PAMA

Draft 2018 CLFS Reveals Fundamental Flaws in PAMA Reporting Exercise; Time to Take Action

By Lâle White  bio As XIFIN predicted, the PAMA reporting exercise has resulted in significant proposed laboratory fee cuts. In fact, the multi-year decrease for the top 20 laboratory tests … [Read more...]

REIMBURSEMENT

Medicare Reimbursement: CMS Issues New Medical Review Instructions to Contractors

On Aug. 14, CMS issued new marching orders to Medicare Administrative Contractors (Contractors). The message: Tighten up the way you target suppliers and providers for medical review. The Targeted … [Read more...]

OIG REPORT

CMS Dished Out $729.4 Million in Wrongful EHR Incentive Payments & We’re Going to Get that Money Back

Wrongful payments of Electronic Health Records (EHR) incentives are at the focus of two of the month's biggest stories in health care compliance. The first came down on May 31 when the Justice … [Read more...]

REIMBURSEMENT

CMS Exercises Enforcement Discretion for PAMA Reporting

As we previously reported, the Centers for Medicare & Medicaid Services (CMS) has indicated that laboratories had sought relief from the March 31 deadline for reporting applicable information … [Read more...]

ENFORCEMENT TRENDS

FISH Test Crackdown against 21st Century Oncology Nets Nearly $25 Million… and Counting

$24.86 million. That's how much a whistleblower has made for the government and herself—so far—in a case against 21st Century Oncology for alleged fraudulent billing of fluorescence in situ … [Read more...]

ENFORCEMENT

OIG Targets Sleep Study Tests

If your lab performs sleep studies on Medicare patients, beware. It is now a high-priority target for federal fraud and abuse enforcement. Here is a look at the risk you face and what you can do to … [Read more...]

COMPLIANCE PERSPECTIVES

Crosswalked Codes in 2017 Clinical Laboratory Fee Schedule

CPT Code Crosswalked To 80305 (Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical … [Read more...]

REIMBURSEMENT

2017 Medicare Lab Payments: The 9 Changes that May Affect Your Reimbursements

As the clock ticks down to 2018 and the new Protecting Access to Medicare Act of 2014 (PAMA) system for lab payments, the Centers for Medicare and Medicaid Services (CMS) issued final Medicare payment … [Read more...]

REIMBURSEMENT

3 Things We Learned from New OIG Report on 2015’s Top 25 Lab Tests by Medicare Payment

Buried in the back of the Office of Inspector General (OIG) recent report on 2015 Medicare payments for Part B lab tests are three key revelations about the new Protecting Access to Medicare Act of … [Read more...]

PAMA

PAMA Update: OIG Status Report on Implementing New Medicare Fee Schedule for Part B Lab Tests

Transition to the new Medicare Part B payment system for lab tests under the Protecting Access to Medicare Act of 2014 (PAMA) is in full swing and about to heat up. With D-day set for Jan. 1, 2018, … [Read more...]


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