Medicare could and should have saved over $20 million in payments for medically unnecessary LDL cholesterol blood tests if CMS hadn’t been asleep at the wheel for the past five years. That’s the gist … [Read more...]
Billing & Coding
OIG Sounds the Alarm on Improper Billing of Lipid Panels & Direct HDL Tests
May 24, 2021
CMS
Price Transparency: 2 of 3 Hospitals Not Complying with New CMS Disclosure Rules, Study Finds
April 3, 2021
Despite vociferous industry protest, the Centers for Medicare and Medicaid Services’ (CMS’s) controversial new hospital price transparency rule officially took effect on Jan. 1, 2021. But through … [Read more...]
Reimbursement
OIG Medicare Lab Spending Report May Warn of Greater Scrutiny of Genetic and Automated Chemistry Tests
August 29, 2020
PAMA and market-based rate reductions for lab testing was supposed to save Medicare bundles of money. But according to a new OIG report, Medicare Part B spending on lab spending for 2018, the first … [Read more...]
Medicare Reimbursement
CMS Waivers Expand COVID-19 Testing Coverage Rules
June 1, 2020
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 Them
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...]
