Gold Cards Offer Labs Limited Relief for Prior Auth Woes

By Virchow | From the Volume XXXI, No. 17 – December 16, 2024 Issue

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Managing Denials and Appeals of Clinical Lab, Path Claims

By Robert Michel | From the Volume XXXI No. 15 – November 4, 2024 Issue

CEO SUMMARY: Based on a study of denials and appeals involving about 20 million lab test claims, the team at XiFin Inc. presents here their findings. They also provide recommendations on steps labs can take to reduce denials and win a greater proportion of appeals. IN RECENT…

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Physicians Tempted by Lure of In-Office Labs, Payers Balk

By Virchow | From the Volume XXXI, No. 14 – October 14, 2024 Issue

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Hurdles Continue When Labs Request Genetic Test Coverage

By Virchow | From the Volume XXXI, No. 13 – September 23, 2024 Issue

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Labs, Payers Don’t Like Prior Authorization for Genetic Tests

By Robert Michel | From the Volume XXXI, No. 10 – July 22, 2024 Issue

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How Private Health Insurers May Respond to FDA LDT Regulation

By Virchow | From the Volume XXXI, No. 8 – June 10, 2024 Issue

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UnitedHealth Group Faces DOJ Antitrust Probe

By Robert Michel | From the Volume XXXI, No. 6 – April 29, 2024 Issue

CEO SUMMARY: Recent events have not been kind to UnitedHealth Group and its subsidiaries UnitedHealthcare and Optum. In February, just as UHG’s Change Healthcare division was hit with a major cyberattack that disrupted billions of dolla…

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Payer Contracts with Labs: Getting the Contract Is Just the Start

By Virchow | From the Volume XXXI, No. 6 – April 29, 2024 Issue

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CMS Issues AI Guidance for Medicare Advantage

By Mary Van Doren | From the Volume XXXI, No. 3 – February 26, 2024 Issue

CEO SUMMARY: With its guidance on how Medicare Advantage plans should use artificial intelligence (AI) when making treatment decisions involving individual patients, the federal Centers for Medicare and Medicaid Services has opened one door in the coming debate on how the federal governme…

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Lab Data Crucial to Insurer Risk Adjustment Models

By Scott Wallask | From the Volume XXX, No. 13 – September 11, 2023 Issue

CEO SUMMARY: Payers who use risk adjustment models as part of Medicare Advantage need diagnostic data that helps them document ICD-10 diagnoses that earn them higher premium payments for sicker pat…

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