In March 2018, Myriad Genetics got a piece of mail no lab provider ever wants to see in its inbox: an OIG subpoena asking for billing records in connection with "an investigation into possible false … [Read more...]
WHISTLEBLOWERS
Billing & Coding: Myriad Genetics Pays $9.1 Million to Settle Claims of Falsely Billing Medicare for Hereditary Cancer Tests
July 30, 2019
WORKING WITH PAYERS
Billing & Coding: Pathology Group Asks CMS to Raise Medicare Prices for BRCA1/2 Sequencing Tests
January 23, 2019
The Association for Molecular Pathology (AMP) thinks the final 2019 Clinical Laboratory Fee Schedule payment amounts shortchanges labs that provide BRCA genetic testing and is calling on CMS to … [Read more...]
CO-ORDINATING DATA
Laboratory Information Systems (LIS): What You Need To Know To Get Paid
July 23, 2018
By Sean McSweeney bio Today, laboratory billing claims require more and more data to successfully get paid. One of the biggest reasons your claims may be getting denied is because you're … [Read more...]
FEE SCHEDULES
How PAMA’s Effect in 2018 Molecular Diagnostic Reimbursement Will Make Labs More Money
June 25, 2018
By Sean McSweeney bio The year 2018 is slated to be much brighter for molecular diagnostic labs as PAMA fee schedules show a higher payment rate and amount for many cancer genomics and … [Read more...]
LEGISLATION
PAMA-Geddon: Lab Industry Takes CMS to Court
January 2, 2018
The nearly three-year struggle between HHS and the lab industry over PAMA has entered a new phase. On December 11, the American Clinical Laboratory Association (ACLA) filed a lawsuit asking the U.S. … [Read more...]
COMPLIANCE TIPS
No One-Size-Fits-All Answer for Frequency of Billing and Coding Audits
August 26, 2016
Q. How often should a laboratory conduct compliance audits of its billing and coding? A. The answer depends on many factors and will vary from provider to provider. The Office of Inspector General's … [Read more...]
Don’t Overlook Free Resources When Preparing Your Laboratory for ICD-10
July 2, 2015
The transition to ICD-10 is approaching fast and laboratories need to ensure they are prepared. While the Centers for Medicare and Medicaid Services (CMS) has indicated in answers to Frequently Asked … [Read more...]
The Art of Appeals: Don't Give Up Too quickly When a Payer Denies Your Claim
June 30, 2015
In the first part of this two-part series, we told you how to reduce the chances that payers would deny your claims. This month, you'll learn what you can do when, despite your best efforts, they … [Read more...]
Get Paid With Less Stress
June 3, 2015
Occasional denials from payers are just part of doing business for health care providers. But labs face challenges getting paid that clinicians don’t. In this two-part series, you’ll learn how to keep … [Read more...]
Ensure Regular training for Billing and Coding staff
June 3, 2015
Don’t overlook continual training of your billing and coding staff. It’s a compliance principle that the OIG emphasized in its initial compliance guidance for laboratories in 1998 and it is still just … [Read more...]
