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Understanding and Navigating Medicare MUE, PTP Edits

Understanding and Navigating Medicare MUE, PTP Edits

by Alex Mitchell | Sep 25, 2025 | Revenue Cycle Management, Pathology Management, Billing & CPT Codes, Denial Management, Industry Insights

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

Medical Billing Audit Unlocks $20K in Claims After Cyberattack

by Alex Mitchell | Sep 15, 2025 | Industry Insights, Revenue Cycle Management, Tips for New Lab Owners, Denial Management, Case Studies, Payer Audits & Alerts

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

Pitfalls to Avoid When Using Diagnosis Z-Codes

by lighthouselab | Sep 12, 2025 | Industry Insights, Revenue Cycle Management, Billing & CPT Codes, Denial Management

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,...
6 Tips for How to Get In Network with Insurance Companies

6 Tips for How to Get In Network with Insurance Companies

by Alex Mitchell | Sep 11, 2025 | Industry Insights, Revenue Cycle Management, CMS Fee Schedules, Payer Audits & Alerts, Clinical Laboratory

00:00 1X   Has your lab or group encountered obstacles when trying to determine how to get in network with insurance companies who represent your patient population? If so, you’re not alone. Health insurance companies manage their provider networks in a...
Guide: Navigating PCR Billing Challenges in MolDx Jurisdictions

Guide: Navigating PCR Billing Challenges in MolDx Jurisdictions

by Alex Mitchell | Jun 12, 2025 | Revenue Cycle Management, Industry Insights, Billing & CPT Codes, Denial Management, Payer Audits & Alerts

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...
No Surprises Act Frequently Asked Questions

No Surprises Act Frequently Asked Questions

by Alex Mitchell | Jun 8, 2025 | Industry Insights, Revenue Cycle Management, Pathology Management, Billing & CPT Codes

Federal Surprise Billing Law effective: Jan. 1, 2022 Overview: The No Surprises Act (NSA) provides individuals and families covered by group and individual health plans protection against unexpected, high-priced medical bills for services delivered at in-network...
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