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Blog Posts by Tag: Regulatory

The 5 Keys to Minimizing the Impact of PAMA

At this year's Executive War College Conference, XIFIN CEO and Executive Chairman, Lâle White presented on PAMA’s effects on laboratories and gave some thought-provoking ideas on how labs can respond. This blog post will cover many of the topics that Lâle discussed, starting with this timeline of industry events which provides background on the laboratory reimbursement environment...

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Final Steps in Preparing for the PAMA Reporting Period (Part 2)

In our last post of this series, we identified “The First Steps in Preparing for the PAMA Reporting Period” as confirming your laboratory’s applicable lab status, executing an RCM data review, and assigning a project team and project team lead. Once you have carried out these steps, there are four additional steps to be taken before you complete your submission.  Step 4:...

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PAMA Data Collection & Reporting – Why EHR Revenue Cycle Modules Aren’t Enough for Hospital Labs (Part 1)

Hospital and health system laboratories are under many of the same pressures as independent clinical laboratories. Compliance obligations and continued fee compression place a tremendous economic burden on many labs. While in the past, some hospital and health system leaders overlooked the economic value of the outreach lab, these leaders now recognize that outreach labs can add both strategic...

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The First Steps in Preparing for the PAMA Reporting Period (Part 1)

Solid reporting from all applicable laboratories is the key to mitigate future PAMA fee schedule cuts. This means labs need to be able to report on actual allowables vs. payments, validate the accuracy of payments, and optimize appeals activity to avoid under-reporting payments. All applicable labs are included in the current data collection period now underway for the first half of 2019.Step 1:...

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Key Considerations for Lab Leaders Regarding the Eliminating Kickbacks in Recovery Act of 2018 (EKRA)

Authors: Marty Barrack, Senior Vice President & General Counsel, XIFIN Rina Wolf, Vice President Commercialization Strategies, Consulting & Industry Affairs, XIFIN The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment...

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Is Your Appeals Process Effective?

Over the last several years, the healthcare industry has undergone an enormous amount of scrutiny and restructuring. From the entrance of Affordable Care Act Health Plans to close examination of utilization trends and a significant increase in the patient burden related to the cost of healthcare, it has become increasingly challenging for healthcare providers to be paid for the services rendered...

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Helping you get “In-Network” Coverage – Faster and Easier

Achieving “in-network” coverage with payors for new or differentiated diagnostics, technology, or remote patient monitoring devices can provide significant advantages for novel diagnostic and medical device companies. The first step in gaining these advantages is getting payors to cover a new test or device for the applicable patient indications. The next step is to negotiate a favorable price...

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CMS Releases the CY 2019 Physician Fee Schedule Final Rule; Addresses Open PAMA Issues

Yesterday the Centers for Medicare and Medicaid Services (CMS) released its final rule on the CY 2019 Physician Fee Schedule and Quality Payment Program (PFS). The 2,378-page document is going to take some time to analyze, but a few sections appear to be taking good steps forward, including use of CMS-1450 14x bill type vs. NPI as the basis to identify outreach labs in the definition of “...

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