Overturning of Molecular Test Coverage Denials Varies Widely, According to UCSF Study
Research into independent medical review data in four states show payers’ internal policies affect rates of overturns
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Up Next for Labs: PAMA Reporting Window Opens May 1
Cuts to reimbursement rates under PAMA have been pushed back again by Congress, this time to January 2027
PAMA Delay Proposed Until 2027 Under a New Federal Spending Bill
However, attorney Danielle Sloane urges labs to be proactive about potential PAMA reporting requirements on Jan. 31 if the bill doesn’t pass quickly
Final Surprise Billing Rules Seek to Provide Fairer Price Dispute Resolution
Revised final rule essentially disarms the threat of insurers having the advantage in out-of-network price disputes.
CMS Proposes Significant Increases to CLIA Fees
While the rule is not yet final, it’s likely that labs will have to pay more in direct CLIA compliance expenses, starting in October.
Surprise Billing Rules Would Give Private Health Plans Advantage in Disputes
The way the No Surprises Act is implemented would essentially allow private health plans to set out-of-network rates in billing disputes.
Malpractice Premiums Rise but Medicare Reimbursement Doesn’t
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Medicare to Cover Over-the-Counter COVID-19 Tests
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CMS Restores Medicare Coverage of Certain Genetic Thyroid Cancer Tests
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Blue Cross Blue Shield Sues National Lab for COVID-19 Test Price Gouging
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Medicare Expands Coverage for CTC Tests
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Labs and Payors Take Their COVID-19 Test Reimbursement Feud to Court
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Labs Sue National Insurers for Not Reimbursing COVID-19 Testing Claims
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