How SALSA Would Create a Sustainable Clinical Lab Fee Schedule
Although clinical laboratories have experienced drastic Medicare rate reductions since the introduction of the Protecting Access to Medicare Act (PAMA) required them to begin reporting private payer data to Medicare in 2017, several pandemic-related delays in recent...
6 Tips for How to Get In Network with Insurance Companies
Has your lab or group encountered obstacles when trying to determine how to get in network with insurance companies who represent your patient population? If so, you’re not alone. Health insurance companies manage their provider networks in a variety of ways and...
Improving Denial Management Through Artificial Intelligence
As CMS and private payors have increased the use of Medically Unlikely Edits and prior authorization programs over that past decade to control costs and utilization, providers and their billers have had to commit an increasing amount of time and resources to denial...
How to Navigate MUE Denial Adjustments
By: Billie Mildenberger, Director of Audit Services, Lighthouse Lab Services RCM Case Study – MUE Denial Adjustments: Medically Unlikely Edits (MUEs) are used by Medicare Administrative Contractors (MACs), to reduce the improper payment rate for Part B claims....