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Top 5 Blog Posts of 2022

As always, XIFIN’s Beyond Billing blog kept abreast of key issues and hot topics within the healthcare industry, staying especially in tune with legislative proposals that can potentially impact reimbursement and revenue.

Here are the top blogs of 2022, with far-ranging topics that include PAMA and SALSA, the No Surprises Act, digital pathology, and revenue cycle management.

1. Laboratory Test Claim Denials and Appeals Trends

Our data is based on an analysis of 25 million claims with 2021 dates of service. Key trends analyzed include:

  • The propensity for denial by top XIFIN payor groups for pathology and molecular
  • The propensity for successful appeals by those payor groups
  • Top appeal reasons and success rates
  • Revenue per appeal for pathology and molecular segments

It is important to understand top denial reasons by segment because these create the biggest bottlenecks in the payment process, dragging out AR days and requiring your team’s time and attention.

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2. Optimizing Patient and Payor Payments with Patient Responsibility Estimator Tool

In 2021, the total US out-of-pocket healthcare patient spending increased by 10% from the previous year and is expected to continue to increase by 9.9% annually through 20231. An increase in a patient’s financial responsibility is a growing problem in healthcare and is driven by several factors.

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3. New CPT Digital Pathology Codes Help Make the Case for AI-Driven Digital Pathology Workflows

The College of American Pathologists (CAP), working with the American Medical Association (AMA) CPT Editorial Panel, has successfully advocated for the inclusion of (13) new digital pathology add-on codes to be effective January 1, 2023. According to the CAP, these new digital pathology CPT codes will be “used to report additional clinical staff work and service requirements associated with digitizing glass microscope slides for primary diagnosis.”

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4. Understand the Black Book Research Criteria to Choose the Right Outsourced RCM Services Provider

As our second blog in this series about the benefits of using Black Book Research’s comprehensive set of assessment criteria to evaluate outsourced revenue cycle management (RCM) service providers, we focus on the measures associated with Security, Compliance, and Trust.

Black Book Research evaluated outsourced diagnostic/laboratory RCM services vendors on 18 different evaluation criteria based on customer feedback through an annual Black Book market research survey.

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5. Mitigating 2023 Proposed Medicare Reimbursement Cuts

Over the past few years, due to the public health emergency (PHE), Congress has stepped in to halt pending Medicare cuts. However, legislative intervention during the PHE only delayed the cuts until the following year. 

With the proposed 2023 Medicare Physician Fee Schedule released in July, which contained several reductions, and the return of the 2% sequestration, healthcare providers need to start planning to mitigate upcoming reimbursement cuts.

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Published by XIFIN
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