Reimbursement Tied to Clinical Records: Impacts and Data Approaches to Improve Profitability
Diagnostic providers are the guardians of an enormous volume of healthcare data within their laboratory information system and revenue cycle management solutions. Yet, this data represents only a subset of the information often requested by payors. In the absence of the right data — and even in the possession of the right data — payors make reimbursement and coverage decisions that negatively impact the bottom line of labs, practices, molecular diagnostic providers, and remote patient monitoring organizations.
Attendees will learn:
• The impact of payor requests for additional information and medical necessity or experimental denials
• Payor behavior uncovered through detailed data analysis
• The importance of capturing clinical indicators, familial & patient history to prevent denials and improve appeals success
• Approaches and technology that enable the use of temporal data, analytics, and pattern recognition to identify anomalies that inform strategy, decisions, negotiations, and workflow
• Data curation best practices for real-world evidence development
• How well organized, centralized, and curated data sets can be leveraged to improve profitability
Moderator: Lori Anderson, Senior Product Manager, VisualStrata, XIFIN, Inc.
Panelists: Patricia Goede, PhD, MS, Vice President, Clinical Informatics, XIFIN, Inc.; Bruce Quinn, MD, PhD, Principal, Bruce Quinn Associates, LLC