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Blog Posts by Tag: Compliance

Effective Compliance Programs are Essential to Manage Risk While Driving Growth for IDTFs (Part 4 of 4)

In the final part of this four-part blog series, we focus on effective compliance programs for independent device testing facilities (IDTFs) revenue cycle management (RCM). If you missed the first three blog posts, you could find them here.Any review of the RCM process needs to include compliance considerations. Compliance requirements keep changing, and a misstep can result in lost revenues,...

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Time Is Running Out to Voice Concern over the SPA 20-0010 Amendment

Important: Public input on this controversial amendment must reach the DHCS no later than Monday, July 27, 2020, to guarantee consideration before SPA 20-0010 is submitted. See various ways to contact the DHCS at the end of this article. The Department of Health Care Services (DHCS) plans to submit its State Planned Amendment (SPA) 20-0010 to the Centers for Medicare & Medicaid Services (CMS...

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The Growing Importance of Revenue Integrity in Hospital Outreach

Revenue integrity continues to be a hot topic in healthcare, even as its exact definition is still being hashed out. Broadly, revenue integrity focuses on reducing compliance risk while ensuring optimal reimbursement. The National Association of Healthcare Revenue Integrity (NAHRI) dryly states the goal of RI is “to prevent recurrence of issues that can cause revenue leakage and/or compliance...

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Fighting Back Against Increased Claim Rejections Under ICD-10

The Dark Report recently reported that the implementation of ICD-10 diagnosis codes in 2015 has resulted in disrupted laboratory test billing and collections, rejected claims, and increased demands for medical-necessity documentation.Lab billing experts, including Kyle Fetter, Executive Vice President and General Manager of Diagnostic Services for XIFIN, said that alongside the new codes, payors...

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Top 5 Industry News Topics of 2019

2019 saw many policy changes and newsworthy events that affected labs and medical billers. Here is a recap of our most-viewed industry news articles of 2019:1. New Codes Effective July 1, 2019 – Proprietary Laboratory Analysis (PLAs)The following new codes may need to be manually added to the HCPCS file by the MACs with an effective date of July 1, 2019. These new codes are also contractor-priced...

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Hottest Blog Topics of 2019

In 2019 we discussed many thought-provoking topics and trends regarding laboratories, medical billing, revenue cycle management, and much more. Here is a short recap of the top 5 most-influential blog posts:1. Hidden Landmines in Revenue Cycle Management: Industry Challenges, Patient Engagement, and Denial TrendsMany trends in payor behaviors and reimbursement go unnoticed due to outdated RCM...

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Critical Elements for an Accurate Total Cost of Billing

A miscalculation of the total cost of billing in a laboratory can lead to a weak bottom line and inferior laboratory accounts receivable performance. Often-missed line items, such as software maintenance, cost of reporting, business intelligence add-ons, and hardware costs, can result in a cost that's closer to four times greater than what was predicted.For example, a laboratory that fails to...

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Upsurge of Medical Necessity Denials Fueled by ICD-10

One perhaps unexpected impact of the adoption of ICD-10 codes in 2015 was the dramatic increase in medical necessity denials of clinical laboratory tests. In an interview for The Dark Report (November 25, 2019 edition), Kyle Fetter, XIFIN Executive Vice President and General Manager, stated the increased data provided by additional diagnosis codes has led to health insurers requesting...

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