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Current Issue of NLR
June 1, 2021
Before You Download Please read the following user agreement and confirm your acceptance of the terms before you download NLR content: I agree that I am the the only person who is accessing my … [Read more...]
Utilization Management
Congress Moves to Limit Prior Authorization Protocols of Medicare Advantage Plans
May 19, 2021
Prior authorization has been a perennial source of friction between payors and providers. While payors have a legitimate need to ensure program integrity and manage utilization of covered health … [Read more...]
Enforcement Trends
The Federal COVID-19 Relief Fraud Crackdown Begins
May 19, 2021
As with so many other businesses, federal COVID-19 relief was (and, in some cases, still is) the only thing that kept some labs afloat during the darkest days of the pandemic. But with the virus in … [Read more...]
Reimbursement
CMS Proposes to Ease, but Not End Hospital Price Transparency
May 19, 2021
If you’re a hospital lab administrator, you’ll probably be happy to learn that the Biden administration is proposing to repeal some of the more troublesome Trump price transparency rules relating. But … [Read more...]
Reimbursement
MCIT Medicare Coverage Rule Could Be Reimbursement “Breakthrough” for Makers of LDTs
May 19, 2021
Medical device makers and members of Congress are growing impatient as CMS sends signals of still further delay on a final decision on a final rule that would automatically provide initial Medicare … [Read more...]
Compliance
New Laws: New HHS Policy Makes Labs Potentially Liable for LGBTQ Discrimination
May 19, 2021
While it doesn’t directly relate to billing and reimbursement, federal civil rights laws have an impact on certain aspects of lab operations. These laws ban your lab from discriminating on the basis … [Read more...]
Technology & Innovation
CMS Delays New Rule Providing Automatic Medicare Coverage of Breakthrough Devices
May 10, 2021
A CMS final rule providing for automatic Medicare coverage for new medical products cleared by the FDA as breakthrough devices under Section 510(k) was supposed to take effect on March 15, 2021. But … [Read more...]
Reimbursement
OIG Sounds the Warning on Improper COVID-19 Vaccination Billing
May 10, 2021
Labs and providers that furnish COVID-19 testing and vaccination services need to look ahead and prepare for the massive federal false billing crackdown that is sure to come if and when the pandemic … [Read more...]
PAMA
MedPAC Explores Simplified PAMA Reporting to Cut Burdens & Restore Lab Prices
May 10, 2021
The upcoming report of the Medicare Payment Advisory Commission (MedPAC) gives the lab industry new hopes for relief from the administrative burdens of Protecting Access to Medicare Act of 2014 (PAMA) … [Read more...]
