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Blog Posts by Tag: Regulatory

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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ACLA Issued a Statement to CMS on Automated Chemistry Test Panels

After claims from the Government Accountability Office (GAO) in November of 2018 that labs unbundling automated chemistry test claims will correlate to a drastic increase in Medicare spending, many industry thought leaders are responding. Most recently, ACLA has released a statement claiming that GAO’s assumptions are not backed by Medicare’s public claims data, or by ACLA’s own survey conducted...

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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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