The Importance of Building Expect Pricing into Your Revenue Forecast

  • Jul 17, 2018

In order to calculate the contractual allowance for third-party payors in legacy billing and revenue cycle management (RCM) systems, laboratories and other diagnostic providers had to calculate an estimate, based on an analysis of historical data at the payor group level (e.g. Medicare, Medicaid, Contracted Payors, etc.). In today’s environment, where many labs do not have contracts with all...


What is MACRA? Is it Going Away?

  • Jul 12, 2018

Will quality reporting under MACRA change? Will it go away? Not likely. The reason: Medicare spend was 15% of total Federal spending in 2017 with payments totaling $702 billion and a projected growth in spend at 4.6% over the next ten years. With these projections the Medicare Hospital Insurance Trust is expected to be depleted in 2026, three years earlier than the 2017 projection 1....


Compliance is a Living Process: "Set it and Forget it" Can Lead to Trouble

  • Jul 11, 2018

Most of today’s laboratories and diagnostic providers are running on even slimmer profit margins. This is due in great part to lower reimbursements resulting from the Protecting Access to Medicare Act (PAMA) clinical laboratory fee schedule (CLFS) that came into effect in early 2018. In this environment there can sometimes be a tug-of-war between doing things “by the book” and taking some...


Keys to Countering PAMA

  • Jul 9, 2018

The second round of PAMA cuts are projected to cut individual test payment rates by up to 15%. With this in mind, now is the time that labs should be looking to market trends and strategies in order to prosper. At  the NYSCLA Annual Meeting this year XIFIN CEO and Executive Chairman gave a presentation on strategies to offset PAMA cuts. View Presentation Slides...


HHS Publishes Semi-Annual Report to Congress

  • Jun 27, 2018

The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued its Semi-Annual Report to Congress covering the period of October 1, 2017 through March 31, 2018. These Reports describe OIG’s work to identify and investigate significant issues and deficiencies related to the administration of HHS programs and operations. We thought the following findings were of...


What SSAE 18 Means For Security

  • Jun 25, 2018

Recently, the AICPA made a change to the original SSAE 16 standards for security to address and clarify complexity issues, updating them to the SSAE 18 standard which went into effect in May 2017. According to, “SSAE18 is the short name for Statement on Standards for Attestation Engagements No. 18. Attestation standards establish requirements and provide application guidance to...


What You Need to Know About the Changing Landscape and the Impact to How Labs Must Submit Claims to Enable Reimbursements

  • Jun 20, 2018

Prior authorization in the medical field is a necessary but flawed process that causes challenges for physicians as well as everyone involved from submission to approval. For those who are unaware, prior authorization is a requirement that a physician obtains approval from a patients health insurance plan to prescribe a specific medication or lab test. Prior authorization is a technique...


Integrating Pathology Into the Care Team – A Workflow Solution for Integrated Healthcare Data Exchange and Collaboration

  • Jun 15, 2018

At the 2018 Executive War College event, XIFIN Vice President of Informatics, Patricia Goede and I discussed the value and importance of integrating pathologists and pathology lab data systems into the cancer care team workflow. Below you’ll find a recap of our talk about integrated pathology approaches—how they impact diagnostics, coordination of care, and improve the patient experience and...