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Blog Posts by Tag: Data Quality - Insurance Discovery

Accurate Patient Responsibility Estimates Dramatically Improve the Patient Experience

Customer experience is one of the most significant long-term differentiators in healthcare and diagnostics, as it is in virtually all other sectors. There is a direct correlation between customer experience and engagement, and consumers have been trained to expect more when it comes to service and experience by companies such as Amazon, Apple, and Southwest Airlines. A survey of 1,000 patients...

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Hidden Landmines in Revenue Cycle Management: Industry Challenges, Patient Engagement, and Denial Trends (Part 1)

This is the first post of a three-part blog series focused on key areas of business performance management for pathology practices, diagnostic laboratories, and molecular diagnostic providers. The other blog posts in this series can be found here:  Part 2 and Part 3 A number of trends in payor behaviors and reimbursement go unnoticed due to...

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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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The First Steps in Preparing for the PAMA Reporting Period (Part 1)

Solid reporting from all applicable laboratories is the key to mitigate future PAMA fee schedule cuts. This means labs need to be able to report on actual allowables vs. payments, validate the accuracy of payments, and optimize appeals activity to avoid under-reporting payments. All applicable labs are included in the current data collection period now underway for the first half of 2019.Step 1:...

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Improving Reimbursement for Remote Patient Monitoring and Medical Devices by Leveraging Real World Data

The diagnostic industry is benefiting from new innovation and data collection opportunities provided by telemetry, wearable diagnostics, and remote patient monitoring devices. These devices are collecting more patient diagnostic and monitoring information than ever before. They also help to save time in the diagnosis and treatment process, reduce healthcare costs, and help physicians monitor...

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Data Quality Is a Cornerstone to Effective Revenue Cycle Management

One of the most challenging obstacles to diagnostic providers getting paid on time for their services is a lack of accurate patient data. Many laboratories struggle with the quality of the data that they receive and because they often lack direct access to the patients, it can be an expensive, manual process for lab team members to chase down incomplete, incorrect, or missing data that is...

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A Conduit for Real-Time Lab Data Exchange

For labs looking for a conduit that allows for the pre-scrubbing of claims to ensure the likelihood of acceptance from the patient’s insurance provider, web services are the answer (Generically, a web service is any standardized software system designed to communicate with another system over the web; here, I will be referring to a specific set of web services created for the healthcare industry...

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There Is More to Self-Pay Patients Than You Think

In today’s complex healthcare environment, many patients who are classified as self-pay may have insurance coverage that could be billed for services. The causes for this discrepancy range from registration process breakdowns to human data entry errors to incomplete or inaccurate data sent from third parties. Regardless of where in the process the error or omission was made, it impacts...

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