National Lab Reporter Newsletter Archive

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Current Issue of NLR

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Utilization Management

Congress Moves to Limit Prior Authorization Protocols of Medicare Advantage Plans

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

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...]


CMS Proposes to Ease, but Not End Hospital Price Transparency

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...]


MCIT Medicare Coverage Rule Could Be Reimbursement “Breakthrough” for Makers of LDTs

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...]


New Laws: New HHS Policy Makes Labs Potentially Liable for LGBTQ Discrimination

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

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...]


OIG Sounds the Warning on Improper COVID-19 Vaccination Billing

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...]


MedPAC Explores Simplified PAMA Reporting to Cut Burdens & Restore Lab Prices

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...]