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...]


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...]


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...]


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...]


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 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...]


Compliance Perspectives: PAMA—What We Know So Far, What You Need to Know to Comply

After much lobbying and debate from stakeholders in the laboratory industry, the Centers for Medicare & Medicaid Services (CMS) is moving forward with implementation of the Protecting Access to … [Read more...]


Industry Questions How Many Hospital Labs Will Be Reporting Under PAMA

When the Centers for Medicare & Medicaid Services (CMS) announced in mid-June the final rules governing the Protecting Access to Medicare Act (PAMA), it drew praise from several groups that had … [Read more...]


Pathology, Cytology Face Potential Cuts in 2017 Physician Fee Schedule

CPT Code 88305 is headed to the chopping block again. The Centers for Medicare & Medicaid Services (CMS) has suggested cutting the technical component of 88305—a tissue examination and a primary … [Read more...]


Labs Get One-Year Reprieve under Final PAMA Rule, New Rates Delayed until 2018

Labs must now begin preparations in earnest to comply with private payor rate reporting requirements under the Protecting Access to Medicare Act of 2014 (PAMA). After much lobbying, debate and delay, … [Read more...]