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Blog Posts by Tag: Prior Authorization

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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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 Three. 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 revenue,...

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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 we...

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