Saturday, December 30, 2023

Xifin Offers Advanced Payor Analytics on Lab Pricing

Xifin, whose services include a large lab billing consultancy, offers an elaborate analytics system for payor contracting and pricing data.   Find it at:

The online web page provides a sampler; for data contracts and strategic services contact Xifin.


For example, in the screen shot below, set to code 80048 (metabolic panel), United has 590 distinct rates, Aetna has 578.   United's weighted average is $8.39, Aetna's is $8.57.   

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For 88305, another sample available to try, a common biopsy surg path code, United has 3,718 distinct rates, Aetna 661.   United's weighted average is $95.38, Aetna's is $73.95.   

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The bubble charts show volume per price (Dollar-cent), for example, Aetna has concentrations at $58, $56, $61 and $65.

(Somewhat similar data was seen in 2017 CMS PAMA pricing data, including popular price bands and including very high and very low outliers). 

Hospitals & HHS

Federal laws require a level of hospital price transparency (at HHS here) but this doesn't display payor & independent lab adjudication.  



See an article at Politico on whether AI can reduce payor administrative burdens.