Advanced diagnostic tests are emerging faster than the clinicians can document their clinical utility. All of this creates an interesting dilemma for payors as far as coverage is concerned. Normally … [Read more...]
LCDs
Palmetto Latest Medicare Contractor to Loosen Up on Covering Molecular Dx Testing
December 29, 2016
Advanced diagnostic tests are emerging faster than the clinicians can document their clinical utility. All of this creates an interesting dilemma for payors as far as coverage is concerned. Normally … [Read more...]
REIMBURSEMENT
OPPS 2017: The 4 Things Labs Need to Know
November 29, 2016
The Centers for Medicare and Medicaid Services (CMS) recently published final rules on reimbursement under the Medicare Hospital Outpatient Prospective Payment System (OPPS) for 2017. In case you do … [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...]
PAMA
PAMA Update: Status Report on Implementation of New Medicare Fee Schedule for Part B Lab Tests
October 20, 2016
Changes to Medicare Part B payment for lab tests under the Protecting Access to Medicare Act of 2014 (PAMA) take effect on Jan. 1, 2018. Less than 15 months from the deadline, the Office of Inspector … [Read more...]
REIMBURSEMENT
OIG Report: Total Medicare Lab Test Payments in 2015 Same as in 2014
October 20, 2016
Medicare Part B paid $7 billion for lab tests in 2015, the same amount it shelled out in 2014. But 2015 Medicare payments for the top 25 lab tests dipped slightly to $4.1 billion, as compared to $4.2 … [Read more...]
REIMBURSEMENT
OIG Addresses Status of PAMA Implementation
October 17, 2016
Changes to Medicare Part B payment for lab tests mandated by the Protecting Access to Medicare Act of 2014 (PAMA) take effect on Jan. 1, 2018. Less than 15 months from the deadline, the Office of … [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...]
