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Blog Posts by Tag: Pathology

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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Best Practice to Maximize Patient Collections Now that the HRSA COVID-19 Uninsured Program has Ended

On March 15, 2022, the Health Resources and Services Administration (HRSA) announced that the Uninsured Program would stop accepting claims as it had exhausted its federal pandemic funding. In the COVID-19 Uninsured Program Shutdown FAQs, HRSA stated: Claims submitted after March 22 for COVID-19 testing and treatment, and after April 5 for vaccination will not be adjudicated for payment. ...

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Considerations When Selecting an LIS for Gynecologic Cytology and Molecular Testing

Laboratories leaders investigating LIS solutions for Gynecologic Cytology and Molecular testing need dynamic solutions that meet all productivity and efficiency goals and regulatory requirements. Other essential factors include cytotech reporting, automated quality control review and reporting, pathology oversight and reporting, Bethesda reporting guidelines, management reporting, lookback...

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Mitigating 2023 Proposed Medicare Reimbursement Cuts

Over the past few years, due to the public health emergency (PHE), Congress has stepped in to halt pending Medicare cuts. However, legislative intervention during the PHE only delayed the cuts until the following year. With the proposed 2023 Medicare Physician Fee Schedule released in July, which contained several reductions, and the return of the 2% sequestration, healthcare providers need to...

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Laboratory Test Claim Denials and Appeals Trends

I recently had the privilege of presenting an in-person workshop in conjunction with The Dark Report Executive War College on Laboratory and Pathology Management. The workshop was on the topic of “Latest Trends and Denials Involving Lab Test Claims.” In this session, I shared XIFIN insights into payor behavior changes and shifting claims processing protocols and highlighted the importance of a...

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How Real-Time Connectivity Can Drive Revenue, Reduce Cost, and Increase Client Satisfaction

In today’s healthcare environment, there is a lot of uncertainty about what revenue will look like in the face of declining reimbursement, increasing payor denials, and staffing shortages. At the same time, there are greater expectations on the workforce to comply with regulations and payor reimbursement requirements, which can differ by payor and state. Therefore, it is essential for healthcare...

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Pathology Laboratories Need Unique LIS Capabilities

Anatomic pathology laboratories receive multiple specimen types including pathology, IHC, molecular, next-gen sequencing, FLOW, cytogenetics, FISH, clinical trials, and specialty testing. This is why anatomic pathology laboratories require a sophisticated laboratory information system (LIS) with enhanced capabilities that can manage everything from routine to highly complex cases. The right...

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New CPT Digital Pathology Codes Help Make the Case for AI-Driven Digital Pathology Workflows

Updated August 2, 2022. The College of American Pathologists (CAP), working with the American Medical Association (AMA) CPT Editorial Panel, has successfully advocated for the inclusion of (13) new digital pathology add-on codes to be effective January 1, 2023. According to the CAP, these new digital pathology CPT codes will be “used to report additional clinical staff work and service...

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