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...]
COVERAGE
Emerging Tests: Medicare to Cover Next Gen-Sequencing Tests for Advanced Cancer
March 26, 2018
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...]
NEWS
FDA Watch: Diagnostics Industry Is Losing a Longstanding “Frenemy”
October 2, 2017
The diagnostics community is saying goodbye to a frenemy of 25 years. On Aug. 29, Alberto Gutierrez, director of the FDA Office of In Vitro Diagnostics (OIVD), announced that he will step down from … [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...]
PRECISION MEDICINE
Medicare Reimbursement: 4 Molecular Assays Score Big Coverage Wins
September 29, 2017
Molecular labs continue to gain ground with Medicare securing four key approvals via finalization of Local Coverage Determinations (LCDs) issued by principal contractor Palmetto GBA this spring. All … [Read more...]
MOLECULAR TESTS
Palmetto Gives Okay to Medicare Coverage of 5 New Molecular Tests
July 17, 2017
Medicare contractors are slowly coming around on covering unproven molecular assays. The most notable new baby steps come from, Palmetto GBA (Columbia, SC), one of Medicare's most important … [Read more...]
