It wasn’t supposed to happen like this. The expectation was that the new PAMA market-based pricing system was going to save Medicare 10 percent or more on lab test reimbursements. But it hasn’t … [Read more...]
OIG Findings
OIG Reports that 2018 Medicare Part B Lab Test Spending Increased Despite PAMA Cuts
September 18, 2020
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...]
PAMA
PAMA Unlocks Golden Age for Innovative Diagnostics
July 30, 2018
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...]
FEE SCHEDULES
How PAMA’s Effect in 2018 Molecular Diagnostic Reimbursement Will Make Labs More Money
June 25, 2018
By Sean McSweeney bio The year 2018 is slated to be much brighter for molecular diagnostic labs as PAMA fee schedules show a higher payment rate and amount for many cancer genomics and … [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...]
PAMA
CMS Ignores Flawed Processes, Finalizes 2018 PAMA Pricing; Labs Need to Take Immediate Action to Offset Impending Lean Times
December 4, 2017
By Kyle Fetter bio The final 2018 clinical laboratory fee schedule (CLFS) is out, and it is evident that the argument that the Centers for Medicare & Medicaid Services (CMS) PAMA … [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...]
PAMA
Draft 2018 CLFS Reveals Fundamental Flaws in PAMA Reporting Exercise; Time to Take Action
October 2, 2017
By Lâle White bio As XIFIN predicted, the PAMA reporting exercise has resulted in significant proposed laboratory fee cuts. In fact, the multi-year decrease for the top 20 laboratory tests … [Read more...]
