Healthcare technology provider XiFin, Inc. alongside consulting firm Sage Growth Partners, has published an independent analysis that estimates millions of dollars are being lost by healthcare providers with their other sources of revenue. The publication titled \”Revealing the Unrealized RCM Revenue Your Metrics Miss\” states that the rising complexity of reimbursement, administrative difficulties, more regulatory changes, and larger responsibilities of the patients’ own funding will eventually cost significant money for the healthcare institutions that have not been able to control this leakage of money very well.
The study suggests that three areas interplaying with each other will be crucial to enhance performance in revenue cycles operations: Revenue Recovery, Operational Efficiency, and Patient Engagement and Access. Estimating Economic Recovery from Mid-Sized Ancillary Specialties
Using the data from stakeholder interviews, sector benchmarks, and specialty reimbursement data sets, the study illustrates the amount of extra revenue that can still be earned by mid-sized ancillary providers: for example, a typical mid-sized radiology company that makes about 350,000 claims per year with each case having on average $50, faces more than $2.6-million of potential gains in their total annual recovery. This consists of $1.75 million in reducing claim denials and underpayment cases, $677,000 through the efficiency of operations, and $214,000 by improving the workflow of patient payment procedures.
Pathology Practices can get around $870,000 worth of annual value. These are, mainly, $430,000 as denial & underpayment cases were decreased, $110,000 as savings via operational cost reductions, and $330,000 because of enhanced patient billing. All in all, the extrapolation of a baseline to major healthcare centers, clinical laboratories, specialty pharmacies, and DME providers would lead us to believe that the amount of unaccounted-for ancillary care income at a company-wide level runs in millions of dollars annually.
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“Revenue cycle teams are being asked to do more with less, especially in service lines where reimbursement is complex and administrative work can build quickly. Our work with XiFin focused on helping providers identify where capturable revenue may be lost and quantify what targeted improvement efforts could be worth,” said Dan D’Orazio, CEO at Sage Growth Partners.
Translating Research into Practice: The XiFin RCM Opportunity Explorer
To help healthcare executives pinpoint specific revenue leakage within their operations, XiFin has introduced the XiFin RCM Opportunity Explorer. The interactive platform applies segment-specific benchmarks across claim volumes, clinical specialties, and average reimbursement rates to calculate custom financial recovery projections.
The benchmarking tool is available through two channels: an online portal for independent self-assessment, or as part of a comprehensive XiFin RCM Opportunity Assessment, where revenue cycle specialists analyze an organization’s specific workflow dynamics, payer mix, and service-line composition.
Additionally, the research highlights real-world outcomes enabled by XiFin’s AI-driven RCM modular suite including a customer deployment that achieved an 85% reduction in appeal completion and submission times alongside a 60% decrease in overall appeal management costs.
