How Clinical Labs Can Improve Payer Network Access and Leverage
00:00 1X For most clinical laboratories looking to improve their payer network, reimbursement challenges aren’t an abstract business concern; they’re existential. For independent and small- to mid-sized reference labs/POLs, one reality remains consistent:... 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...
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... 