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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XIFIN Named a 12-Time Inc. 5000 Honoree a Testament to Company’s Crucial Support of Healthcare Diagnostics

Inc. has just published its 5,000 fastest-growing private companies in America list for 2021, and XIFIN is among its ranks for the 12th time in its 24-year history. During a period of unprecedented challenges for the healthcare industry and a significant shift towards telehealth, XIFIN proved able to not only meet the technological demands of diagnostic providers facing enormous testing volume...

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Telehealth Is Here to Stay

One of the lasting changes born of the pandemic is the expectation by healthcare providers that they will continue to leverage telehealth and remote patient monitoring platforms in their practices. According to the “COVID 19 Telehealth Impact Study” conducted by the COVID 19 Healthcare Coalition, in 2018 only 18% of physicians incorporated telehealth as part of their care model, primarily due to...

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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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