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Blog Posts by Tag: Compliance

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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6 Key Areas Lab RCM Provides Value

Too often, hospital outreach and outpatient lab leaders have enterprise revenue cycle management (RCM) systems pushed on them in a misguided attempt to save money or increase the ROI of the health system’s hefty EMR or EHR technology investments. However, a purpose-built laboratory RCM more than pays for itself while improving enterprise system ROI by increasing cash collections while reducing...

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ACLA Issued a Statement to CMS on Automated Chemistry Test Panels

After claims from the Government Accountability Office (GAO) in November of 2018 that labs unbundling automated chemistry test claims will correlate to a drastic increase in Medicare spending, many industry thought leaders are responding. Most recently, ACLA has released a statement claiming that GAO’s assumptions are not backed by Medicare’s public claims data, or by ACLA’s own survey conducted...

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Hidden Landmines in Revenue Cycle Management: 4 Rules of Report Analysis to Follow (Part 3)

This is the third post of a three-part blog series focused on key areas of business performance management for pathology practices, hospital outreach programs, diagnostic laboratories, and molecular diagnostic providers. The other blog posts in this series can be found here: Part 1 and Part 2 At the recent Executive War College, I had the honor of...

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Final Steps in Preparing for the PAMA Reporting Period (Part 2)

In our last post of this series, we identified “The First Steps in Preparing for the PAMA Reporting Period” as confirming your laboratory’s applicable lab status, executing an RCM data review, and assigning a project team and project team lead. Once you have carried out these steps, there are four additional steps to be taken before you complete your submission.  Step 4:...

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Meeting Compliance Requirements – Why EHR Revenue Cycle Modules Aren’t Enough for Hospital Labs (Part 2)

As discussed in Part 1 of this 4-part series, too often we see hospital and health system leaders expecting outreach and outpatient laboratories to use the hospital’s enterprise revenue cycle management (RCM) module that is offered as part of the EMR/EHR software. While the health system may believe that the enterprise RCM system is the most cost-effective option, this fails to take into account...

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New Study Demonstrates GAO’s PAMA Report Based on Faulty Assumptions

In a XIFIN blog post from April 5, we address that the Government Accountability Office (GAO) report entitled, “Medicare Laboratory Tests Implementation of New Rates May Lead to Billions in Excess Payments” appears to demonstrate a misunderstanding of how price and panel bundling work in laboratory billing and reimbursement.The report appears to suggest that American Medical Association (AMA)...

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Key Considerations for Lab Leaders Regarding the Eliminating Kickbacks in Recovery Act of 2018 (EKRA)

Authors: Marty Barrack, Senior Vice President & General Counsel, XIFIN Rina Wolf, Vice President Commercialization Strategies, Consulting & Industry Affairs, XIFIN The Substance Use-Disorder Prevention that Promotes Opioid Recovery and...

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