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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...

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On the Road to Herd Immunity, Labs and Payors Navigate Reimbursement Hurdles

Will I get paid for this? That’s not a question anyone wants to be posing when it comes to their work. Yet for most of 2020, amid the pandemic, it was one of the most pervasive questions from diagnostic laboratories to payors. While COVID-19 diagnostic testing volumes fluctuated dramatically, laboratories faced uncertainty in getting reimbursed for processing these tests. Then, in January 2021,...

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First Coast Publishes Rates for New External Electrocardiographic Recording Codes

In late 2020, CMS announced that it would be moving from the temporary Category III codes for long term ECG monitoring and will instead use Category I CPT codes, starting January of 2021. CMS did not add national rates for the codes but is instead looking to the MACs to price individually.There has been much attention on the initial Novitas proposed rates as they were a substantial reduction...

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UHC Implements DEX Z-Code Requirements on Medicare Advantage Claims Starting June 1, 2021

Effective 6/1/2021, UHC will require pathology providers currently submitting a DEX Z-Code for the Medicare MolDx program to also submit their registered Z-code on UHC Medicare Advantage claims. In the same format as Medicare, the Z-code will be submitted in Loop 2400. While UHC will not require a separate registration of these z-codes, providers will need to ensure qualifying tests are...

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Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension

In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, CMS has instructed the Medicare Administrative Contractors (MACs) to temporarily hold all claims with dates of service on or after April 1, 2021. Per CMS’s announcement, this is intended to only take place for a short period of time and should not have any significant impact to providers’ cash flow....

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Payor Relations Insider: The Introduction of Turnaround Time Requirements for SARS–CoV–2 Testing

To ensure COVID testing is performed in as timely a manner as possible, CMS created a turnaround time-dependent reimbursement policy. Since its introduction in January 2021, many other payors have also adopted this pricing schema. The COVID-19 Public Health Emergency has created new burdens for clinical diagnostic laboratories. The results of these SARS-CoV-2 tests are used for critical treatment...

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HRSA High Throughput COVID-19 Claims: Correction Timeline

HHS confirmed there was a system error in the reimbursement for high throughput COVID-19 PCR testing claims, with HCPCS U0003 and U0004, for the HRSA COVID-19 Uninsured Patient Program. HHS indicated on their FAQ page they would not implement the add-on reimbursement for HCPCS U0005 on January 1, 2021 and would continue reimbursing independent laboratories at the rate of $100 for COVID-19...

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UHC Announces Designated Diagnostic Provider Requirements for Coverage

On February 24, 2021, XIFIN learned that UHC has delayed the application deadline from February 28, 2021 to March 10, 2021. The go-live date of July 1, 2021 is still in place. Additional requests to confirm how places of service 81, 11, 19, 22 are impacted has been requested from UHC. XIFIN will provide additional updates as they are received. UHC recently announced plans to implement the...

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