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Blog Posts by Tag: Prior Authorization

The Importance of Connectivity and Automation to Accelerate Revenue Cycle Management: A Focus on Insurance Eligibility and Discovery

Kouri AndrewsDirector, EDI Operations, XIFIN Mike FauverAVP Health Systems, XIFIN Using disconnected systems to manage the complexity of medical claim billing and revenue cycle management (RCM) can lead to errors, inefficiencies, and rework. This drives delayed reimbursement and higher operating...

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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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California Bill Passes that Prohibits Prior Authorization for Biomarker Testing in Cancer Patients

On October 6, 2021, Senate Bill No. 535 was approved by Governor Gavin Newsom and filed with the Secretary of State in California. The bill will prohibit health insurance and health plans from requiring prior authorization for biomarker testing for an insured individual with advanced or metastatic stage 3 or 4 cancer, as well as biomarker testing for cancer progression or recurrence in these...

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How to Reduce Retro Authorizations to Improve Reimbursement

Enjoy the following content from our partner, Infinx. The reimbursement landscape for clinical labs and remote patient monitoring has never been so challenging or so precarious. Patient and third-party payor responsibility continues to shift, and there is no end in sight for ongoing changes and increases in government regulations and insurance requirements.In a rapidly changing and consumer-...

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Top 3 Challenges in Community Oncology Revenue Cycle Management

Community oncology continues to experience a dramatic shift in market dynamics. Substantive developments include a proliferation of acquisitions, the CMS Merit-Based Incentive Payment System (MIPS) and larger shift to value-based reimbursement models, as well as exploration of precision medicine as the standard of care.Notable changes that directly constrain practice financial health include fee...

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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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The Value of Payor-Specific Appeals Automation

Clarisa BlattnerSenior Director MDx Support Services, XIFIN Scott BurkClient Success Manager, XIFIN The growing number of appeals and the high costs associated with them is a challenge for many laboratories and diagnostic providers. These costs are exacerbated if the laboratory uses a traditional...

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How an Accurate Patient Out-of-Pocket Expense Estimator Helps Prevent Surprise Billing

There has been a lot written about surprise billing lately and the No Surprises Act, which includes surprise billing legislation, was signed into law the final week of 2020 and is slated to go into effect on Jan. 1, 2022. Surprise medical bills are bills received by patients with unexpected balances due. This can occur when, for example, a patient receives care from a hospital that is in-network...

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