Things are getting ugly. The unfortunate convergence of resurgent COVID-19 cases, lingering testing supply bottlenecks and Thanksgiving are once more stretching labs to the breaking point and fraying … [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...]
Billing & Coding
AMA Creates New CPT Code 87426 for COVID-19 Antigen Testing
June 30, 2020
On June 24, the American Medical Association Current Procedural Terminology (CPT) approved new CPT code 87426 to report COVID-19 antigen tests, which use immunofluorescent or immunochromatographic … [Read more...]
Billing & Coding
CMS Issues Reminders for Billing COVID-19 Specimen Collection & Symptom/Exposure Assessment
June 29, 2020
On June 18, CMS offered up some guidance on billing Medicare for COVID-19 symptom and exposure assessment and specimen collection performed on and after March 1, 2020: Use CPT code 99211 to bill … [Read more...]
SCORECARD
Scorecard: SVT False Billing Settlements Near the $3 Million Mark
March 9, 2020
Urine drug testing for purposes of medical treatment is deemed medically necessary under Medicare billing and payment rules. The same is not true for specimen validity tests (SVT), a quality control … [Read more...]
Labs In Court
October 28, 2019
A roundup of recent cases and enforcement actions involving the diagnostics industry ACLA Goes for Knockout Punch in PAMA Lawsuit Case: Having survived a first-round setback, the American … [Read more...]
REIMBURSEMENT
Medicare Reimbursement: MIPS Bonuses Are Easy to Earn, IF You Can Get into the Program
September 23, 2019
On July 11, CMS announced the results of 2018, Year 2 under the Merit-based Incentive Payment System (MIPS). Bottom line: The total number of clinicians participating declined from 1.06 million to … [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
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...]
REIMBURSEMENT
Kentucky Pain Clinic Pays $127K to Settle Specimen Validity Test Billing Claims
April 12, 2019
Case: The Northern Kentucky Center for Pain Relief agreed to pay the OIG $126,799.90 to settle claims of billing Medicare for specimen validity testing (SVT). Explanation: Under Medicare rules, urine … [Read more...]
PAYER CONTRACTS
Three key items to negotiate for successful payer contracts
April 8, 2019
By Steve Selbst bio The purpose of this article is to help you, as a provider, to focus on three key items to look for in payer contracts that will help you to get profitable contracts in … [Read more...]
