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Blog Posts by Tag: Regulatory

No Surprises Act: Examining the Independent Dispute Resolution Process

The Final Rule implementing the No Surprises Act provides new guidance for the payor-provider independent dispute resolution (IDR) process. The Final Rule directs certified IDR entities to consider the qualifying payment amount as well as certain other specific factors when resolving out-of-network rate disputes and requires payors to be more transparent about changes to codes or modifiers that...

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No Surprises Act: 4 Key Steps to Providing Good Faith Estimates

The No Surprises Act protects patients from receiving a surprise medical bill by prohibiting balance billing and requiring providers to provide good faith estimates (GFE) of services. A GFE should be provided to all patients who are uninsured and should include all services expected to be provided by both primary and co-providers.While the legislation went into effect on January 1, 2021, HHS did...

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Best Practice to Maximize Patient Collections Now that the HRSA COVID-19 Uninsured Program has Ended

On March 15, 2022, the Health Resources and Services Administration (HRSA) announced that the Uninsured Program would stop accepting claims as it had exhausted its federal pandemic funding. In the COVID-19 Uninsured Program Shutdown FAQs, HRSA stated: Claims submitted after March 22 for COVID-19 testing and treatment, and after April 5 for vaccination will not be adjudicated for payment. ...

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Preparing for the Next Phase of Virtual Care and Remote Patient Monitoring

Tina VossProduct Marketing Manager, XIFIN Melanie PhanProduct Marketing, XIFIN On July 15, 2022, the COVID-19 federal Public Health Emergency (PHE) was extended for an additional ninety (90) days. Many wonder when the PHE extension will end and what that will mean for virtual care and remote...

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Things to Consider When Moving to an Insurance-Based Reimbursement Model for Remote Patient Monitoring and Medical Devices

Negotiating payment agreements with commercial and government payors can increase both your market share and your revenue substantially. But it can be challenging for smaller or newer medical device or remote patient monitoring companies and IDTFs to get the attention of large payors. One way to help this is to have a well-articulated, compelling value proposition, such as filling a known gap in...

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Three Steps to Radiology MIPS Success

There are three critical steps to maximizing Medicare reimbursement by optimizing your MIPS score. But first, radiologists need to understand the 2022 MIPS changes and requirements that must be met to avoid the negative 9% payment adjustment for noncompliance and achieve a bonus.Physicians have two tracks to choose from under the CMS Quality Payment Program: MIPS and Advanced Alternative Payment...

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The Value of True Customer Advocacy

XIFIN Complaint to CMS Results in Modified Guidance on Health Plans’ Payment of Claims Customer advocacy is a core tenet of our business at XIFIN. While it’s easy for companies to say that customer-centricity and advocacy are core values, the proof is whether customers experience the value and impact of said commitment. The following article, reprinted from the XIFIN XiConnect Customer Newsletter...

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Three Questions You Should Be Asking to Determine if the No Surprises Act Applies to You

How do the billing protections established under the No Surprises Act impact my group?This is what everyone is asking. It’s a very complex question that isn’t answered with a simple yes or no. However, listed below are three questions you should ask to determine if any of your services are impacted by the No Surprise Act legislation.*  Is the...

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