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Blog Posts by Tag: Molecular

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, 2021.  A UHC representative informed XIFIN in a July 17, 2020 correspondence, “To ensure compliance with these requirements, free-standing and outpatient hospital lab providers should register their laboratory...

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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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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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Hidden Landmines in Revenue Cycle Management: Misleading Metrics (Part 2)

This is the second 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 3 Below, we have detailed the need for a complete understanding of...

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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, hospital outreach programs, 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...

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Improve Reimbursement for Genomic Tests by Leveraging Real World Data

Since the sequencing of the human genome in 2003, genomic testing has become the fastest growing category of biomarker testing within the diagnostic laboratory industry. Many laboratory developed genomic tests use next-generation sequencing (NGS) as an approach to target numerous genomic variants with both proven and emerging evidence of clinical utility. While the panel approach is forward-...

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