30th Annual Executive War College

The revenue cycle management (RCM) landscape continues to evolve, driven by increasingly stringent payor policies that make securing reimbursement for diagnostic services more challenging. To address these complexities, diagnostic providers must adopt data-driven strategies and agile processes supported by cutting-edge technology.

This session offers a sneak peek of the soon-to-be-published findings from XiFin’s 2025 Payor Denial Impact Report, offering fresh insights based on data from millions of claims. Join our experts as they dive into the latest denial and appeal trends, their impact on reimbursement, and the actionable strategies to capitalize upon/counter these trends.

This information-packed session will cover payor-specific insights such as leading denial reasons by payor group and performance benchmarks to evaluate and elevate your organization’s performance.
After discussing the trends evident in the data, our speakers will describe how these results inform XiFin-recommended best practices for denial management and appeals processing. This includes exploring strategies for navigating tricky payor policies and protocols to improve appeal outcomes, how to assess the financial impact and value of your appeals process through improved reimbursement speed and success rates and measuring productivity enhancements gained through an advanced appeals process.

Understanding performance results and underlying and sometimes hidden trends is key to tackling payor challenges head-on and achieving better denials and appeals success.

Artificial Intelligence (AI) is more than a buzzword—it’s a powerful tool delivering measurable ROI in diagnostic revenue cycle management. In this session, Northwell Health Laboratories, a trusted XiFin partner for over 20 years, shares its experience integrating AI-powered Exception Processing (EP) technology. This collaboration yielded significant advancements in claim management by prioritizing claims, aligning them with the most effective team members, and automating critical workflows.

Learning points:

• Quantifying AI’s ROI: Understand how AI technology can deliver clear, measurable returns in laboratory revenue cycle management
• Operational Efficiency: Learn how AI-driven claim prioritization and automation can streamline workflows and improve resource allocation
• Real-World Applications: Gain insights from a laboratory successfully using AI on the practical implementation and outcomes of AI-powered EP technology
• Future Innovations: Explore the latest advancements in AI and how they can further revolutionize RCM strategies to achieve greater financial success

Provider ordering and engagement—and the technology that supports them—are essential to financial performance. Anchored by real-world success stories from large national laboratories, this session covers the tools and metrics that drive successful strategies for engaging referring providers in a meaningful, outcome-oriented way.

One example: One large laboratory (over $50 million in annual revenue) partnered with XiFin to streamline workflows and migrate over 1,000 provider team members to using portals for insurance verification, patient financial responsibility estimates, and correcting missing information and billing errors. By proactively addressing billing errors through automated workflows, the client was able to resubmit more than 100,000 claims in 20 weeks, the majority of which were previously denied. This effort resulted in accelerated reimbursement timelines and an estimated future collection rate of over $10+ million.

Learning Points:

• Accelerate Reimbursement: Heighten provider engagement to proactively reduce errors and missing information—and downstream denials
• Workflow Efficiency: Leverage technology to eliminate paper-intensive costs, bottlenecks, and inefficiencies
• KPIs for Measuring Successful Provider Engagement: Quantity the effectiveness of your provider engagement strategy and identify opportunities for meaningful improvement
• Best Practices for Implementation: Appropriate allocate time and effort to ensure a successful, outcome-oriented engagement strategy

Navigating the increasingly complex prior authorization (PA) process presents significant challenges, especially for advanced molecular and genetic diagnostic testing, specialty medical devices, and remote patient monitoring services. While point solutions may offer an efficient first step for routine testing, a more programmatic approach is essential for addressing the intricacies of PAs for complex procedures. This session will illustrate how integrating PA strategies into the broader revenue cycle management (RCM) process provides the visibility and coordination necessary to achieve meaningful results.

Attendees will gain insights into:

• The challenges patients and providers face due to aggressive and opaque PA policies and how to advocate for coverage, patient access, and responsible reimbursement.
• Data-driven perspectives on tracking PA success: Does higher PA success correlate to improved payment outcomes? How many claims are denied for unrelated reasons?
• The critical role of specialized expertise, such as genetic counselors, in improving claim accuracy and reimbursement outcomes. Learn how deploying niche skill sets at strategic workflow points reduces rework and drives financial success.
• The improved operational and financial performance achieved by one XiFin customer who has adopted a collaborate, programmatic approach to managing prior authorizations.
• Recommend best practices shared by XiFin’s new PA partner, careviso, for maximizing PA success and overcoming common obstacles.

Join us to examine how a collaborative, programmatic approach to prior authorization can transform your RCM processes, optimize reimbursement, and deliver better patient and provider outcomes.