By Sean McSweeney bio In a press release on May 30, 2017, the Centers for Medicare & Medicaid Services (CMS) commented regarding their fraud prevention initiative program and their … [Read more...]
FEE SCHEDULES
Industry Buzz: ACLA Goes for Kill in PAMA Lab Fees Challenge Case
February 26, 2018
Attorneys for the American Clinical Laboratory Association asked the federal court for summary judgment in its lawsuit challenging the legality of the new PAMA-based Medicare Part B fee schedule for … [Read more...]
FEE SCHEDULES
OPPS 2018: Revised Payment Rates & a New ADLT Date of Service Exemption
November 13, 2017
With all of the PAMA commotion, CMS's publication of the 2018 Medicare Hospital and Ambulatory Surgical Outpatient Prospective Payment System (OPPS) final rule has flown under the radar. In case you … [Read more...]
TOP OF THE NEWS
PAMA-Geddon: CMS Slashes 2018 Part B Lab Rates
October 24, 2017
Resisting industry pleas for a delay, CMS is sticking to the Jan. 1 start date for the new PAMA payment system. Even worse, it's sticking to its misguided formula for pricing lab tests. Result: The … [Read more...]
MEDICARE COVERAGE
“Applicable Labs”: The Fly in the PAMA Market-Based Pricing Ointment
October 23, 2017
The lab industry has no objection to basing Medicare payments for lab tests on the actual rates charged to payors in the private market. What has the industry so upset is how CMS has executed the … [Read more...]
FEE SCHEDULES
CORRECTION: Molecular Assays Stave Off Big Cuts in 2017 Clinical Laboratory Fee Schedule
May 17, 2017
Editor's Note: The lead story in the November 25, 2016 issue of LIR is about changes to the 2017 Clinical Laboratory Fee Schedule affecting reimbursement for clinical laboratory tests. The … [Read more...]
FEE SCHEDULES
3 Things You Need to Know about the Lab Fee Schedule
December 6, 2016
The Centers for Medicare and Medicaid Services (CMS) issued the final 2017 Clinical Laboratory Fee Schedule (CLFS) on Nov. 21. Here is a look at the three key changes you need to know about going into … [Read more...]
FEE SCHEDULES
2017 Clinical Laboratory Fee Schedule: The 3 Changes Affecting Your Reimbursement
November 25, 2016
The Centers for Medicare and Medicaid Services (CMS) issued the final 2017 Clinical Laboratory Fee Schedule (CLFS) on Nov. 21. The winners: The small group of labs that provide new specialty molecular … [Read more...]
FEE SCHEDULES
Crosswalked Codes in 2017 Clinical Laboratory Fee Schedule
November 7, 2016
CPT Code Crosswalked To 80305 (Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical … [Read more...]
FEE SCHEDULES
Are Commercial Payers Citing Proposed CMS Gapfill Rates, Trying to Negotiate Lower Reimbursement?
September 22, 2016
During the summer, the Centers for Medicare & Medicaid Services (CMS) published proposed interim gapfill prices for 15 molecular tests. The agency said it would likely publish final prices later … [Read more...]
