Blog Posts by Tag: Molecular
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...
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...
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...
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...
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 and often...
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 presenting with...
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 the...
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 reimbursement go unnoticed...
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