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...]
REIMBURSEMENT
Update on Palmetto’s Molecular Dx Testing LCDs
January 6, 2017
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...]
FEE SCHEDULES
3 Things You Need to Know about the Lab Fee Schedule
December 6, 2016
The Centers for Medicare and Medicaid Services (CMS) issued the final 2017 Clinical Laboratory Fee Schedule (CLFS) on Nov. 21. Here is a look at the three key changes you need to know about going into … [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...]
