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Blog Posts by Tag: Regulatory

XIFIN Makes Progress on Misuse of CO-45 Remediations

Last August, XIFIN reported that it had collected evidence of widespread and longstanding misuse of the CO-45 Remittance Advice Reason Code (RARC). The CO-45 is a charge that exceeds the fee schedule/maximum allowable or contracted/legislated fee arrangement. It represents the facility's contractual payment obligation, and the patient cannot be billed for that amount, which, instead, should be...

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Outreach Labs Brace for Forthcoming Transparency Regulations

The Centers for Medicare and Medicaid Services’ (CMS) new hospital price transparency regulations will go into effect on January 1, 2021. Outreach labs are anticipating new challenges as a result of the rules.According to Adam Bonislawski’s article in 360DX, “Labs Brace for Potential Plusses, Minuses of Price Transparency Regulations,” the new regulations could: Interfere with a lab’s...

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Recapping the NILA Lab Leaders Forum and Mid-Winter Meeting

Last weekend’s NILA conference covered a number of items currently impacting laboratories across the country. Several topics, in particular, saw repeated discussions and, in some cases, vigorous debate from the audience. Here are the hottest topics and key takeaways from the NILA meeting:Prior Authorization’s Pinch This was potentially one of the most intriguing discussions revolved around prior...

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Fighting Back Against Increased Claim Rejections Under ICD-10

The Dark Report recently reported that the implementation of ICD-10 diagnosis codes in 2015 has resulted in disrupted laboratory test billing and collections, rejected claims, and increased demands for medical-necessity documentation.Lab billing experts, including Kyle Fetter, Executive Vice President and General Manager of Diagnostic Services for XIFIN, said that alongside the new codes, payors...

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Top 5 Industry News Topics of 2019

2019 saw many policy changes and newsworthy events that affected labs and medical billers. Here is a recap of our most-viewed industry news articles of 2019:1. New Codes Effective July 1, 2019 – Proprietary Laboratory Analysis (PLAs)The following new codes may need to be manually added to the HCPCS file by the MACs with an effective date of July 1, 2019. These new codes are also contractor-priced...

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Hottest Blog Topics of 2019

In 2019 we discussed many thought-provoking topics and trends regarding laboratories, medical billing, revenue cycle management, and much more. Here is a short recap of the top 5 most-influential blog posts:1. Hidden Landmines in Revenue Cycle Management: Industry Challenges, Patient Engagement, and Denial TrendsMany trends in payor behaviors and reimbursement go unnoticed due to outdated RCM...

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Congress Passes LAB Act; PAMA Reporting Delayed by One Year

On December 19th, after multiple years of uproar from ACLA and other stakeholders on behalf of seniors who rely on lab tests, Congress has officially passed the Laboratory Access for Beneficiaries Act, also known as the LAB Act. This bill, which is expected to be signed by the president into law soon, will delay the reporting of lab payment data required by PAMA (Protecting Access to Medicare Act...

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3 Steps to Ease the Prior Authorization Burden

Enjoy the following content from our partner, Infinx. It’s no secret that prior authorization (PA) requirements create a time-intensive burden that delays patient care and takes providers and staff away from their clinical activities only to spend that time with administrative tasks and redundant paperwork. The American Hospital Association (AHA) reported that...

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