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
March 8, 2020
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
January 30, 2020
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
November 6, 2019
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
October 28, 2019
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
October 17, 2019
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
August 28, 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
March 27, 2019
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
March 15, 2019
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
February 22, 2019
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...]
