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Blog Posts by Tag: Regulatory

Addressing EKRA Sales Force Compensation Mandates to Improve Both Compliance and Profitability

EKRA - Eliminating Kickbacks in Recovery Act - is a relatively new law that has some important implications for all diagnostic laboratories, and not just toxicology labs, which precipitated the legislation. Passed in October 2018, it was widely understood the law was intended to combat the opioid crisis. Recently, due in part to COVID-19 and government concerns over fraud and abuse, there has...

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Proposed Changes to Hospital Price Transparency Rule: Radiology, Laboratory and Pathology Impacted

The Hospital Price Transparency Rule was introduced to help patients identify the cost of hospital items or services before receiving care.  Under the rule, hospitals are required to provide clear, accessible pricing information online in two ways:A comprehensive machine-readable file containing standard charges for all items and services provided by the hospital. A consumer-friendly list of...

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CMS Offers MIPS Reporting Flexibilities for Pathologists During COVID

The Quality Payment Program (QPP) was established by CMS as part of the Medicare Access and CHIP Reauthorization Act of 2015. The QPP transformed the Medicare payment system to focus more on value of service than volume. Under QPP, there are two payment tracks, Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM), both of which involve levels of financial...

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Hospital Price Transparency: Does it Change Your Outreach Lab Program Strategy?

Recently, I had the great privilege to participate in a Healthcare Financial Management Association (HFMA) virtual panel discussion on compliance with hospital price transparency requirements. One of the primary topics I covered during the discussion was how technology can help reduce the “lift” for hospital outreach laboratories to achieve and maintain compliance with the new rule, which became...

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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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