FEE SCHEDULES

Reimbursement Trends: Part B Medicare Lab Payments Up Slightly in 2017

According to a new OIG report, Clinical Laboratory Fee Schedule payments for lab tests in 2017, the last year under the pre-PAMA payment system, totaled $7.1 billion, up slightly from the $6.8 billion … [Read more...]

REIMBURSEMENT

PAMA: OIG Backing of CMS Heats Up Market-Based Lab Rates Controversy

CMS did it right and saved Medicare a boatload of money in the process, concludes a new OIG report reviewing the methods CMS used to establish "market-based" rates for Medicare Part B lab tests. Of … [Read more...]

PAMA

Proposed 2019 Medicare PFS: The 5 Things Labs Need to Know

On July 12, CMS issued the proposed 2019 Medicare physician fee schedule (PFS), with comments scheduled to end on Sept. 10. Takeaways: 1. Physician Payment RatesĀ  CMS is proposing a 0.25% increase … [Read more...]

PAMA

Proposed 2019 Medicare HOPPS Rule: The 4 Things Labs Need to Know

Heads up to labs that bill Medicare for services to hospital outpatients: CMS issued the proposed 2019 hospital Outpatient Prospective Payment System (OPPS) on July 25, with comments scheduled to end … [Read more...]

BILLING AND COLLECTIONS

Medicare Reimbursement: New HOPPS Date of Service Rules for ADLTs & Molecular Pathology Tests Take Effect

Here's what labs that bill Medicare for outpatient lab tests need to know about the new CMS rules exempting advanced diagnostic laboratory tests (ADLTs) and molecular pathology tests from Hospital … [Read more...]

PAMA

PAMA Unlocks Golden Age for Innovative Diagnostics

By Chance Scott  bio The publication of the 2018 Clinical Laboratory Fee Schedule (CLFS) in January saw a long and heated debate within the lab community come to fruition. When Congress … [Read more...]

BILLING & COLLECTIONS

Getting Paid: Medicare to Cover Next Gen-Sequencing Tests for Advanced Cancer

In the PAMA era, there are two salient trends in Medicare Part B lab reimbursements: Sharply lower prices for traditional tests; and Wider coverage of newly emerging tests, including some that … [Read more...]

OVERPAYMENTS

CMS to OIG: Get Back the $66.3 Million You Improperly Paid to Labs for Urine Validity Tests

As if times were not already tense enough for labs that bill Medicare for urine drug tests, the OIG ratcheted up the pressure another notch on Feb. 20 by issuing a new report chiding CMS for making … [Read more...]

REIMBURSEMENT

Out of Network: 6 Frequently Asked Questions

By Richa Singh  bio As labs face an increasingly challenging reimbursement environment, more providers are doubling down on out-of-network strategies to maximize on collections … [Read more...]

INDUSTRY NEWS

CAP Files Amicus Brief in Support of ACLA Motion for Summary Judgement in PAMA Lawsuit

The College of American Pathologists (CAP) filed an amicus curiae brief in support of a motion by the American Clinical Laboratory Association (ACLA) for summary judgement to set aside how the … [Read more...]


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