In its final days, the Trump administration finalized (and, in the eyes of many in the health care industry, rushed) regulatory changes designed to ease prior authorization rules and improve provider … [Read more...]
Utilization Management
New Federal Regulations Streamline and Speed Up Payor Prior Authorization
January 30, 2021
PANDEMIC
Hospitals, Labs, LTCs Face Big Fines for Failing to Meet New CMS COVID-19 Test Daily Reporting Rules
September 17, 2020
Nursing and other long-term care (LTC) facilities have been a hotspot for COVID-19 infection since the public health emergency began. On Aug. 27, CMS issued a new Interim rule requiring LTC facilities … [Read more...]
Fee Schedules
2021 Medicare Physician Fee Schedule Slashes Lab Reimbursements 5% but Provides Some PAMA Relief
September 4, 2020
On Aug. 3, CMS released the proposed Medicare Physician Fee Schedule (PFS) rule for 2021. Bottom line on top: The agency is slashing lab reimbursement rates. Here are the four key takeaways for labs. … [Read more...]
Medicare Reimbursement
The 4 Things Labs Need to Know about CMS’ Newly Proposed 2021 OPPS Rule
September 3, 2020
On Aug. 4, CMS posted the proposed Outpatient Prospective Payment System (OPPS) Rule for 2021. In case you don’t feel like reading all 785 pages of the Rule, here’s a high level summary of the four … [Read more...]
New Laws
January 1, 2021 Is D-Day for Hospital Pricing Transparency
September 3, 2020
It appears to be full speed ahead for hospital price transparency. The controversial effort to make hospitals divulge information about their healthcare pricing, including lab procedures, is very much … [Read more...]
CARES Act
CMS Issues Guidance on Private Payor Reimbursement of COVID-19 Testing
May 24, 2020
If your lab is performing COVID-19 testing for patients covered by private insurance and health plans, you need to be aware of the reimbursement rules set out in the new COVID-19 relief legislation. … [Read more...]
Billing & Coding
New HCPCS Codes for COVID-19 Specimen Collection
April 16, 2020
CMS has established two new Level II HCPCS codes for COVID-19 specimen collection: G2023 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus … [Read more...]
LDTs
VITAL Act Would Eliminate FDA Regulation of New Tests During Health Emergencies
April 13, 2020
In standing aside and allowing test makers to validate and perform COVID-19 laboratory developed tests (LDTs) and not wait for Emergency Use Authorization (EUA), the FDA has actually acknowledged what … [Read more...]
Reimbirsement
Congress Calls on Insurers to Cover Coronavirus Testing without Charging Patients
March 30, 2020
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...]
Coronavirus
FDA Takes Unprecedented Measures to Promote Rapid Development of Coronavirus Diagnostic Tests
March 19, 2020
The FDA is following a two-prong strategy to promote and expedite development and validation of a test capable of safe, rapid and reliable detection of novel coronavirus (COVID-19), the disease caused … [Read more...]
