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Blog Posts by Tag: Regulatory

UHC Announces Designated Diagnostic Provider Requirements for Coverage

On February 24, 2021, XIFIN learned that UHC has delayed the application deadline from February 28, 2021 to March 10, 2021. The go-live date of July 1, 2021 is still in place. Additional requests to confirm how places of service 81, 11, 19, 22 are impacted has been requested from UHC. XIFIN will provide additional updates as they are received. UHC recently announced plans to implement the...

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Top 5 Blog Posts of 2020

Through one of the most challenging years for the healthcare industry, XIFIN contributed thought-provoking articles to help traverse these difficult times. Here are 2020's most popular blog posts.1. How Upcoming Changes to United Health's Laboratory Test Registry May Impact Your LabWhen the COVID-19 pandemic was declared, United Healthcare (UHC) delayed implementing the Laboratory Test Registry...

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UHC Suspends Prior Auth Requirements for Trichomonas & Candida, Will Adopt CMS Billing Policy for Prostates on January 1, 2021

Suspension of Trichomonas and Candida Prior Auth Requirements Beginning Oct. 1, 2020, for all commercial and UnitedHealthcare Community Plan plans included in the genetic and molecular testing program, UHC will be suspending prior authorization and notification requirements for the following three genetic and molecular CPT codes performed in an outpatient setting: 87480: Infectious agent...

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2021 CMS Proposed Medicare Physician Fee Schedule Released

On August 4, 2020 CMS released its 2021 proposed physician fee schedule. Unfortunately, under the proposed schedule, pathology and several other specialties would take the brunt of some significant reductions. This is largely the result of the redistributive effects of previously finalized changes to the office/outpatient E/M visits taking effect in 2021. The results of these reductions will have...

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Is the FDA on a Dangerous Path? Overstepping LDT Authority Hampered COVID Response and Has Long Term Consequences for US Healthcare

As I recently discussed during my session at this year’s Executive War College, one important aspect of the COVID pandemic and laboratory testing during this time is how it exemplified the detrimental consequences of FDA overreach — which contributed in large part to testing delays and a hamstrung response in the outbreak’s early days — and how that overstepping poses risk going forward. On July...

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G0416 Prostate Update for Cigna: Go-Live August 18, 2020

As announced by Cigna earlier this summer, beginning August 18, 2020 Cigna will require pathology groups to submit G0416 for prostate needle biopsies instead of 88305. Prostate biopsies will no longer be reimbursed using the 88305.XIFIN confirmed with Cigna that this applies to all Cigna plans, not just a select few. Commercial payors aligning with CMS guidelines on G codes is becoming a trend...

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Florida Society of Pathology Pushes to Retain PCCL Reimbursement from Medicaid

Florida Society of Pathology (FSP) held a call for members on July 15th to review the process the organization had taken upon learning the state’s Medicaid plan would no longer fund Professional Component of Clinical Laboratory (PCCL) reimbursement. Florida is among less than a handful of states, including California and Illinois, that sill receive reimbursement for PCCL charges for Medicaid...

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How Upcoming Changes to United Health’s Laboratory Test Registry May Impact Your Lab

Important Update:In response to the COVID-19 Public Health Emergency (PHE), UHC has made a decision to delay the implementation of the Laboratory Test Registry Protocol to January 1, 2022. Starting January 1, 2022 (Previously October 1, 2020, before the recent decision to delay), United Healthcare (UHC) requires in-network, free-standing, and outpatient hospital lab providers’ claims for test...

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