By Sean McSweeney bio Laboratory audits have a much harder impact on your lab than intended. As detailed by the NCBI, the audit's intent is to review and assess laboratory performance to … [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...]
CO-ORDINATING DATA
Laboratory Information Systems (LIS): What You Need To Know To Get Paid
July 23, 2018
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 … [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...]
COVERAGE
Emerging Tests: Medicare to Cover Next Gen-Sequencing Tests for Advanced Cancer
March 26, 2018
In the PAMA era, there are two salient trends in Medicare Part B lab reimbursements: Sharply lower prices for traditional tests; and Wider coverage of newly emerging tests, including some that … [Read more...]
REIMBURSEMENT
Out of Network: 6 Frequently Asked Questions
March 19, 2018
By Richa Singh bio As labs face an increasingly challenging reimbursement environment, more providers are doubling down on out-of-network strategies to maximize on collections … [Read more...]
INSIDE THE LAB INDUSTRY
PAMA-geddon: Lab Industry Asks Court to Stop New Medicare Fee Schedule
February 5, 2018
With CMS refusing to back down, the lab industry has escalated the dispute and asked a U.S. District Court to step in and prevent enforcement of the 2018 PAMA-inspired Part B Clinical Lab Fee Schedule … [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...]
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...]
