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Blog Posts by Tag: Regulatory

ACLA Launches “Stop Lab Cuts” Campaign Urging Congress to Enact SALSA

The American Clinical Laboratory Association (ACLA) has launched the Stop Lab Cuts advocacy campaign, urging Congress to stop further Clinical Laboratory Fee Schedule (CLFS) cuts under the Protecting Access to Medicare Act (PAMA) through the enactment of the Saving Access to Laboratory Services Act (SALSA).The campaign includes advertising, media outreach, grassroots engagement, stakeholder...

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AUC Penalty Phase Delayed–Why Radiologists Need to Act Now, Not Later

The appropriate use criteria (AUC) program was established under The Protecting Access to Medicare Act (PAMA) of 2014 to ensure providers ordered the most appropriate advanced diagnostic imaging services for Medicare beneficiaries. Under the program, ordering providers will consult an electronic portal called a Clinical Decision Support Mechanism (CDSM) to ensure the established appropriate use...

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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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No Surprises Act: 4 Key Steps to Providing Good Faith Estimates

The No Surprises Act protects patients from receiving a surprise medical bill by prohibiting balance billing and requiring providers to provide good faith estimates (GFE) of services. A GFE should be provided to all patients who are uninsured and should include all services expected to be provided by both primary and co-providers.While the legislation went into effect on January 1, 2021, HHS did...

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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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Preparing for the Next Phase of Virtual Care and Remote Patient Monitoring

Tina VossProduct Marketing Manager, XIFIN Melanie PhanProduct Marketing, XIFIN On July 15, 2022, the COVID-19 federal Public Health Emergency (PHE) was extended for an additional ninety (90) days. Many wonder when the PHE extension will end and what that will mean for virtual care and remote...

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Things to Consider When Moving to an Insurance-Based Reimbursement Model for Remote Patient Monitoring and Medical Devices

Negotiating payment agreements with commercial and government payors can increase both your market share and your revenue substantially. But it can be challenging for smaller or newer medical device or remote patient monitoring companies and IDTFs to get the attention of large payors. One way to help this is to have a well-articulated, compelling value proposition, such as filling a known gap in...

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Three Steps to Radiology MIPS Success

There are three critical steps to maximizing Medicare reimbursement by optimizing your MIPS score. But first, radiologists need to understand the 2022 MIPS changes and requirements that must be met to avoid the negative 9% payment adjustment for noncompliance and achieve a bonus.Physicians have two tracks to choose from under the CMS Quality Payment Program: MIPS and Advanced Alternative Payment...

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