First Coast Publishes Rates for New External Electrocardiographic Recording Codes

In late 2020, CMS announced that it would be moving from the temporary Category III codes for long term ECG monitoring and will instead use Category I CPT codes, starting January of 2021. CMS did not add national rates for the codes but is instead looking to the MACs to price individually.There has been much attention on the initial Novitas proposed rates as they were a substantial reduction...

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UHC Implements DEX Z-Code Requirements on Medicare Advantage Claims Starting June 1, 2021

Effective 6/1/2021, UHC will require pathology providers currently submitting a DEX Z-Code for the Medicare MolDx program to also submit their registered Z-code on UHC Medicare Advantage claims. In the same format as Medicare, the Z-code will be submitted in Loop 2400. While UHC will not require a separate registration of these z-codes, providers will need to ensure qualifying tests are...

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Preparing for Market Disruption – Operational Lessons From COVID-19

Conor WardVP of Sales, XIFIN Joe NollarAVP LIS Product Development, XIFIN In March 2021, we had the privilege of being interviewed by Linda Wilson, Senior Editor of Medical Laboratory Observer (MLO). The discussion focused on what has been learned by laboratories during the...

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The Remaining 20%: How Payor Policies and Specific Language Increase Success Rates of Appeals (Part 3)

This blog post is part three of the series. View part one. View part two. As we’ve covered statistically where our greatest challenges and opportunities lie, it’s important to recognize the appeal process is NOT a one-size-fits-all solution. Lesson 1: Report Documentation — “If it isn’t documented, it wasn’t billable” Appeals with path...

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After Large Spikes in 2020, Diagnostic Laboratory Testing Volumes on the Decline

As XIFIN CEO Lâle White wrote in her recent LinkedIn article, the COVID-19 pandemic created many challenges for the diagnostic industry in 2020. In the preceding years, many laboratories were running lean with little excess capacity. With the surge in COVID-19 testing demand, labs had to quickly add capacity to handle the new testing volume. In addition, dynamic regulatory changes designed...

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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 have any significant impact to providers’ cash flow....

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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 unexpected balances the patient owes. This can occur for example when a patient receives care from a hospital that is in-network but is seen by a...

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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 uncollected. Many finance executives see this method as...

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