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

this post was updated on June 1, 2021. In March 2021, United Healthcare announced an updated policy for Medicare Advantage plans, whereas they will be requiring providers to include the appropriate DEX Z-Code identifier on claims beginning June 1, 2021. United Healthcare has announced this policy update has been delayed and will not be implemented on June 1, 2021. Further communication will be...

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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...

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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 to...

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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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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 Two. 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 outcomes on all attempts to recover revenue,...

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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 these SARS-CoV-2 tests are used for critical treatment...

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