XIFIN Blog Compliance

The new system turns a straightforward process into an unnecessarily complicated and expensive one. Is the BCBS Association, forcing the Blues to enforce their exclusivity arrangements that disadvantage regional labs and prohibit them from competing in the market place?

Diagnostic services already face challenges in recouping R&D costs. Lower fee schedules, coverage for "investigational" services likely to stifle investment and development.

By forcing labs to obtain a Z code prior to submission of any claim and by defining tests with non-coverage as investigational, Palmetto is effectively attempting to close the loop for providers utilizing the appeal process to obtain coverage. With the MolDx program guidelines, Palmetto's second LCD (Non-standardized organ panels) targeting Molecular Diagnostics tests by eliminating any coding that requires more than one CPT code to report, is even more deliberate in its attempt to eliminate adherence to established coding guidelines and consequently, the use of the Medicare laboratory and physician fee schedules.

MGMA’s research suggests that critical coordination among many practices and their trading partners has not yet occurred. Practices that do not successfully implement Version 5010 by the Jan. 1, 2012, compliance date face possible disruption in cash flow, say experts. The Medical Group Management Association (MGMA) is calling on the Department of Health and Human Services (HHS) to issue a HIPAA 5010 contingency plan permitting health plans to adjudicate claims that may not have all the required data.