By: Dyana Williams, Client Engagement Manager Medical necessity plays a pivotal role in determining whether a service or procedure will be covered by insurance. It refers to the requirement that a healthcare service must be appropriate and essential for the diagnosis...
In the complex landscape of laboratory and diagnostic test reimbursement, it can be difficult to understand how best to pursue coding and payment strategies for new tests when working across various government and private payers. One straightforward approach is to...
By: Cassie Penn, Client Manager, Lighthouse Lab Services Laboratories have been in a whirlwind since the COVID pandemic started in 2019. Now that we have reached the end of the pandemic and the Public Health Emergency, laboratories need to work on tightening up their...
By: Ann Lambrix, VP of RCM Consulting, Lighthouse Lab Services. About this article: Our monthly “RCM Industry Spotlight” series highlights timely findings from Lighthouse’s proprietary RCM Spotlight denial management tool. If you’d like to...
Independent laboratories have been pushed to the brink of financial instability in recent years due to the price cuts mandated by the Protecting Access to Medicare Act of 2014 (PAMA). However, as part of a yearslong effort to rectify the problematic pricing and...
This article was updated with new information on March 5, 2023. As labs throughout the country continue to explore new revenue streams in the face of seemingly endless annual cuts from CMS and commercial payers, many are adding genetic testing and molecular...