Inside the Lab Industry

Medicare Expands Coverage for CTC Tests

Biocept announced that it has received expanded Medicare coverage for use of its Target Selector assay to identify HER-2 positive circulating tumor cells under a final CMS local coverage determination … [Read more...]


Labs and Payors Take Their COVID-19 Test Reimbursement Feud to Court

The very public feud between health insurers and labs over payment of COVID-19 tests has just entered a new stage: litigation. FFCRA, CARES & the Free Test Mandate  On March 18, 2020, at … [Read more...]


Labs Sue National Insurers for Not Reimbursing COVID-19 Testing Claims

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

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...]


Feds Say Insurers Not Required to Pay for Employer Return to Work COVID-19 Testing

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...]


Reimbursement of COVID-19 Testing: Private Payors

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...]


Reimbursement of COVID-19 Testing: Medicare

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...]


Reimbursement: Congress Calls on Insurers to Cover Coronavirus Testing without Charging Patients

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...]


Genetic Testing: New Medicare Early NGS Cancer Test Coverage Policy Is Less than Meets the Eye

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...]


Laboratory Information Systems (LIS): What You Need To Know To Get Paid

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...]