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Blog Posts by Author: Diana Richard

Automation of Prior Authorizations and Appeals is Possible and Key to Reducing Costs

Many issues are challenging diagnostic providers’ ability to maximize payor reimbursements, such as the significant increase in required prior authorizations (PAs) and the high cost of appeals.These issues are even more difficult for laboratories and remote patient monitoring device companies using traditional billing systems that have few or no automation tools. Hospital outreach programs and...

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UHC Suspends Prior Auth Requirements for Trichomonas & Candida, Will Adopt CMS Billing Policy for Prostates on January 1, 2021

Suspension of Trichomonas and Candida Prior Auth Requirements Beginning Oct. 1, 2020, for all commercial and UnitedHealthcare Community Plan plans included in the genetic and molecular testing program, UHC will be suspending prior authorization and notification requirements for the following three genetic and molecular CPT codes performed in an outpatient setting: 87480: Infectious agent...

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2021 CMS Proposed Medicare Physician Fee Schedule Released

On August 4, 2020 CMS released its 2021 proposed physician fee schedule. Unfortunately, under the proposed schedule, pathology and several other specialties would take the brunt of some significant reductions. This is largely the result of the redistributive effects of previously finalized changes to the office/outpatient E/M visits taking effect in 2021. The results of these reductions will have...

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G0416 Prostate Update for Cigna: Go-Live August 18, 2020

As announced by Cigna earlier this summer, beginning August 18, 2020 Cigna will require pathology groups to submit G0416 for prostate needle biopsies instead of 88305. Prostate biopsies will no longer be reimbursed using the 88305.XIFIN confirmed with Cigna that this applies to all Cigna plans, not just a select few. Commercial payors aligning with CMS guidelines on G codes is becoming a trend...

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Florida Society of Pathology Pushes to Retain PCCL Reimbursement from Medicaid

Florida Society of Pathology (FSP) held a call for members on July 15th to review the process the organization had taken upon learning the state’s Medicaid plan would no longer fund Professional Component of Clinical Laboratory (PCCL) reimbursement. Florida is among less than a handful of states, including California and Illinois, that sill receive reimbursement for PCCL charges for Medicaid...

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COVID-19: Maintaining Momentum During Volume Recessions

Pathology practices and laboratories across the country have begun to feel the financial impact of COVID-19. With most states placing a moratorium on elective surgeries until late April, or strongly recommending it, diagnostics providers are seeing anywhere from a 30-60% drop in their outreach volumes (see our Lab Volume Index for a more detailed breakdown). With the deterioration of margins in...

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Recapping the NILA Lab Leaders Forum and Mid-Winter Meeting

Last weekend’s NILA conference covered a number of items currently impacting laboratories across the country. Several topics, in particular, saw repeated discussions and, in some cases, vigorous debate from the audience. Here are the hottest topics and key takeaways from the NILA meeting:Prior Authorization’s Pinch This was potentially one of the most intriguing discussions revolved around prior...

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Understanding Trends in Denials & Patient Responsibility

A XIFIN analysis of aggregated client data and denial trends reveals billing policy changes are impacting laboratory financials and patient out-of-pocket expenses. Without proper workflow automation, increased denials are also impacting back-office productivity.Over the last eight years, the diagnostics industry has realized a significant decrease in revenue due to numerous reimbursement cuts....

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