Blog Posts by Date: Mar 2021


Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension

In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, CMS has instructed the Medicare Administrative Contractors (MACs) to temporarily hold all claims with dates of service on or after April 1, 2021. Per CMS’s announcement, this is intended to only take place for a short period of time and should not...

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How an Accurate Patient Out-of-Pocket Expense Estimator Helps Prevent Surprise Billing

There has been a lot written about surprise billing lately and the No Surprises Act, which includes surprise billing legislation, was signed into law the final week of 2020 and is slated to go into effect on Jan. 1, 2022. Surprise medical bills are bills received by patients with unexpected balances due. This can occur when, for example, a patient...

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5 Strategies to Boost Your Revenue Cycle Profitability

In some hospital areas, such as outpatient, outreach, and ancillary service centers, revenue and profitability suffers when relying on electronic medical records (EMR) systems and enterprise RCM processes.Why? Using existing EMR technology when handling RCM activity associated with all claims can lead to high-volume, low-value claims being...

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The Remaining 20%: The Critical Role Appeals Play in Profitability (Part 2)

This blog post is part two of the series. View Part One. View Part Three. The first installment of this three part series provides data on denial trends in the pathology, molecular, and the clinical laboratory marketplace. Understanding root causes for specific denials enables us to initiate a strategic, multi-tiered approach to appeals. Measuring...

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Payor Relations Insider: The Introduction of Turnaround Time Requirements for SARS–CoV–2 Testing

To ensure COVID testing is performed in as timely a manner as possible, CMS created a turnaround time-dependent reimbursement policy. Since its introduction in January 2021, many other payors have also adopted this pricing schema. The COVID-19 Public Health Emergency has created new burdens for clinical diagnostic laboratories. The results of...

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The Remaining 20%: The Critical Role Denials Play in Lost Revenue (Part 1)

This blog post is part one of the series. View Part Two. View Part Three. In revenue cycle management we’ve always been of the mindset that 60-80% of billing is clean when the order is received and relatively simple to do well; however, it is how the remaining percentage is tackled that will determine whether your efforts are truly successful....

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HRSA High Throughput COVID-19 Claims: Correction Timeline

HHS confirmed there was a system error in the reimbursement for high throughput COVID-19 PCR testing claims, with HCPCS U0003 and U0004, for the HRSA COVID-19 Uninsured Patient Program. HHS indicated on their FAQ page they would not implement the add-on reimbursement for HCPCS U0005 on January 1, 2021 and would continue reimbursing independent...

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