Tagged with Pathology Billing
There are many complex regulations and steps involved when it comes to pathology billing and coding. Mistakes can occur at many points of your “front-end” and “back-end” processes. This can reduce collections and increase days in A/R, delay reimbursement and lead to compliance violations or fines. In today´s era of ongoing pressures on pathology reimbursement,…
An EMR provides many benefits for pathology billing and management including reduced denials and more patient time for providers
The White House has announced that beginning on March 6, Medicare administered by CMS will temporarily pay clinicians to providing virtual visits and other telehealth services to beneficiaries.
A new CPT® code has been created that streamlines novel coronavirus testing offered by hospitals, health systems and laboratories in the United States. The new code became effective March 13, 2020 for use as the industry standard for reporting of novel coronavirus tests across the nation’s health care system.
Effective May 1, UnitedHealthcare (UHC) will deny any non-patient lab test claims submitted by hospital outreach labs if billed under the hospital’s facility participation agreement. The insurer is requiring that hospital outreach labs are credentialed and contracted as an independent reference lab in order to get their non-patient lab test claims paid.
On February 13, CMS introduced a new code that enables labs conducting Coronavirus tests to bill for the specific test instead of using an unspecified code.
Effective January 1, UnitedHealthcare (UHC) will update the procedure code list for the Radiology Notification and Prior Authorization programs based on code changes made by the American Medical Association (AMA). Claims with dates of service on or after January 1 are subject to these changes.
On October 9, the Department of Health and Human Services (HHS) announced proposed changes that seek to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute. The proposed rule has been designed to provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposed changes are intended to ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.
AdvantEdge Healthcare Solutions is a national top 10 medical billing company that is a leading vendor to pathology practices across the country for billing, coding, and revenue cycle management services since 1967. If you have questions about how AdvantEdge can improve your pathology practice billing and coding so that you are collecting every dollar that…
On September 26, CMS issued The Omnibus Burden Reduction (Conditions of Participation) Final Rule, which advances the ‘Patients over Paperwork’ initiative aimed at reducing administrative costs in healthcare.
The Texas Health and Human Services Commission announced, on October 1, that the state will be given $11.6 billion over the next three years to help reimburse health care providers for indigent services and is intended to benefit hospitals, clinics, public ambulance, and dental providers.
In a letter to the House Ways and Means Committee, Chairman Richard Neal has proposed that the Departments of Health and Human Services (HHS), the U.S. Labor and Treasury Department, along with other interested parties, consolidate their efforts to develop standards for rates for surprise bills.
Two physician lawmakers have proposed new legislation that aims to improve the accuracy of information in health plan provider directories and protect patients from surprise out-of-network bills. The Improving Provider Directories Act (HR 4575) would require health plans to provide an avenue for people to report errors in provider directories, in a “highly visible way”.
The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.
By Brice Voithofer, Senior Vice President Through continuous process improvement (CPI) successful companies constantly re-evaluate their business process to assure they are running their business in the most effective, efficient, and innovative manner. Medical practices are no different and must adapt to the ever-changing landscape to survive long-term. Companies that thrive are the ones that…
Effective September 1, UnitedHealthcare (UHC) will add a new policy for molecular pathology and will make changes to its procedure to modifier policy.
By Steve MacCrea, Director of Account Management A recent study by Laboratory Economics (LE) –an independent research and analysis firm focusing on pathology and the laboratory services industry– shows that 82.4% of labs and pathologists cite declining reimbursement as one of the industry’s biggest challenges. During the month of July, LE disseminated it’s Anatomic Pathology & Clinical…
On June 20, CMS released a renewed guidance to state Medicaid agencies that outlines the necessary assurances that states should make to ensure that program resources are reserved for those who meet eligibility requirements.
CMS, on June 28, released its report summary of the Affordable Care Act (ACA) risk adjustment program for the 2018 benefit year. The analysis found that 572 health insurers offering ACA plans participated in the program in 2018, and transfers between the companies totaled $10.4 billion.
CMS, on June 21, issued several new or updated frequently asked questions documents on the Bundled Payments for Care Improvement (BPCI) Advanced Model, an Advanced Alternative Payment Model launched last October that will run through 2023.