Sunday, January 26, 2025

Xifin Portal Offers Insights to Commercial Genomic Pricing

The revenue cycle consultancy XIFIN offers a fascinating open-access portal, called "Payor Intelligence Hub."  Find it here:

https://www.xifin.com/lp/xifin-payor-intelligence-hub/

Payer Transparency Monitor

Let's look at one of the resources, Payer Rate Transparency MonitorXIFIN writes, 

  • "This innovative tool now offers a more comprehensive view of the payor landscape, through interactive visualizations of more than 7 terabytes of data reported by payors pursuant to the CMS Transparency in Coverage (TiC) Final Rule.  
  • It allows providers to select their diagnostic test category, billing codes, and billing modifiers across one- or multiple payors to better understand and inform their market access and payor relations strategies."

Pull down menus offer several categories, such as Medical Devices versus Laboratory.   Each gives you several open-access options for CPT codes.  For example, select Molecular then BRCA 81162.  Here, you can see payment level data for CIGNA and UHC.   The Cigna weighted average is higher $2229, while UHC weighted average is $1782.   But you'll also note that Cigna has contracts at numerous price rates (many little bubbles) where UHC aggregates a lot of payments at $765 and $1094 (large bubbles.)


Total payment range is huge (e.g. $18 to $20,827).   That huge range of outlier low and high payments was also seen when CMS collected commercial payer data under PAMA in 2017, and gave the public access to a very large cloud database of anonymous rates.

Payor Policy Changes

Open access to some pages  for payor policy updates.  Here.

XIFIN White Papers

In addition, XIFIN has a "resources" page where they periodically issue or update white papers on lab reimbursement and policy data.