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Blog Posts by Tag: Molecular

4 Ways to Maximize Revenue Regarding Genetic Testing

As genetic testing has continued to increase, reimbursements on genetic test claims remain a significant challenge for clinical laboratories and anatomic pathology groups.According to Concert Genetics, the number of total genetic tests in 2012 was 10,000. By year-end 2020, that number had grown to 166,450 tests. Not only is the number of tests increasing, but the testing is becoming more...

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

this post was updated on June 1, 2021. In March 2021, United Healthcare announced an updated policy for Medicare Advantage plans, whereas they will be requiring providers to include the appropriate DEX Z-Code identifier on claims beginning June 1, 2021. United Healthcare has announced this policy update has been delayed and will not be implemented on June 1, 2021. Further communication will be...

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After Large Spikes in 2020, Diagnostic Laboratory Testing Volumes on the Decline

As XIFIN CEO Lâle White wrote in her recent LinkedIn article, the COVID-19 pandemic created many challenges for the diagnostic industry in 2020. In the preceding years, many laboratories were running lean with little excess capacity. With the surge in COVID-19 testing demand, labs had to quickly add capacity to handle the new testing volume. In addition, dynamic regulatory changes designed to...

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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 revenue,...

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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 we...

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How Upcoming Changes to United Health’s Laboratory Test Registry May Impact Your Lab

Important Update:In response to the COVID-19 Public Health Emergency (PHE), UHC has made a decision to delay the implementation of the Laboratory Test Registry Protocol to January 1, 2022. Starting January 1, 2022 (Previously October 1, 2020, before the recent decision to delay), United Healthcare (UHC) requires in-network, free-standing, and outpatient hospital lab providers’ claims for test...

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Routine Lab Volume in the US Sees Steep Drop, Gradual Recovery Due to COVID-19

Diagnostic laboratories remain at the forefront of US efforts to assess and control the spread of COVID-19. Diagnostics play a critical role both in the US pandemic response and also in helping the country as states establish plans to re-open. As states, and therefore laboratories, continue to focus on COVID-19 virus testing with the recent addition of antibody testing, elective and non-urgent...

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United Healthcare Reimbursement Policy Update for Molecular Pathology

United Healthcare announced that the effective date of their reimbursement policy update for molecular pathology has moved from dates of service beginning September 1, 2019, to dates of service beginning November 1, 2019.This reimbursement policy change affects claims submitted with codes for Tier 1 and Tier 2 Molecular Pathology. Tier 2 Molecular Pathology codes are 81400 – 81408, and are to be...

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