Medicare Reimbursement

CMS Waivers Expand COVID-19 Testing Coverage Rules

On May 1, CMS issued regulatory waivers temporarily expanding coverage and clarifying billing of COVID-19 testing for Medicare and Medicaid beneficiaries during the public health emergency (PHE). Here … [Read more...]

Coronavirus

CMS Develops Additional Code for Coronavirus Lab Tests 

On March 6, the Centers for Medicare & Medicaid Services (CMS) announced a  second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain … [Read more...]

Industry Buzz

Lab Companies Scramble to Bring Coronavirus Detection Tests to Market

Along with an urgent public health challenge, the outbreak of the novel 2019-nCoV coronavirus in Wuhan, China, first reported on Dec. 31, has created a strategic opportunity for makers of lab tests. … [Read more...]

CMS

Lab Fails in Bid to Get Medicare Payment Suspension Set Aside

Case: In 2017, CMS suspended 100% of Medicare payments to True Health Diagnostics (THD) based on what it called “credible allegations of fraud.” Two years later, while the suspension was still in … [Read more...]

CMS

The New CMS Medicare Exclusion Rules & How to Comply with

On Nov. 4, 2019, a new Final Rule, aka the Program Integrity Enhancements to the Provider Enrollment Process, broadens CMS’ powers to kick labs and other providers and suppliers out of Medicare and … [Read more...]

Brief Your CEO: It May Become Easier to Get CMS Stark Clearance for Business Deals with Referral Sources

Part of the challenge of running a lab compliance program is making your officers aware of how business transactions your lab makes with a physician that refers patients to you for testing creates the … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: August 2019

Of the 12 new items in the OIG's Work Plan this month, six indirectly impact lab providers and services. Medicare Payments of Positive Airway Pressure (PAP) Devices for Obstructive Sleep Apnea (OSA) … [Read more...]

CMS

PAMAgeddon: GAO Official Acknowledges Flaws in Lab Price Report as a Powerful Senator Enters the Scene

In November 2018, the U.S. Government Accountability Office (GAO) issued a controversial report suggesting that the new PAMA system will result in billions of dollars worth of Medicare overpayments … [Read more...]

OUTPATIENT PAYMENTS

How to Determine Date of Service for Part B Billing of Outpatient Lab Tests

Date of service rules affect whether outpatient lab tests are part of the Hospital Outpatient Prospective Payment System (HOPPS) bundled payment or can be billed separately under Part B. Last month, … [Read more...]

REIMBURSEMENT

Medicare Reimbursement: CMS Limits NGS Early Cancer Test Coverage but Industry Fires Back

Getting Medicare to cover Next Generation Sequencing (NGS) tests has been a slow go. And the latest CMS National Coverage Determination (NCD) for early stage cancer NGS testing of patients with … [Read more...]


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