solution.
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About FrontRunnerHC
FrontRunnerHC has partnered with XIFIN to seamlessly integrate their PatientRemedi Insurance Discovery application with XIFIN RPM, delivering valid insurance coverage for self-pay patients and reducing the staffing expenses associated with discovery.