Blog Posts by Tag: Revenue Cycle Management
Overcoming Reimbursement Compression: The Latest Trends in Denials for Laboratories and Pathology Practices
This is the second article in a three-part series on denial and appeals trends. This article focuses on claim denial trends by payor group and by market segment, and denial trends for claims with a 2021 date of service differ from a similar analysis completed on claims with dates of service in 2018. If you missed the first article in this series on the importance of physician engagement in...
3 RCM Reports You Should Be Reviewing to Monitor Payor Payment Trends
Payor reimbursement behavior is complex and constantly changing. Payors make policy changes regularly and it’s challenging for medical providers to keep track of whether they are being reimbursed in full. Staying on top of payments whether for contracted or non-contracted reimbursements can require significant resources. Yet, if not monitored regularly, organizations will miss out on earned...
Denials and Appeals Management: The Importance of Patient Engagement
Revenue cycle management (RCM) for laboratories and pathology practices is constantly evolving in complexity. Payors introduce new and more rigid policies that make collecting reimbursement for services rendered increasingly difficult. XiFin recently published a new whitepaper, Overcoming Reimbursement Compression: The Latest Trends in Denials and Appeals Management for Laboratories and...
Outsourcing Your Billing Processes: When does it make sense for outpatient diagnostic services?
From IT and EHR support to back-office functions, hospitals are increasingly turning to business process outsourcing (BPO) to relieve staffing and financial pressures. Within the hospital ecosystem – where technology and processes are typically optimized for high-acuity clinical encounters – outpatient and ancillary services departments can find it difficult to overcome their unique business...
Automation Strategies for Molecular Diagnostic Market-Share Expansion
This blog post is the third in our series covering the keys to success for market-share expansion in molecular diagnostics based on our recently published whitepaper, “The Executive’s Guide to Molecular Diagnostic Market-Share Expansion”. If you missed either of the first two posts in this series, you can find the first post, “Molecular Diagnostic Market-Share Expansion: Keys to Success” here and...
The Importance of Physician and Patient Engagement for Molecular Diagnostic Market-Share Expansion
This blog is the second in our series covering the keys to success for market-share expansion in molecular diagnostics outlined in our recent whitepaper, “The Executive’s Guide to Molecular Diagnostic Market-Share Expansion”. We encourage you to read Part 1 and Part 3.As more molecular diagnostic testing moves from physician offices and laboratories to the home, molecular diagnostics...
No Surprises Act: 2023 Changes and Clarifications
Effective January 1, 2022, the No Surprises Act (NSA) established new federal protections against surprise medical bills and balance billing for services received from out-of-network providers.Since January 2022, CMS has published over 50 resources related to the Act, five of which were released as recently as December. In August 2022, CMS issued the final rules, entitled “Requirements Related to...
Optum’s Laboratory Benefit Manager Program: Focus on CPT 81479
In 2022, Optum launched its new laboratory benefit management (LBM) program to help health plans reduce unnecessary lab testing through automated payment denial. The LBM program leverages Avalon Healthcare Solutions, which has developed evidence-based lab policies with automated software tools, and the MolDX program, which identifies and establishes Medicare coverage and reimbursement for...
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