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...]
FEE SCHEDULES
Medicare Reimbursement: Labs Propose Solutions to PAMA Part B Pricing Problem
October 15, 2018
FALSE CLAIMS
Florida Doctor Jailed 5 Months for Lying to a Medicare Auditor
October 11, 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...]
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...]
STARK LAW
Stark Relief: Comments Urge Change but Don’t Expect Anything Too Dramatic
October 9, 2018
After decades of resistance, CMS is giving serious indications of its willingness to entertain changes to relieve the "undue regulatory impact and burden" imposed by the Stark Law. Back in June, CMS … [Read more...]
STARK LAW
CMS Mulls Stark Law Relief: This Time It May Be for Real
July 16, 2018
After decades of complaining about the Stark Law, the lab industry may now have an actual opportunity to secure meaningful relief. On June 20, CMS issued a Request for Information (RFI) seeking input … [Read more...]
MACRA REQUIREMENT
How to Adjust to the April 2018 Medicare Beneficiary Cards
July 9, 2018
By Sean McSweeney bio In a press release on May 30, 2017, the Centers for Medicare & Medicaid Services (CMS) commented regarding their fraud prevention initiative program and their … [Read more...]
FEE SCHEDULES
PAMA Reimbursement: CMS Explains How to Get ADLT Status for New Lab Tests
June 11, 2018
Although the 2018 market-based Clinical Laboratory Fee Schedule (CLFS) is officially in effect, implementation of the new PAMA Part B payment rules for lab tests remains a work in progress. On March … [Read more...]
DRUG TESTING
Part B Reimbursement: OIG Flags $66.3 Million in Improper Urine Specimen Validity Test Payments
March 16, 2018
These are tense times for providers of urine drug tests for Medicare and Medicaid patients. And on Feb. 20, the hot seat got even hotter with the issuance of a new OIG report saying CMS made $66.3 … [Read more...]
FOCUS ON
Value Care: CMS Value Modifier Programs Ends Not with a Bang but a Whimper
March 5, 2018
Thanks for nothing. While CMS likes to congratulate itself for using provider pay adjustments to "transform the healthcare delivery system," more often than not, the rhetoric fails to live … [Read more...]
HEALTH CARE REFORM
Medicare Reimbursement: Federal Government Funding Extension Includes a Boatload of Medicare Changes
February 26, 2018
The government shutdown fiasco is having an impact on Medicare spending and reimbursement. But the crucial details are being buried in the legislative paperwork. So we decided to ferret them out for … [Read more...]
