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...]
FOCUS ON
CLIA: After 36 Years, CMS Gives Lab Accreditation a Good Hard Look
January 16, 2018
"May you live in interesting times." If you've been in the clinical labs business for a while, you probably appreciate the wisdom behind this ancient Chinese curse. 2018 is shaping up to be a very … [Read more...]
REIMBURSEMENT
Medicare Reimbursement: CMS Finalizes Controversial PAMA Fee Schedule
December 12, 2017
It's official. CMS is going forward with its controversial 2018 PAMA Clinical Laboratory Fee Schedule (CLFS). Regrettably, the final version closely tracks the preliminary one (See GCA, Oct. 24, 2017, … [Read more...]
FOCUS ON
PAMA Implementation: PLA Codes for Advanced Dx Tests Are Off to a Flying Start
November 16, 2017
PAMA implementation is so sweeping that it requires a shift in not just payment paradigm but also CPT codes. This has served as the impetus for development of a new class of codes known as … [Read more...]
CMS
OPPS 2018: Revised Payment Rates & a New ADLT Date of Service Exemption
November 16, 2017
With all of the PAMA commotion, CMS's publication of the 2018 Medicare Hospital and Ambulatory Surgical Outpatient Prospective Payment System (OPPS) final rule has flown under the radar. In case you … [Read more...]
CMS
Medicare Reimbursement: CMS Proposes MACRA Physician Performance Requirements for 2018
August 21, 2017
On June 30, CMS issued a Proposed Rule addressing a key part of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) implementation: the Quality Payment Program (QPP) for 2018, the second … [Read more...]
HEALTH CARE REFORM
Labs to CMS: Push Back PAMA & Add Hospital Labs to CLFS Mix
August 17, 2017
The lab industry continues to wait nervously for word from CMS regarding PAMA. Demand 1: Fix the Fee Schedule Methodology The industry's paramount concern remains the formula CMS proposes to use to … [Read more...]
