VOL. 4, ISSUE 3 | JUNE 2025
Precision in Every Price: How XiFin® Empower RCM’s Pricing Logic Drives Accurate Billing and Faster Reimbursement
Getting paid quickly and correctly depends on accurate pricing. Small errors in pricing can result in big problems, such as denials, underpayments, manual rework, and delayed revenue. XiFin Empower RCM includes robust pricing logic to help ensure every claim is priced correctly the first time. The Empower RCM pricing engine automatically runs hourly (or as configured during implementation). Each time it runs, it identifies accessions/encounters eligible for pricing by verifying that the six required data elements are present: 1. Date of Service (DOS) 2. Test ID
Why It Matters: The Benefits of Configurable Pricing Logic Well-structured pricing logic does more than automate charge capture—it plays a direct role in financial and operational success. Empower RCM’s pricing logic helps you: ✓ ✓ Reduce claim denials and rework ✓ ✓ Improve reimbursement speed and accuracy ✓ ✓ Support compliance with payor and client contracts ✓ ✓ Maintain consistent pricing practices across test types, payors, and client agreements
3. Payor ID 4. Client ID
5. Place of Service 6. Final Report Date Once all six elements of pricing data are confirmed, Empower RCM’s pricing logic automatically evaluates numerous pricing variables, including:
After applying all applicable rules, Empower RCM calculates the total price for the claim and updates the accession’s financial status. All pricing activity is logged, offering full traceability for quality control, escalation resolution, and compliance. Pricing methods are visible in the Order Test screen. This transparency empowers your teams with the data they need to make informed decisions.
■ Single vs. profile diagnostics ■ Relevant payor and client rules ■ Modifiers and client billing categories ■ Consolidation logic
■ Discounts, capitation logic, and expect pricing ■ Special fee schedules and cost-based pricing for “no markup” states
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