You Make the Call: Self-Disclosing Non-Compliant Arrangements with Large Physician Groups

SITUATION Fictional Med (FM), a large physician-owned clinic, is one of your lab's biggest customers. So your heart sinks when during an internal compliance audit, you discover that your lab has been … [Read more...]

CLFS 2018

CMS Ignored Congressional Intent in Implementing New Clinical Lab Payment System Under PAMA, ACLA Charges in Suit

The government agency that runs the Medicare program failed to follow a congressional directive to implement a market-based laboratory payment system, thereby jeopardizing Medicare patients' access to … [Read more...]


OIG Calls on CMS to Do Better at Medicare Collecting Overpayments

The system Medicare uses to detect and recover overpayments isn't working as well as it should be, according to a new OIG report. The Overpayment Collection System CMS relies on special contractors … [Read more...]


Medicare Reimbursement: CMS Issues New Medical Review Instructions to Contractors

On Aug. 14, CMS issued new marching orders to Medicare Administrative Contractors (Contractors). The message: Tighten up the way you target suppliers and providers for medical review. The Targeted … [Read more...]


Labs Keep Up the Pressure to Delay PAMA & Add Hospital Lab to CLFS Formula

The lab industry continues to wait nervously for word from CMS regarding PAMA. Demand 1: Fix the Fee Schedule Methodology The industry's paramount concern remains the formula CMS proposes to use to … [Read more...]


3 Things We Learned from New OIG Report on 2015’s Top 25 Lab Tests by Medicare Payment

Buried in the back of the Office of Inspector General (OIG) recent report on 2015 Medicare payments for Part B lab tests are three key revelations about the new Protecting Access to Medicare Act of … [Read more...]


PAMA Update: OIG Status Report on Implementing New Medicare Fee Schedule for Part B Lab Tests

Transition to the new Medicare Part B payment system for lab tests under the Protecting Access to Medicare Act of 2014 (PAMA) is in full swing and about to heat up. With D-day set for Jan. 1, 2018, … [Read more...]


Industry Questions How Many Hospital Labs Will Be Reporting Under PAMA

When the Centers for Medicare & Medicaid Services (CMS) announced in mid-June the final rules governing the Protecting Access to Medicare Act (PAMA), it drew praise from several groups that had … [Read more...]


Pathology, Cytology Face Potential Cuts in 2017 Physician Fee Schedule

CPT Code 88305 is headed to the chopping block again. The Centers for Medicare & Medicaid Services (CMS) has suggested cutting the technical component of 88305—a tissue examination and a primary … [Read more...]


Labs Get One-Year Reprieve under Final PAMA Rule, New Rates Delayed until 2018

Labs must now begin preparations in earnest to comply with private payor rate reporting requirements under the Protecting Access to Medicare Act of 2014 (PAMA). After much lobbying, debate and delay, … [Read more...]