FEE SCHEDULES

OPPS 2018: Revised Payment Rates & a New ADLT Date of Service Exemption

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

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

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

  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

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

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

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?

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...]

ENFORCEMENT

CMS Bars Theranos’ California Lab from Medicare Program

Elizabeth Holmes dropped out of college to start up Theranos. Now Theranos and Holmes have been dropped from the Medicare program. Theranos has confirmed that the Centers for Medicare & Medicaid … [Read more...]

ENFORCEMENT

CMS Scrutiny Continues for Theranos

By Ron Shinkman, Editor, Laboratory Industry Report The Theranos saga has just entered its most critical state, as the Centers for Medicare & Medicaid Services (CMS) recommended the company's … [Read more...]


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