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Blog Posts by Author: Diana Richard

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

Effective 6/1/2021, UHC will require pathology providers currently submitting a DEX Z-Code for the Medicare MolDx program to also submit their registered Z-code on UHC Medicare Advantage claims. In the same format as Medicare, the Z-code will be submitted in Loop 2400. While UHC will not require a separate registration of these z-codes, providers will need to ensure qualifying tests are...

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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 Two. 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...

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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...

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UHC Announces Designated Diagnostic Provider Requirements for Coverage

On February 24, 2021, XIFIN learned that UHC has delayed the application deadline from February 28, 2021 to March 10, 2021. The go-live date of July 1, 2021 is still in place. Additional requests to confirm how places of service 81, 11, 19, 22 are impacted has been requested from UHC. XIFIN will provide additional updates as they are received. UHC recently announced plans to implement the...

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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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