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Blog Posts by Tag: Prior Authorization

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...

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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 unexpected balances the patient owes. This can occur for example when a patient receives care from a hospital that is in-network but is seen by a...

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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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Achieving Success with Next-Generation Sequencing: AI-driven Scale Plus a Strong Reimbursement Strategy

XIFIN, Inc. and Fabric Genomics recently collaborated on a webinar designed for laboratories launching or planning to launch Next-Generation Sequencing (NGS) tests. The two primary topics of the webinar are: The use of artificial intelligence (AI) to drive scale with panel testing, including practical considerations for implementing NGS testing and selecting the right panels, and automating...

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Top 5 Blog Posts of 2020

Through one of the most challenging years for the healthcare industry, XIFIN contributed thought-provoking articles to help traverse these difficult times. Here are 2020's most popular blog posts.1. How Upcoming Changes to United Health's Laboratory Test Registry May Impact Your LabWhen the COVID-19 pandemic was declared, United Healthcare (UHC) delayed implementing the Laboratory Test Registry...

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Connecting and Automating Diagnostic Revenue Cycle Management: Eligibility Verification Speeds Reimbursement, Drives Revenue, and Reduces Operating Cost

When laboratories and other diagnostic providers use multiple disconnected systems to manage the complexity of diagnostic claim billing and revenue cycle management (RCM), this often leads to errors, rework, and other inefficiencies, ultimately driving higher operating costs. Diagnostic providers sometimes attempt to connect or “bolt-on” supplemental capabilities to augment missing or subpar RCM...

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Automation of Prior Authorizations and Appeals is Possible and Key to Reducing Costs

Many issues are challenging diagnostic providers’ ability to maximize payor reimbursements, such as the significant increase in required prior authorizations (PAs) and the high cost of appeals.These issues are even more difficult for laboratories and remote patient monitoring device companies using traditional billing systems that have few or no automation tools. Hospital outreach programs and...

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