On July 1, 2023, the Centers for Medicare and Medicaid Services (“CMS”) implemented a new National Correct Coding Initiative (“NCCI”) Procedure-to-Procedure (“PTP”) edit for codes 80305, 80306, and 80307 for presumptive drug test(s), and codes G0480-G0483, and...
The 2024 Medicare Physician Fee Schedule Proposed Rule released July 13 is already generating pushback from lab and pathology advocates, such at the College of American Pathologists (CAP), who contend these services and the physicians who provide them cannot sustain...
Our latest denial spotlight uncovers how RCM Spotlight, a powerful, AI-assisted tool for revenue cycle and denial management, optimized billing processes for one of our independent lab clients to unlock nearly $200,000 in reimbursement opportunities for previously...
The American Medical Association CPT Editorial Panel recently announced 30 new digital pathology add-on codes that will go into effect Jan. 1, 2024. According to the College of American Pathologists (CAP), the new digital pathology Category III CPT codes will be used...
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...
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