Industry Insights
Stay up to date on the latest news in the laboratory reimbursement industry. Subscribe to receive resources covering updates and insights into federal and commercial payers, reimbursement regulations, CMS coding adjustments, federal regulations and more.
CMS Makes Improvements to Prior Authorization Process
The Centers for Medicare & Medicaid Services (CMS) has released the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) on January 17, 2024. The rule aims to advance interoperability and enhance prior authorization processes in healthcare. It...
Cigna Announces Rollback of Prior Authorization Requirements
Cigna has taken a significant step towards simplifying the healthcare process by eliminating prior authorization requirements for 25 medical procedure codes. This decision is in line with Cigna's ongoing efforts to enhance patient care and reduce administrative...
UnitedHealthcare’s Z-Code Requirement for Genetic Testing Claims Impacts Laboratories and Payers
UPDATE: 1/2/2024 UHC announced that the policy requiring the use of Palmetto GBA's DEX Z-codes will now be effective for dates of service on or after April 1, 2024. UHC outlines that claims for molecular pathology services will be denied if the DEX Z-code information...
Why and How Your Lab Can Support SALSA
"With strong bipartisan and bicameral support of SALSA, Congress has the opportunity to fix the flawed PAMA framework and prevent reduced access to essential testing, stifled innovation, and weakened laboratory infrastructure essential to public health preparedness....
How Labs Are Affected by the End of the COVID-19 Public Health Emergency
The U.S Department of Health & Human Services released a fact sheet for the transition out of the COVID-19 Public Health Emergency that will end on May 11, 2023. Transitioning away from the emergency phase of the spread of the virus will affect the billing process...
Blogs
Laboratory Medical Billing – Decisions of Profitability
The Complex Landscape of Laboratory Medical Billing The success of a lab truly lies in the foundation of the success of it's laboratory medical billing process. Without proper reimbursement, labs...
Optimizing Revenue with Specialized Pathology Billing Practices
In the ever-evolving landscape of healthcare, pathology practices are faced with the constant challenge of maximizing revenue while providing accurate and efficient diagnostic services. Pathology...
Maximizing Lab Billing Efficiency with Laboratory Modifiers
In the realm of medical laboratory billing and coding, laboratory services occupy a critical position. Accurate coding of laboratory tests is not only essential for ensuring proper reimbursement but...
Advantages of Laboratory Credentialing and Payer Network Status
As a laboratory billing company, we understand that the financial health of laboratories is intrinsically tied to their ability to navigate the complex world of healthcare billing. One key factor...
How Laboratories May Be Impacted During a Government Shutdown
All eyes of the nation are on Washington this week as the looming possibility of a government shutdown is poised to close big parts of the federal government at least temporarily—including many...
8 Things to Know About Physician Billing Guidelines for Laboratory Services
Billing for laboratory services is a crucial piece in the healthcare system that has only grown in complexity over the last decade. Trends such as labs shifting from COVID-19 and the rise of...
Why Patients Aren’t Paying Your Lab Tests and How to Fix It
The medical laboratory billing process is an essential piece in effectively managing and growing a laboratory. Without giving proper attention to setting up an efficient billing environment before...
Navigating the Eligibility Process in Laboratory Billing: A Comprehensive Guide
Determining patient eligibility for laboratory services has become a complex task for laboratories to handle as payer requirements shift constantly. Accurate eligibility verification ensures...
Choosing the Right Outsourced Laboratory Billing Vendor: Key Considerations
Laboratory stakeholder’s face numerous challenges both starting and managing their labs, including finding an efficient billing and revenue cycle management solution. Outsourcing laboratory billing...