Medical testing lab Genesis Laboratory Management is suing UnitedHealth Group for not paying claims for COVID-19 tests. The lawsuit, filed on June 2 in the U.S District Court for the district of New … [Read more...]
OIG Findings
OIG Reports that 2018 Medicare Part B Lab Test Spending Increased Despite PAMA Cuts
September 18, 2020
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...]
Reimbursement
Feds Say Insurers Not Required to Pay for Employer Return to Work COVID-19 Testing
June 30, 2020
Since the public health emergency began, the US government has taken the position that insurers shouldn’t be allowed to make consumers pay for COVID-19 lab tests. But now comes news that insurers will … [Read more...]
CMS
Reimbursement of COVID-19 Testing: Private Payors
May 2, 2020
COVID-19 relief legislation, i.e., the Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security Act (CARES) require payors to cover COVID-19 testing without … [Read more...]
CMS
Reimbursement of COVID-19 Testing: Medicare
May 2, 2020
How about some good news for a change? On April 15, CMS announced that it was increasing reimbursements for high-throughput SARS-CoV-2 lab tests. Here are the three key takeaways. Which Tests … [Read more...]
Coronavirus
Reimbursement: Congress Calls on Insurers to Cover Coronavirus Testing without Charging Patients
March 17, 2020
As labs scramble to come up with a coronavirus detection assay and CMS creates a billing and coding regimen, Congress is working to ensure that private payors provide coverage of SARS-CoV-2 testing. … [Read more...]
REIMBURSEMENT
Genetic Testing: New Medicare Early NGS Cancer Test Coverage Policy Is Less than Meets the Eye
January 3, 2020
For Myriad Genetics, Foundation Medicine and other manufacturers of next-generation sequencing (NGS)-based test panels for early-stage cancer risk assessment, the recent announcement of CMS’ decision … [Read more...]
CO-ORDINATING DATA
Laboratory Information Systems (LIS): What You Need To Know To Get Paid
September 30, 2019
By Sean McSweeney bio Today, laboratory billing claims require more and more data to successfully get paid. One of the biggest reasons your claims may be getting denied is because you're not … [Read more...]
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
Medicare Reimbursement: Part B Lab Payments in Final Year before PAMA
November 5, 2018
Part B payments for lab tests in 2017, the final year under the old reimbursement rules, totaled $7.1 billion, up slightly from the $6.8 billion Medicare paid in 2016 and little changed over the … [Read more...]
