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Blog Posts by Tag: Regulatory

Ensuring Oncology Practice Compliance with the No Surprises Act

The adverse impacts of surprise billing have garnered significant national attention, culminating in rare bi-partisan supported legislation that directly impacts community oncology practices. The No Surprises Act was signed into law as part of the Consolidated Appropriations Act of 2021.Surprise billing occurs when patients unknowingly receive either emergency or non-emergency care from an out-of...

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4 Ways to Maximize Revenue Regarding Genetic Testing

As genetic testing has continued to increase, reimbursements on genetic test claims remain a significant challenge for clinical laboratories and anatomic pathology groups.According to Concert Genetics, the number of total genetic tests in 2012 was 10,000. By year-end 2020, that number had grown to 166,450 tests. Not only is the number of tests increasing, but the testing is becoming more...

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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 laboratory uses a traditional...

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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 and...

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

this post was updated on June 1, 2021. In March 2021, United Healthcare announced an updated policy for Medicare Advantage plans, whereas they will be requiring providers to include the appropriate DEX Z-Code identifier on claims beginning June 1, 2021. United Healthcare has announced this policy update has been delayed and will not be implemented on June 1, 2021. Further communication will be...

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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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