Balancing Compliance, Risk, and Revenue in Toxicology Testing
00:00 1X For many labs, toxicology has long been a top target for payer audits. Reimbursement cuts and stricter “medical necessity” interpretations are raising denials, claw-backs, and scrutiny, especially around frequency of testing and documentation quality....
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...
Medical Billing Audit Unlocks $20K in Claims After Cyberattack
00:00 1X As we look back at recent trends, 2024 may go down as the year of the cyberattack. In February of last year, the Change Healthcare breach made national headlines as the largest healthcare cyberattack in history, halting claims submission and disrupting...
Pitfalls to Avoid When Using Diagnosis Z-Codes
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, often needs to be...
