The Stark Law is like the weather: Everybody talks about it but nobody does anything about it. But that all may be about to change if CMS Administrator Seema Verma is to be believed. During her recent … [Read more...]
REIMBURSEMENT
The Newest PAMA Controversy: The GAO Report & Intervention of a Powerful Senator
March 25, 2019
The recent moves by CMS to include certain hospital outreach labs as "applicable laboratories" for purposes of PAMA reporting and pricing (see National Intelligence Report (NIR), Dec. 31, 2018) has … [Read more...]
FOCUS ON
Medicare Reimbursement: New Guidance on Date of Service Rules for Part B Billing of Hospital Outpatient Lab Tests
February 19, 2019
In 2018, new date-of-service rules took effect for billing and coding of outpatient lab tests under Medicare Part B, rather than as part of the Hospital Outpatient Prospective Payment System (HOPPS) … [Read more...]
CMS
Post-PAMA: Government Report Warns of Medicare Overspending(!) for Lab Tests
December 31, 2018
As if the deep price cuts inflicted by PAMA weren't infuriating enough, now the US Government Accountability Office (GAO) is claiming that labs may be getting overpaid. In a report issued late … [Read more...]
CORRECTION
Correction: PAMA Relief—CMS 1450 14x TOB Labs DO Count!
December 20, 2018
Two articles appearing on the G2 website, "CMS Offers Some PAMA Relief But Not Nearly Enough" (G2 Compliance Advisor/Lab Compliance Advisor) and "2019 CLFS Offers Some PAMA Relief But Not Nearly … [Read more...]
PAMA
Medicare Reimbursement: ACLA Court Appeal Maintains 2-Front War for PAMA Relief
December 14, 2018
It's official. The ACLA is appealing the September federal court decision to dismiss its PAMA lawsuit (ACLA v. Azar). Here's a quick rundown of the three things you need to know. 1. The Legal … [Read more...]
CMS
Medicare Appeals: CMS Tries to Speed the Process & Unjam the Backlog
November 26, 2018
On Oct. 2, CMS proposed revisions to rules for appealing adverse Medicare claim determinations (Proposed Rules). The goal is to speed the process that currently takes three to four years and loosen … [Read more...]
FALSE CLAIMS
Florida Doctor Jailed 5 Months for Lying to a Medicare Auditor
November 12, 2018
Lying to a Medicare auditor or otherwise obstructing a Medicare audit is a crime that can get you jailed. A 73-year-old endocrinologist specializing in diabetes management just learned that lesson the … [Read more...]
FEE SCHEDULES
Medicare Reimbursement: Labs Propose Solutions to PAMA Part B Pricing Problem
October 15, 2018
CMS recently issued its annual proposed rule on 2019 Medicare Part B reimbursement. For many labs, the number one concern is the proposed extension of the controversial PAMA "market pricing" scheme to … [Read more...]
CMS
Reimbursement Trends: OIG Report Shows Slight Uptick in 2017 Medicare Part B Lab Payments
October 10, 2018
On Jan. 1, 2018, the new Medicare Part B PAMA Clinical Laboratory Fee Schedule (CLFS) in which lab test reimbursements are based on a single national fee lab schedule for lab tests rather than 57 … [Read more...]
