Surprise Billing Rules Would Give Private Health Plans Advantage in Disputes
The way the No Surprises Act is implemented would essentially allow private health plans to set out-of-network rates in billing disputes.
Reimbursement-lir
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PAMA-geddon: Lab Industry Asks Court to Stop New Medicare Fee Schedule
From - Laboratory Industry Report
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…
CMS Ignores Flawed Processes, Finalizes 2018 PAMA Pricing; Labs Need to Take Immediate Action to Offset Impending Lean Times
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 process was…
“Applicable Labs”: The Fly in the PAMA Market-Based Pricing Ointment
From - Laboratory Industry Report
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…
FDA Watch: Diagnostics Industry Is Losing a Longstanding “Frenemy”
From - Laboratory Industry Report
The diagnostics community is saying goodbye to a frenemy of 25 years. On Aug. 29, Alberto Gutierrez, director of the…
Draft 2018 CLFS Reveals Fundamental Flaws in PAMA Reporting Exercise; Time to Take Action
By Lâle White bio
As XIFIN predicted, the PAMA reporting exercise has resulted in significant proposed laboratory fee cuts. In fact…
Palmetto Gives Okay to Medicare Coverage of 5 New Molecular Tests
From - Laboratory Industry Report
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 contractors in the form of…
Update on Palmetto’s Molecular Dx Testing LCDs
From - Diagnostic Testing & Emerging Technologies
Advanced diagnostic tests are emerging faster than the clinicians can document their clinical utility. All of this creates an interesting dilemma for…
