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Blog Posts by Tag: Regulatory

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Challenges, Patient Engagement, and Denial TrendsMany trends in payor behaviors and reimbursement go unnoticed due to outdated RCM...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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The Ugly Truth About Payors and PAMA

Recently CAP Today provided an excellent recap of XIFIN CEO and Executive Chairman, Lâle White's Executive War College presentation "Ugly Truth about Payors & PAMA: What Labs Can Expect and How to Respond." In this blog post, we break down some of the key points: PAMA Is a Price Reduction ProgramContrary to its publicized goal of achieving market-based pricing, the government...

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United Healthcare Reimbursement Policy Update for Molecular Pathology

United Healthcare announced that the effective date of their reimbursement policy update for molecular pathology has moved from dates of service beginning September 1, 2019, to dates of service beginning November 1, 2019.This reimbursement policy change affects claims submitted with codes for Tier 1 and Tier 2 Molecular Pathology. Tier 2 Molecular Pathology codes are 81400 – 81408, and are to be...

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Insights on the Current State of the Laboratory Industry

Today’s laboratory environment is constantly changing in some way or another, and those who wish to stay relevant and succeed must embrace digital transformation and stay on top of new rules and regulations. At XIFIN, we recognize that laboratories can often be overlooked in the wide scope of healthcare and understand the importance of engaging with our customers and partners. By pooling our...

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ACLA Wins in Appeals Court Versus HHS

Recently, the DC Court of Appeals determined that federal courts do in fact “have jurisdiction to decide the merits of a challenge to the federal government’s administration of the Protecting Access to Medicare Act (PAMA).”1 This ruling will result in the ACLA vs. Azar case being sent back to the DC District Court to determine if the decision from HHS/CMS to exclude hospital outreach labs from...

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