Blog Posts by Author: Diana Richard
Overcoming Reimbursement Compression: The Latest Trends in Denials for Laboratories and Pathology Practices
This is the second article in a three-part series on denial and appeals trends. This article focuses on claim denial trends by payor group and by market segment, and denial trends for claims with a 2021 date of service differ from a similar analysis completed on claims with dates of service in 2018. If you missed the first article in this series on the importance of physician engagement in...
Denials and Appeals Management: The Importance of Patient Engagement
Revenue cycle management (RCM) for laboratories and pathology practices is constantly evolving in complexity. Payors introduce new and more rigid policies that make collecting reimbursement for services rendered increasingly difficult. XiFin recently published a new whitepaper, Overcoming Reimbursement Compression: The Latest Trends in Denials and Appeals Management for Laboratories and...
How Radiologists Can Maximize Their MIPS Scores by Documenting Performance
Under the traditional Merit-Based Incentive Payment System (MIPS), there are four weighted performance categories that contribute to your total MIPS score. For this blog, we’ll be taking a closer look at the Quality Performance category, which has an impact of between 30 – 85% on your total MIPS score, depending on your practice size and patient population. Meeting the requirements of the Quality...
Optum’s Laboratory Benefit Manager Program: Focus on CPT 81479
In 2022, Optum launched its new laboratory benefit management (LBM) program to help health plans reduce unnecessary lab testing through automated payment denial. The LBM program leverages Avalon Healthcare Solutions, which has developed evidence-based lab policies with automated software tools, and the MolDX program, which identifies and establishes Medicare coverage and reimbursement for...
2023 MIPS – Examining How Pathology Scores Are Calculated
In the 2023 Quality Payment Program (QPP) final rule, there were minimal changes to the traditional Merit-Based Incentive Payment System (MIPS). The final rule focuses on further refining MIPS Value Pathways (MVPs) implementation. However, there are no pathology-related MVPs at this time. Therefore, the majority of pathologists will continue to participate under the traditional MIPS program.Two...
Laboratory Test Claim Denials and Appeals Trends
I recently had the privilege of presenting an in-person workshop in conjunction with The Dark Report Executive War College on Laboratory and Pathology Management. The workshop was on the topic of “Latest Trends and Denials Involving Lab Test Claims.” In this session, I shared XIFIN insights into payor behavior changes and shifting claims processing protocols and highlighted the importance of a...
HRSA Set to Stop Accepting Claims on March 22, 2022
On Wednesday, March 15, 2022, the Office of Management and Budget (OMB) submitted a letter to Speaker of the House, Nancy Pelosi, regarding concerns of dwindling funds for the Health Resources and Services Administration (HRSA) Uninsured Program. In this letter, OMB stated that “On March 3, we requested $22.5 billion in emergency funding by mid-March to avoid severe disruptions to our COVID...
The Right Strategic Partnership Enables Pathology Practices to Maximize Financial Performance and Patient Care
Most of the individuals I know that have pursued careers in healthcare, have done so for one reason — they want to help people. With that responsibility it is inherent that patient care is a constant priority. As revenue margins continue to compress under pressure due to reimbursement cuts and the increased cost of doing business, it is more important than ever that medical practices and...
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