XiFin, a prominent provider of advanced healthcare information technologies, recently unveiled its groundbreaking Payor Rate Transparency Monitor. This innovative tool stands out by comparing contracted rates published by major health plan providers like UnitedHealthcare. It goes beyond traditional transparency efforts, delving into specific billing codes and modifiers established by the Centers for Medicare & Medicaid Services (CMS). Offering crucial insights, it assists laboratories and diagnostic providers in refining managed care, market access, and contracting strategies by revealing a range of contracted rates for common services and actual reimbursement rates.

This tool empowers providers to make well-informed decisions by comparing this data to their cost information, fostering confidence in rate negotiations. Beyond individual benefits, the Monitor illuminates the broader reimbursement landscape, potentially clarifying pricing data and industry averages. Notably, it exposes disparities, such as contracted rates for basic metabolic panels varying from less than a penny to several hundred dollars. Moreover, it highlights the unsustainably low average rates offered by some major payors, contrasting with more supportable approaches by others.

XiFin's Payor Rate Transparency Monitor draws on data resulting from the Health Plan Transparency in Coverage Rule, which compels payors to disclose billing codes for all in-network and out-of-network reimbursement rates to CMS. Despite being publicly available, these extensive health plan datasets are complex to summarize. XiFin's dedicated data scientists have meticulously processed and converted this information into easily consumable insights, providing cross-payor visualizations.

Key features of the Monitor include the ability to:

1. Explore In-Network Contract Rates: Make comparisons across common billing codes and related modifiers for UnitedHealthcare, Aetna, and Cigna.
2. Spotlight Detailed Visualizations: Engage with interactive bubble charts and comprehensive analyses showcasing lowest, highest, and weighted average rates for each payor for specific services.
3. Feature New Codes Monthly: Starting with 23 common codes, such as lipid panels and urinalysis,

The Monitor will introduce new codes monthly, providing ongoing insights for XiFin customers to benchmark their financial strategies against others.

Source: businesswire.com

 

 

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