Full Focus: Navigating the New CMS Billing Edit for Drug Testing
A new CMS edit code is substantially impacting the operations of drug testing laboratories serving Medicare patients nationwide. This NCCI prepayment edit results in claims for definitive drug testing being automatically denied when billed on the same claim with presumptive tests. Given this dramatic shift, how can toxicology labs and pain management providers best respond in order to minimize impacts to their patients and overall operations?
Join us at 1 p.m., Wednesday, Aug. 16, for our next webinar as we discuss what's driving the implementation of this edit and offer steps for navigating these developments to keep your revenue cycle healthy.
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1. Unpacking the New NCCI Edit Impacting Drug Testing
Check out our latest blog ahead of this week's webinar for a preview of how labs are currently responding to the new National Correct Coding Initiative (NCCI) edit affecting codes 80305, 80306, and 80307 for presumptive drug test(s), and codes G0480-G0483, and G0659 for definitive drug test(s).
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2. UHC Delays Z-Code Requirements for Molecular Testing
UHC is delaying the implementation of Z-Code requirements for molecular test claims from August 1 to October 1, 2023. This first wave of affected codes includes 136 CPT codes and 106 PLA codes. Z-Code requirements impacting some PCR-based microbiology tests are expected to be implemented within a year.
When interviewed last month by Lab Economics, Lighthouse VP of RCM Solutions Ann Lambrix noted other private payers have also begun instituting coverage policies to rein in growth of PCR-based testing. Given this reality, she said she expects UHC commercial plans to follow a similar path to the Medicare Advantage Z-Code rollout.
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3. How Medical Labs Are Evolving as 2024 Approaches
Following years of turbulence caused by the pandemic and shifting government regulations, the medical laboratory industry has finally returned to a state of relative normalcy. As we approach 2024, Lighthouse President Jon Harol offers his takeaways on how the industry has recovered and what stakeholders should expect in regard to growth in the near future.
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4. Find Us in Philly at Future Labs Live Oct. 4-5, 2023
Future Labs Live USA is a leading event focused on the future of laboratories with over 150+ speakers from the world’s leading laboratories, and 1000+ attendees from around the world. Start-ups and disruptors will meet lab heads and lab techs together with the tech innovators and practice innovators of the future.
Lighthouse President Jon Harol will be a featured speaker at the event, offering his insight on what steps labs should pursue in order to remain successful amidst ongoing reimbursement and staffing challenges.
Register for FREE and join lab leaders this October 4-5 at the Pennsylvania Convention Center: https://rb.gy/du8nv
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1. Denial Spotlight: Mitigating Timely Filing Denials on Lab Claims
In the ongoing deployment of our RCM Spotlight denial management tool for our clients, a recurring trend has emerged: Timely filing consistently ranks among the top five denial reasons for both independent and hospital-based laboratories.
While these denials are a fairly common reoccurrence for ancillary providers such as labs, there are steps providers should pursue to minimize these payment disruptions.
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2. Sustaining Clinical Pathology Revenue Amidst Ongoing Challenges
For hospital-based pathology groups, mastering the complex revenue cycle management processes surrounding the capture and billing of Professional Component of Clinical Laboratory (PCCP) services is paramount when the group is not being otherwise compensated through their contract with the facility. Check out this blog for insight on the consequences of overlooking charge volume gaps and more tips.
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3. HCCI Reports Higher Prices for Hospital Outreach Tests (from The Dark Report)
A recent report from the Health Care Cost Institute revealed hospital outpatient lab tests cost self-insured employers three to five times more than the same tests performed in independent or physician office labs, according to an in-depth analysis from the July 10, 2023, edition of The Dark Report. Asked to provide comments on this trend, Lighthouse President Jon Harol noted the price gap essentially boils down to negotiating power.
"When certain hospitals charge more to run outpatient tests than independent lab companies, this often has nothing to do with cost structure," Harol said. "In these cases, it has everything to do with the way the contracts between the hospital and health insurer were negotiated."
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Deep Dive: 6 Strategies to Boost Medical Laboratory Retention |
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For medical laboratories, attracting and retaining top talent is essential for providing quality patient care and achieving organizational success. Employee turnover, especially due to retirements and the aging workforce, has become one of the most significant hurdles labs face as the industry works to bolster the overall recruitment pipeline. In the interim, it is crucial for lab leaders to implement innovative strategies that show a true investment in their employees to foster a loyal and engaged workforce.
In this article, we cover:
- The benefits of defining clear growth paths for employees.
- How to remain competitive in your local market.
- Incentives to consider, such as improving shift differentials.
- And more.
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“Roll out the red carpet to make sure new employees want to stay in the industry,” Luellen suggested. “Investing in them will show that you care about their growth, and they’ll return that to you in terms of staying and valuing you as an employer.”
-- Tara Luellen, VP of Lab Director Services, LLS
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This email is brought to you as a service from Lighthouse Lab Services to provide quality and timely information that can improve your laboratory operations. We strive to maintain our position as the country’s premiere lab consulting firm and support your success. |
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The Lab Insighter is a monthly publication for Lab Owners and Decision Makers.
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Contact us at:
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