VOL. 4, ISSUE 3 | JUNE 2025
Precision in Every Price: How XiFin® Empower RCM’s Pricing Logic Drives Accurate Billing and Faster Reimbursement Continued from page 3 The Empower RCM Pricing Method Hierarchy The Empower RCM pricing process starts by considering the two main types of fee schedules: Empower RCM logs every pricing decision, creating a powerful audit trail. Use it to: ■ Track down root causes of pricing errors ■ Escalate issues quickly with full context
client-based and non-client-based. 1. Client-Based Fee Schedules
■ Train staff using real-world scenarios ■ Conduct QA reviews or internal audits
Tailored to a specific client ID, these reflect negotiated rates, special programs, or volume- based discounts for client billing. 2. Non-Client Fee Schedules
For insurance and self-pay scenarios, these reflect retail or contract-based payor pricing. The appropriate fee schedule is automatically applied based on the accession details and pricing logic rules. Powerhouse Behind the Scenes: The XiFin Empower RCM Pricing Engine
Runs hourly (or as configured) Identifies eligible accessions Applies pricing rules (contracts, modifiers, discounts)
Updates accession’s financial status Waits for joins if needed (based on “Max Days to Wait” configuration) Logs errors and creates an audit trail Management Tip: Use audit logs for pricing QA or escalation tracking.
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4 Calculates total charges
Next, Empower RCM follows a hierarchical pricing logic , evaluating each method in order until a valid price is found. Once pricing is applied using the appropriate method, the logic stops searching—ensuring consistency and accuracy. Key pricing methods applied include: ■ Manual Pricing: Price updates made by users on the Accession Test Update screen.
■ Cost-Based: Uses actual costs—common for reference labs or non-markup states. ■ Client Billing Category (CBC): Includes flat monthly agreements and carve-outs.
■ Incremental Pricing: Adjusts based on volume tiers, client or patient frequency and/or client types (e.g., research studies).
Continued on page 5
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