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Blog Posts by Tag: Laboratory

2023 MIPS – Examining How Pathology Scores Are Calculated

In the 2023 Quality Payment Program (QPP) final rule, there were minimal changes to the traditional Merit-Based Incentive Payment System (MIPS). The final rule focuses on further refining MIPS Value Pathways (MVPs) implementation. However, there are no pathology-related MVPs at this time. Therefore, the majority of pathologists will continue to participate under the traditional MIPS program.Two...

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Top 5 Blog Posts of 2022

As always, XIFIN’s Beyond Billing blog kept abreast of key issues and hot topics within the healthcare industry, staying especially in tune with legislative proposals that can potentially impact reimbursement and revenue.Here are the top blogs of 2022, with far-ranging topics that include PAMA and SALSA, the No Surprises Act, digital pathology, and revenue cycle management. 1. Laboratory Test...

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It’s Important to Know How Your LIS Stacks Up. Take This Survey to Find Out.

The laboratory information system (LIS) plays a vital role in diagnostics. The LIS is the workhorse of the lab and is vital to day-to-day workflow and functionality. This essential system supports operational efficiency, testing capacity, timely specimen reporting, analytics, and business reporting.Many labs continue to use homegrown or on-premise systems that do not take advantage of the many...

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ACLA Launches “Stop Lab Cuts” Campaign Urging Congress to Enact SALSA

The American Clinical Laboratory Association (ACLA) has launched the Stop Lab Cuts advocacy campaign, urging Congress to stop further Clinical Laboratory Fee Schedule (CLFS) cuts under the Protecting Access to Medicare Act (PAMA) through the enactment of the Saving Access to Laboratory Services Act (SALSA).The campaign includes advertising, media outreach, grassroots engagement, stakeholder...

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PAMA vs SALSA: 2023 Clinical Lab Fee Schedule Predictions

The Protecting Access to Medicare Act  (PAMA) of 2014 set clinical laboratory fee schedule (CLFS) reimbursement rates on an unsustainable course of multiyear double-digit cuts. Under PAMA, the first set of Medicare CLFS payment rates resulted in cuts of 10% per year in 2018, 2019, and 2020.  As a result of the COVID-19 public health emergency, no reductions were introduced in 2021 or 2022....

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No Surprises Act: Examining the Independent Dispute Resolution Process

The Final Rule implementing the No Surprises Act provides new guidance for the payor-provider independent dispute resolution (IDR) process. The Final Rule directs certified IDR entities to consider the qualifying payment amount as well as certain other specific factors when resolving out-of-network rate disputes and requires payors to be more transparent about changes to codes or modifiers that...

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No Surprises Act: 4 Key Steps to Providing Good Faith Estimates

The No Surprises Act protects patients from receiving a surprise medical bill by prohibiting balance billing and requiring providers to provide good faith estimates (GFE) of services. A GFE should be provided to all patients who are uninsured and should include all services expected to be provided by both primary and co-providers.While the legislation went into effect on January 1, 2021, HHS did...

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Must-Have Compliance Capabilities to Manage Risk and Help Drive Growth

Thorough RCM processes address a myriad of compliance issues that can cost an organization money, business freedom, and even exit opportunities. Compliance requirements are continually changing, and any misstep could result in lost revenue, fines, and even extreme penalties such as debarment, corporate integrity agreements, and criminal consequences for the company and responsible individuals. ...

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