Medicare Reimbursement: CMS Provides Needed PAMA Relief—But Newly Covered Hospital Labs Must Report in 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: PAMA Relief—CMS 1450 14x TOB Labs DO Count!

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...]


Reimbursement Trends: Part B Medicare Lab Payments Up Slightly in 2017

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...]


PAMA: OIG Backing of CMS Heats Up Market-Based Lab Rates Controversy

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...]


Proposed 2019 Medicare PFS: The 5 Things Labs Need to Know

On July 12, CMS issued the proposed 2019 Medicare physician fee schedule (PFS), with comments scheduled to end on Sept. 10. Takeaways: 1. Physician Payment Rates  CMS is proposing a 0.25% increase … [Read more...]


Proposed 2019 Medicare HOPPS Rule: The 4 Things Labs Need to Know

Heads up to labs that bill Medicare for services to hospital outpatients: CMS issued the proposed 2019 hospital Outpatient Prospective Payment System (OPPS) on July 25, with comments scheduled to end … [Read more...]


Medicare Reimbursement: New HOPPS Date of Service Rules for ADLTs & Molecular Pathology Tests Take Effect

Here's what labs that bill Medicare for outpatient lab tests need to know about the new CMS rules exempting advanced diagnostic laboratory tests (ADLTs) and molecular pathology tests from Hospital … [Read more...]


PAMA Unlocks Golden Age for Innovative Diagnostics

By Chance Scott  bio The publication of the 2018 Clinical Laboratory Fee Schedule (CLFS) in January saw a long and heated debate within the lab community come to fruition. When Congress … [Read more...]


Getting Paid: Medicare to Cover Next Gen-Sequencing Tests for Advanced Cancer

In the PAMA era, there are two salient trends in Medicare Part B lab reimbursements: Sharply lower prices for traditional tests; and Wider coverage of newly emerging tests, including some that … [Read more...]


CMS to OIG: Get Back the $66.3 Million You Improperly Paid to Labs for Urine Validity Tests

As if times were not already tense enough for labs that bill Medicare for urine drug tests, the OIG ratcheted up the pressure another notch on Feb. 20 by issuing a new report chiding CMS for making … [Read more...]