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...]
Billing and Coding
OIG Calls on CMS to Crack Down on Improper Payment of Definitive Drug and LDL Cholesterol Tests
June 28, 2021
History tells us that whenever OIG issues a report pointing out a pattern of Medicare Part B overpayments for lab tests, labs and physicians that provide those tests should be concerned. In recent … [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...]
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...]
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...]
PAMA
MedPAC Explores Simplified PAMA Reporting to Cut Burdens & Restore Lab Prices
April 22, 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...]
Utilization Management
New Federal Regulations Streamline and Speed Up Payor Prior Authorization
January 30, 2021
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...]
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...]
