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Blog Posts by Author: Diana Richard

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...

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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...

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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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Pathology Denial Metrics and Implementing a Strategic Appeals Processes

Pathology practices are becoming increasingly inundated with added requirements for prior authorization and medical necessity documentation. Insurance requirements are becoming more onerous, and lines are increasingly blurred around what is required for claims to meet individual payor standards for reimbursement. Failure to meet a single requirement, on even a small percentage of claims, is...

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UHC Implements DEX Z-Code Requirements on Medicare Advantage Claims Starting June 1, 2021

this post was updated on June 1, 2021. In March 2021, United Healthcare announced an updated policy for Medicare Advantage plans, whereas they will be requiring providers to include the appropriate DEX Z-Code identifier on claims beginning June 1, 2021. United Healthcare has announced this policy update has been delayed and will not be implemented on June 1, 2021. Further communication will be...

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Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension

In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, CMS has instructed the Medicare Administrative Contractors (MACs) to temporarily hold all claims with dates of service on or after April 1, 2021. Per CMS’s announcement, this is intended to only take place for a short period of time and should not have any significant impact to providers’ cash flow....

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The Remaining 20%: The Critical Role Appeals Play in Profitability (Part 2)

This blog post is part two of the series. View Part One. View Part Three. The first installment of this three part series provides data on denial trends in the pathology, molecular, and the clinical laboratory marketplace. Understanding root causes for specific denials enables us to initiate a strategic, multi-tiered approach to appeals. Measuring outcomes on all attempts to recover revenue,...

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The Remaining 20%: The Critical Role Denials Play in Lost Revenue (Part 1)

This blog post is part one of the series. View Part Two. View Part Three. In revenue cycle management we’ve always been of the mindset that 60-80% of billing is clean when the order is received and relatively simple to do well; however, it is how the remaining percentage is tackled that will determine whether your efforts are truly successful. That could never be truer than with the climate we...

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