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...]

NEWS

Government Shutdown: The Impact on the Agencies that Regulate Labs

As we go to press, the longest U.S. government shutdown in history drags on with no end in sight. And while it may not affect your lab directly, the shutdown will have an indirect impact to the extent … [Read more...]

PAMA

Medicare Reimbursement: CMS Provides Needed PAMA Relief—But Newly Covered Hospital Labs Must Report in 2019

The battle between CMS and the lab industry over Medicare Part B pricing for lab tests could be on the road to resolution notwithstanding the ACLA's recent court loss. But even as the legal battle … [Read more...]

ENFORCEMENT

Provider Fined for Not Taking Compliance Measures Required by Its CIA

Case: Nearly 10 years ago, a new Affordable Care Act rule requiring labs and other providers to investigate their credit balances for potential Medicare overpayments took effect. In 2015, Pediatric … [Read more...]

CORRECTION

Correction: PAMA Relief—CMS 1450 14x TOB Labs DO Count!

Two articles appearing on the G2 website, "CMS Offers Some PAMA Relief But Not Nearly Enough" (G2 Compliance Advisor/Lab Compliance Advisor) and "2019 CLFS Offers Some PAMA Relief But Not Nearly … [Read more...]

MACRA REQUIREMENT

How to Adjust to the April 2018 Medicare Beneficiary Cards

By Sean McSweeney  bio In a press release on May 30, 2017, the Centers for Medicare & Medicaid Services (CMS) commented regarding their fraud prevention initiative program and their … [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...]


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