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Blog Posts by Tag: Molecular

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

Effective 6/1/2021, UHC will require pathology providers currently submitting a DEX Z-Code for the Medicare MolDx program to also submit their registered Z-code on UHC Medicare Advantage claims. In the same format as Medicare, the Z-code will be submitted in Loop 2400. While UHC will not require a separate registration of these z-codes, providers will need to ensure qualifying tests are...

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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...

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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...

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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...

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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...

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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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Integrating Laboratory and Clinical Data: A Framework for Improving Reimbursement of Genomic Testing

IntroductionIn 2017, there were roughly 75,000 genetic tests on the market with about ten new tests added daily.1 The rapid expansion of genomic testing, particularly next-generation sequencing (NGS) panels, has led to uncertainty about their appropriate use, interpretation, and clinical utility. Indefinite clinical utility leads to claims denials which are appealed through a lengthy...

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