Diagnostic laboratories continue to be a crucial part of nationwide efforts to provide access to COVID-19 testing, which is critical to managing the pandemic. XIFIN CEO Lâle White and Kyle Fetter, Executive Vice President & General Manager of Diagnostic Services, recently joined healthcare analysts from UBS for an audio conference to provide insights on the testing volume and capacity across its customer lab networks, discuss payor claims and reimbursement activity and share key learnings from its own COVID-19 return-to-work protocols. Among these, XIFIN reveals that antibody testing volumes are lower than expected – a potential concern as America re-opens.
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XIFIN Laboratory Volume Index (Graphic: Business Wire)
“COVID-19 has impacted volumes, mix and reimbursement for a variety of diagnostic providers. As we move forward to the next stage of this pandemic, it’s critical that information on the spread of COVID-19 be timely, accurate and based on science,” said Lâle White, Executive Chair and CEO at XIFIN. “Until a vaccine or an effective treatment is found, testing is the way we will derive the facts needed to manage the virus and potentially avoid another lockdown. We are seeing confusion surrounding antibody testing that is impacting availability of crucial data, and the key players involved – physicians, labs, payors and government – must all work together to educate and steer our complex health system into obtaining this necessary and scientifically-grounded data.”
Lab Testing Volumes Rebound Since March; Antibody Testing Notably Low
For the past three months, XIFIN has analyzed its vast stores of data to inform its Lab Volume Index, a weekly reporting of lab testing volume data across the US. XIFIN serves hospital-based and independent diagnostic labs and has been seeing 20 to 25% of all COVID-19 and antibody testing claims across the country via its system.
A high-level analysis reveals that COVID-19 started to impact routine testing volumes in March, as states began to shut down and impose stay-at-home orders. Routine testing levels were at a low of 45% in April compared to baseline pre-COVID levels, but have since rebounded to 80% overall, although some types of laboratories saw routine testing fall to as low as 34% of baseline. COVID-19 testing began to have an impact in late March, generating about 10% of baseline volume; as of June 15, it contributes 48% of baseline volumes, with another 7% attributed to antibody testing. In all, the combination of routine, COVID-19 and antibody testing is at 130% of baseline overall. Some lab segments are seeing nearly 160% of baseline volumes while others are still straining to meet pre-COVID levels, which demonstrates that capacity still exists nationally.
Notably, antibody testing volumes have been significantly lower than anticipated. XIFIN experts anticipate that these volumes will rise in conjunction with return-to-work activity but note that stronger coverage cooperation from the payor industry is needed.
Payor Response to COVID-19 Adds Stress to Already-Stretched System
XIFIN serves as an intermediary between laboratories and health insurance providers, exceeding $40 billion in gross annual claims billing for hospital-based and independent diagnostic lab RCM customers. As a result, the company is well-positioned to observe payor behavior when it comes to COVID-related claims. Under the CARES Act, private health plans are required to eliminate co-pays, deductibles and claim denials for diagnostics and care related to COVID-19. The company reports that the payor response to the pandemic has been slow and inconsistent, creating challenges to adequate reimbursement, ongoing testing plans and back-to-work efforts.
In March, XIFIN saw approximately 22% of payors had erroneously denied some portion of COVID-19 PCR testing claims initially. These erroneous denials have since dropped to about 8% today. Of those, about half will likely be resolved through payor education – good news for labs, their patients and a system that is already stressed. The remaining improperly denied claims for smaller regional insurers, amounting to 4% overall, will require appeals efforts to clear.
Now, antibody testing reimbursement has proven to be a bigger concern. Initially, XIFIN was seeing payors improperly deny or mis-pay 43% of these claims. After two months, this has decreased to approximately 25%. The bulk of these pertain to incorrect reimbursement rates for antibody testing, largely due to the use of pre-existing CPT codes. Despite Medicare setting a price point for COVID-related antibody tests in the $40s, XIFIN is seeing a median reimbursement rate of $20, with some payors reimbursing as low as $2. Some payors have agreed to review pricing for COVID antibody tests while many have stuck to the contractual pricing that was established for those codes, prior to the pandemic, which directly conflicts with the intent of the CARES Act.
As the demand for antibody testing grows and becomes an integral piece of return-to-work plans, XIFIN calls on payors to not only reduce the number of erroneous denials but to adhere to Medicare’s guidance on appropriate reimbursement rates for the industry.
XIFIN Leading the Way for Return to Work Protocols
As employers consider bringing more employees back to physical workplaces, COVID-19 and antibody testing is a key factor in returning to normalcy strategically and safely. San Diego-based XIFIN initiated its own employer-testing protocol for employees who have been deemed essential personnel. Partnering with a leading California laboratory and XIFIN’s health insurer, voluntary testing was offered to XIFIN employees by physician order. With plans in place to maintain a routine COVID-19 and antibody testing program for its employees, XIFIN’s framework can act as a model to enable the type of monitoring that will maintain employee and public confidence.
As businesses across the nation create their own return-to-work protocols, dual testing frameworks will be critical in providing the scientific data that will be needed for informed planning at the national, state and local levels.
A full replay of the UBS audio conference is available here.
About XIFIN, Inc.
XIFIN is a health information technology company that leverages diagnostic information to improve the quality and economics of healthcare across its portfolio of solutions, including revenue cycle management, laboratory information systems, precision medicine informatics and digital pathology consultation services. Its cloud-based platform offers real-time connectivity, workflow automation, data exchange and actionable insights, linking healthcare stakeholders in the delivery and reimbursement of care. To learn more, visit www.XIFIN.com, follow XIFIN on Twitter and LinkedIn, or subscribe to the XIFIN blog.