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Lab prior-authorization programs continuing to evolve

Lab prior-authorization programs continuing to evolve

by Alex Mitchell | Aug 7, 2017 | Pathology Management

With United Healthcare set to unveil a national prior-authorization process for genetic and molecular testing for fully insured members on Oct. 1, most major health plans are now utilizing some form of a laboratory benefits management (LBM) program in various parts of...
Understanding the benefits of registry reporting

Understanding the benefits of registry reporting

by Alex Mitchell | Feb 20, 2017 | CMS Fee Schedules, Pathology Management, Revenue Cycle Management

Understanding registries With the first reporting period for the Merit-based Incentive Payment System now underway, you’re probably already spent some time considering how you’ll report your quality data (and if you haven’t, now’s the time to start)! Most groups...

How offshore billing services will impact your practice’s bottom line

by Alex Mitchell | May 4, 2016 | Pathology Management, Revenue Cycle Management

During the past five years, we have seen many billing companies lower their cost for services.  When this trend is examined, it becomes apparent that the lower cost is available because these billing services are offshoring their services. As medical billing companies...

Anthem BCBS Adopts CMS Rules for Clinical Pathology Billing

by Alex Mitchell | Feb 16, 2016 | Pathology Management, Revenue Cycle Management

Anthem BCBS takes a cue from CMS regarding payments for clinical pathology New rules look at modifier and place of service, essentially cutting payments Billing for anatomic pathology is unchanged The states of Indiana, Kentucky, Missouri, Ohio and Wisconsin are...

Another Round of Payment Denials with IHCs, 88341 and the Prostate G Codes

by Alex Mitchell | Mar 13, 2015 | Revenue Cycle Management, Pathology Management, Billing & CPT Codes

It seems our latest audit has caught a glitch in Medicare Immunohistochemistry (IHC) payments. We found that Cahaba GBA, which serves as the Medicare administrative contractor for Alabama, Georgia, and Tennessee, is denying claims for CPT code 88341 as multiples,...

The Warning Signs of a Failing Billing Company or Revenue Cycle Management Firm

by Alex Mitchell | May 8, 2014 | Revenue Cycle Management, Pathology Management

By: Mick Raich, former President, RCM Solutions We have worked with 86 different revenue cycle entities over the past 12 years.  From hospital CBO’s to large national firms to small firms with only two clients.  There are certain trends we see whenever a billing firm...
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