Molecular Test Reimbursement: MolDX, Z-Codes & Payer Reform
00:00 1X If you work in a clinical or molecular lab, you’re living this tension every day: advancements in testing keep moving forward, but reimbursement rules lag months or even years behind. New molecular tests, infectious disease diagnostics, and proprietary...
Understanding and Navigating Medicare MUE, PTP Edits
The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was installed to promote national correct coding methodologies and to control improper coding leading to payment. NCCI Procedure-to-Procedure (PTP) code pair edits are automated prepayment... Pitfalls to Avoid When Using Diagnosis Z-Codes
00:00 1X Lighthouse billing and coding specialists have recently observed a rising trend of claim denials for laboratory services involving the Z00.00 diagnosis code. This code, which is used for general adult medical examinations without abnormal findings,... Guide: Navigating PCR Billing Challenges in MolDx Jurisdictions
00:00 1X Laboratories performing polymerase chain reaction (PCR)-based diagnostic testing continue to face significant billing and reimbursement challenges, particularly in regions covered by the Molecular Diagnostic Services Program (MolDx). As labs operating...
