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...]
REIMBURSEMENT
Kentucky Pain Clinic Pays $127K to Settle Specimen Validity Test Billing Claims
April 12, 2019
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...]
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...]
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...]
PAMA
Medicare Reimbursement: CMS Provides Needed PAMA Relief—But Newly Covered Hospital Labs Must Report in 2019
January 21, 2019
The battle between CMS and the lab industry over Medicare Part B pricing for lab tests could be on the road to resolution notwithstanding the ACLA's recent court loss. But even as the legal battle … [Read more...]
CORRECTION
Correction: PAMA Relief—CMS 1450 14x TOB Labs DO Count!
December 20, 2018
Two articles appearing on the G2 website, "CMS Offers Some PAMA Relief But Not Nearly Enough" (G2 Compliance Advisor/Lab Compliance Advisor) and "2019 CLFS Offers Some PAMA Relief But Not Nearly … [Read more...]
FEE SCHEDULES
Reimbursement Trends: Part B Medicare Lab Payments Up Slightly in 2017
November 19, 2018
According to a new OIG report, Clinical Laboratory Fee Schedule payments for lab tests in 2017, the last year under the pre-PAMA payment system, totaled $7.1 billion, up slightly from the $6.8 billion … [Read more...]
REIMBURSEMENT
PAMA: OIG Backing of CMS Heats Up Market-Based Lab Rates Controversy
September 24, 2018
CMS did it right and saved Medicare a boatload of money in the process, concludes a new OIG report reviewing the methods CMS used to establish "market-based" rates for Medicare Part B lab tests. Of … [Read more...]
