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Blog Posts by Tag: Revenue Cycle Management

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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Seven Factors to an Effective Compliance Program

This is the second article of a multi-part series on the many dimensions of compliance related to diagnostic providers, independent device testing facilities (IDTFs), and hospital outreach laboratory services. The responsibility of compliance does not rest on the shoulders of one individual or committee. Compliance responsibility for laboratories, IDTFs, pathology practices, and hospital outreach...

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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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Building an Effective Compliance Program and Compliant Diagnostic Systems That Work: An Overview

The healthcare industry is in a state of constant change in laws, regulations, reimbursement and payor requirements, and commercial and patient expectations. It is hard for any individual healthcare provider to keep up with all of these changes. The diagnostic business, in particular, is under pressure to stay in compliance. Over the course of the next several weeks, the XIFIN Beyond Billing Blog...

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Delta Variant Impact on Lab Testing Volumes

The impact of the SARS-CoV-2 Delta variant is increasingly severe. The CDC has determined this strain is nearly twice as contagious as previous variants and two studies indicate Delta patients are more likely to be hospitalized than those infected with Alpha or the original virus strains.1 97.4% of all U.S. COVID-19 cases stem from this variant.2Infection numbers are rising rapidly. On August 11...

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Pathology Denial Metrics and Implementing a Strategic Appeals Processes

Pathology practices are becoming increasingly inundated with added requirements for prior authorization and medical necessity documentation. Insurance requirements are becoming more onerous, and lines are increasingly blurred around what is required for claims to meet individual payor standards for reimbursement. Failure to meet a single requirement, on even a small percentage of claims, is...

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The Value of Highly Flexible Client/Physician e-Invoicing Capabilities

There are several scenarios in which ordering entities, such as physician practices, want other healthcare providers, like laboratories or medical device companies, to bill them for services performed or devices delivered rather than billing payors or patients. For example, if a diagnostic provider offers only non-covered services, such as a new genetic test or novel medical device, the ordering...

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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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